Soft Tissue Sarcoma
Conditions
Keywords
STS, Negative Pressure Wound Therapy, Surgery with preoperative irradiation
Brief summary
This is a randomized (1:1 ratio), prospective, comparative, controlled, open-label study. The aim is to compare the efficacy of negative pressure therapy (PREVENA™) versus standard postoperative wound management on the wound healing after surgery for previously irradiated Soft Tissue Sarcoma (STS)
Detailed description
The gold standard treatment for primary non-metastatic STS is complete surgical resection. Peri-operative Radiation Therapy (RT) has been proved to improve local control . Nevertheless, the timing of RT, whether preoperative or postoperative, remains a debate. Both have similar local control efficacy, but preoperative RT results in lower rates of long-term fibrosis and lymphedema and improved joint mobility than postoperative RT. On the other hand, the adverse effect of pre-operative RT is a higher rate of wound post-operative complications and re-operations. Any effort to reduce the high rate of postoperative complications could offer the advantage of preoperative RT in terms of reduced long-term sequelae compared with postoperative RT without a higher wound complication rate postoperatively. Short retrospective series of Negative Pressure Wound Therapy (NPWT) after surgical resection of Soft Tissue Sarcoma (STS) have reported very encouraging results in preventing wound complications: patients treated with NPWT were less likely to develop wound complications than those who did not receive it. Both groups did not report an increased rate of local recurrence. The use of NPWT would also reduce the cost of care by avoiding complications. That's why the investigators propose this study comparing the use of a negative pressure dressing to a conventional dressing in patients with STS of the limbs or trunk resected after neo-adjuvant external radiotherapy.
Interventions
DEVICEPrevena
PREVENA™ is a CE-marked class IIa medical device. The PREVENA™ Incision Management System is also intended to manage the environment of closed surgical incisions and surround intact skin in patients at risk for developing post-operative complications, such as infection, by maintaining a closed environment via the application of a negative pressure wound therapy system to the incision.
Sponsors
Centre Leon Berard
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
NONE
Intervention model description
The randomization (1:1 ratio) will be stratified according to STS location (upper limb vs lower limb vs trunk) and ASA class (1 or 2 vs ≥ 3).
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age ≥ 18 years at the day of consenting to the study * Patients with primary STS of the limb or trunk treated with preoperative external radiation therapy (decided in multidisciplinary board) * Intent to cure resection required for STS planned between 3 to 8 weeks after the end of RT * Planned primary wound closure, including local or distant jambeau * Ability to understand and willingness for follow-up visits * Covered by a medical insurance * Signed and dated informed consent document indicating that the patient has been informed of all aspects of the trial prior to enrolment.
Exclusion criteria
* Known hypersensibility to silver * Patients with a diagnosis of Ewing's sarcoma, chondrosarcoma, osteosarcoma, or desmoid tumor. Nota bene: Only patients with bone tumors are affected; patients with soft tissue tumors can be included in the study. * Patient in relapse setting; * Patient requiring a surgical revision after R1 or R2 resection; * Planned blade drainage; * Planned no wound-closure and skin graft after resection * Patient requiring authorship or curators or patient deprived of liberty.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| The efficacy of negative pressure therapy (PREVENA) versus standard postoperative wound management on the wound healing after surgery for previously irradiated STS | Within the 3-month postoperative period. | Assessed by major wound complications rate |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Three months secondary surgery for wound healing problem rate | At 3 months post-surgery visit | Assessed by the proportion of patients experiencing a second surgery for wound healing problem within 3 postoperative months |
| Hospitalization duration | At 3 months post-surgery visit | Defined as the number of hospitalization days from the date of surgery to the date of discharge |
| Time to complete wound healing | Up to 27 months | Defined as the interval from surgery to 100% healing (total wound closure with no need for dressing and any local care) |
| Three month deep infection rate | At 3 months post-surgery visit | Assessed by the proportion of patients experiencing a second surgery for wound healing problem within 3 postoperative months |
| Quality of life using EQ-5D-5L | At 28 days and 3 months after surgery for each patients | Assessed by EQ-5D-5L introduce by EuroQol Group in 2009 with five dimensions : mobility, self-care, usual activities, pain/discomfort and anxiety/depression. Each dimension has five levels : no problems, slight problems, moderate problems, severe problems and extreme problems. A minimum value is 0 and a maximum value is 100. A mean worst value is 0 and a better mean value is 100. |
| Incidence of Adverse Events | Up to 27months | Defined by the number of patients with Adverse Events (any type and any grade using the NCI-CTC AE scale version 5.0) |
| Quality of life using FACT-G | At 28 days and 3 months after surgery for each patients | Assessed by FACT-G : Functionnal Assesment of Cancer Therapy with 27 items. There are four domains of HRQOL in cancer patients: Physical, social, emotional, and functional well-being. A minimum value is 0 and a maximum value is 4. A mean worst value is 0 and a better mean value is 108. |
| Number and types of major wound complications (MWCs) | Up to 27 months | Assessed by a number and differens types of a major wound complications |
Countries
France
Contacts
Primary ContactFrançois Gouin, MD, Chirurgien
Backup ContactSéverine METZGER, Project Manager
Outcome results
None listed