Limb function following conservation treatment of adult soft tissue sarcoma
Identifieur interne : 006299 ( Istex/Corpus ); précédent : 006298; suivant : 006300Limb function following conservation treatment of adult soft tissue sarcoma
Auteurs : Martin H. Robinson ; Louise Spruce ; Ros Eeles ; Ian Fryatt ; Clive L. Harmer ; J. Meirion Thomas ; G. WestburySource :
- European Journal of Cancer and Clinical Oncology [ 0277-5379 ] ; 1991.
Abstract
Quality of life and limb function were studied in 54 patients who were disease-free 2 or more years after limb-conserving treatment for soft tissue sarcoma of the leg or pelvic girdle. Tumours of the thigh predominated (25 patients) and the mean tumour size was 9.9 cm. 41 patients had been treated with a combination of surgery and radiotherapy (29 with conventional and 12 with high dose), 12 with surgery alone and one with irradiation and intra-arterial doxorubicin. Only 15 patients had a normal range of movement in all lower limb joints and only 12 had normal power in all muscle groups; tumours of the lower leg were particularly unfavourable in this respect. Gait was normal in 42 patients but 8 required a walking aid and 4 a joint support. 16 had detectable lymphoedema but only 2 needed to wear compression hosiery. 35 patients still experienced pain at some time but only 6 required analgesia. However, when assessed by questionnaire for locomotion, grooming and home/leisure/vocational activities, 37 patients (68%) reported excellent function, and only 2 had moderate impairment. Function loss was most marked in leisure (25 patients) and vocational (8) activities, but was mild in 66% of cases. Multivariate analysis was carried out to determine the prognostic factors for poor limb function. The results suggested that overall functional score was predominantly determined by gait (P < 0.001), muscle power or range of movement (P < 0.001), with increasing age, female sex and the use of radiotherapy poor prognostic factors. Reduced muscle power or range of movement were the major factors determining gait (P < 0.02) with the use of radiotherapy the significant prognostic factor for both in the conventionally treated group. Doses in excess of 60 Gy resulted in increased fibrosis and a worse functional outcome. Extent of surgery was not an independent prognostic factor for limb function, although univariate analysis suggested an association with range of movement in the conventionally treated group (P < 0.025). Despite significant objective loss of range of movement and muscle power patients retain excellent limb function and quality of life following limb conserving treatment. For optimal function, radiotherapy should be given with small fractions to a dose not exceeding 60 Gy.
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DOI: 10.1016/0277-5379(91)90417-C
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Robinson</name><affiliation><mods:affiliation>Department of Radiotherapy, Sarcoma Unit, Royal Marsden Hospital, Fulham Road, London SW3 6JJ UK</mods:affiliation></affiliation></author><author><name sortKey="Spruce, Louise" sort="Spruce, Louise" uniqKey="Spruce L" first="Louise" last="Spruce">Louise Spruce</name><affiliation><mods:affiliation>Department of Physiotherapy, Sarcoma Unit, Royal Marsden Hospital, Fulham Road, London SW3 6JJ UK</mods:affiliation></affiliation></author><author><name sortKey="Eeles, Ros" sort="Eeles, Ros" uniqKey="Eeles R" first="Ros" last="Eeles">Ros Eeles</name><affiliation><mods:affiliation>Department of Radiotherapy, Sarcoma Unit, Royal Marsden Hospital, Fulham Road, London SW3 6JJ UK</mods:affiliation></affiliation></author><author><name sortKey="Fryatt, Ian" sort="Fryatt, Ian" uniqKey="Fryatt I" first="Ian" last="Fryatt">Ian Fryatt</name><affiliation><mods:affiliation>Department of Computing and Statistics, Sarcoma Unit, Royal Marsden Hospital, Fulham Road, London SW3 6JJ UK</mods:affiliation></affiliation></author><author><name sortKey="Harmer, Clive L" sort="Harmer, Clive L" uniqKey="Harmer C" first="Clive L." last="Harmer">Clive L. Harmer</name><affiliation><mods:affiliation>Department of Radiotherapy, Sarcoma Unit, Royal Marsden Hospital, Fulham Road, London SW3 6JJ UK</mods:affiliation></affiliation></author><author><name sortKey="Thomas, J Meirion" sort="Thomas, J Meirion" uniqKey="Thomas J" first="J. Meirion" last="Thomas">J. Meirion Thomas</name><affiliation><mods:affiliation>Academic Department of Surgery, Sarcoma Unit, Royal Marsden Hospital, Fulham Road, London SW3 6JJ UK</mods:affiliation></affiliation></author><author><name sortKey="Westbury, G" sort="Westbury, G" uniqKey="Westbury G" first="G." last="Westbury">G. 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Robinson</name><affiliation><mods:affiliation>Department of Radiotherapy, Sarcoma Unit, Royal Marsden Hospital, Fulham Road, London SW3 6JJ UK</mods:affiliation></affiliation></author><author><name sortKey="Spruce, Louise" sort="Spruce, Louise" uniqKey="Spruce L" first="Louise" last="Spruce">Louise Spruce</name><affiliation><mods:affiliation>Department of Physiotherapy, Sarcoma Unit, Royal Marsden Hospital, Fulham Road, London SW3 6JJ UK</mods:affiliation></affiliation></author><author><name sortKey="Eeles, Ros" sort="Eeles, Ros" uniqKey="Eeles R" first="Ros" last="Eeles">Ros Eeles</name><affiliation><mods:affiliation>Department of Radiotherapy, Sarcoma Unit, Royal Marsden Hospital, Fulham Road, London SW3 6JJ UK</mods:affiliation></affiliation></author><author><name sortKey="Fryatt, Ian" sort="Fryatt, Ian" uniqKey="Fryatt I" first="Ian" last="Fryatt">Ian Fryatt</name><affiliation><mods:affiliation>Department of Computing and Statistics, Sarcoma Unit, Royal Marsden Hospital, Fulham Road, London SW3 6JJ UK</mods:affiliation></affiliation></author><author><name sortKey="Harmer, Clive L" sort="Harmer, Clive L" uniqKey="Harmer C" first="Clive L." last="Harmer">Clive L. Harmer</name><affiliation><mods:affiliation>Department of Radiotherapy, Sarcoma Unit, Royal Marsden Hospital, Fulham Road, London SW3 6JJ UK</mods:affiliation></affiliation></author><author><name sortKey="Thomas, J Meirion" sort="Thomas, J Meirion" uniqKey="Thomas J" first="J. Meirion" last="Thomas">J. Meirion Thomas</name><affiliation><mods:affiliation>Academic Department of Surgery, Sarcoma Unit, Royal Marsden Hospital, Fulham Road, London SW3 6JJ UK</mods:affiliation></affiliation></author><author><name sortKey="Westbury, G" sort="Westbury, G" uniqKey="Westbury G" first="G." last="Westbury">G. Westbury</name><affiliation><mods:affiliation>Academic Department of Surgery, Sarcoma Unit, Royal Marsden Hospital, Fulham Road, London SW3 6JJ UK</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">European Journal of Cancer and Clinical Oncology</title><title level="j" type="abbrev">EJCCO</title><idno type="ISSN">0277-5379</idno><imprint><publisher>ELSEVIER</publisher><date type="published" when="1991">1991</date><biblScope unit="volume">27</biblScope><biblScope unit="issue">12</biblScope><biblScope unit="page" from="1567">1567</biblScope><biblScope unit="page" to="1574">1574</biblScope></imprint><idno type="ISSN">0277-5379</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0277-5379</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Quality of life and limb function were studied in 54 patients who were disease-free 2 or more years after limb-conserving treatment for soft tissue sarcoma of the leg or pelvic girdle. Tumours of the thigh predominated (25 patients) and the mean tumour size was 9.9 cm. 41 patients had been treated with a combination of surgery and radiotherapy (29 with conventional and 12 with high dose), 12 with surgery alone and one with irradiation and intra-arterial doxorubicin. Only 15 patients had a normal range of movement in all lower limb joints and only 12 had normal power in all muscle groups; tumours of the lower leg were particularly unfavourable in this respect. Gait was normal in 42 patients but 8 required a walking aid and 4 a joint support. 16 had detectable lymphoedema but only 2 needed to wear compression hosiery. 35 patients still experienced pain at some time but only 6 required analgesia. However, when assessed by questionnaire for locomotion, grooming and home/leisure/vocational activities, 37 patients (68%) reported excellent function, and only 2 had moderate impairment. Function loss was most marked in leisure (25 patients) and vocational (8) activities, but was mild in 66% of cases. Multivariate analysis was carried out to determine the prognostic factors for poor limb function. The results suggested that overall functional score was predominantly determined by gait (P < 0.001), muscle power or range of movement (P < 0.001), with increasing age, female sex and the use of radiotherapy poor prognostic factors. Reduced muscle power or range of movement were the major factors determining gait (P < 0.02) with the use of radiotherapy the significant prognostic factor for both in the conventionally treated group. Doses in excess of 60 Gy resulted in increased fibrosis and a worse functional outcome. Extent of surgery was not an independent prognostic factor for limb function, although univariate analysis suggested an association with range of movement in the conventionally treated group (P < 0.025). Despite significant objective loss of range of movement and muscle power patients retain excellent limb function and quality of life following limb conserving treatment. For optimal function, radiotherapy should be given with small fractions to a dose not exceeding 60 Gy.</div></front></TEI><istex><corpusName>elsevier</corpusName><keywords><teeft><json:string>radiotherapy</json:string><json:string>sarcoma</json:string><json:string>tumour</json:string><json:string>prognostic</json:string><json:string>muscle power</json:string><json:string>lymphoedema</json:string><json:string>limb function</json:string><json:string>chemotherapy</json:string><json:string>resection</json:string><json:string>buttock</json:string><json:string>soft tissue sarcomas</json:string><json:string>tumour size</json:string><json:string>node</json:string><json:string>westbury</json:string><json:string>physiotherapy</json:string><json:string>prognostic factors</json:string><json:string>soft tissue sarcoma</json:string><json:string>breast cancer</json:string><json:string>null hypothesis</json:string><json:string>poor muscle power</json:string><json:string>severe restriction</json:string><json:string>functional score</json:string><json:string>conventional doses</json:string><json:string>tissue sarcoma</json:string><json:string>functional outcome</json:string><json:string>radiation fibrosis</json:string><json:string>limb</json:string><json:string>pelvic girdle</json:string><json:string>tissue damage</json:string><json:string>confidence interval</json:string><json:string>multivariate analysis</json:string><json:string>buttock groin thigh knee</json:string><json:string>tissue sarcomas</json:string><json:string>abnormal gait</json:string><json:string>surgery</json:string><json:string>dos</json:string><json:string>royal marsden hospital</json:string><json:string>high dose</json:string><json:string>joint support</json:string><json:string>tumour site</json:string><json:string>more years</json:string><json:string>joint movement</json:string><json:string>radical radiotherapy</json:string><json:string>postoperative radiotherapy</json:string><json:string>first part</json:string><json:string>wound complications</json:string><json:string>significant correlation</json:string><json:string>vocational activities</json:string><json:string>limb function table</json:string><json:string>muscle group</json:string><json:string>local recurrence</json:string><json:string>functional assessment</json:string><json:string>surgical resection</json:string><json:string>second part</json:string><json:string>equivalent dose</json:string><json:string>muscle power evaluation</json:string><json:string>major group</json:string><json:string>major groups</json:string><json:string>severest restriction</json:string><json:string>royal marsden hospital sarcoma unit</json:string><json:string>lower limb tumours</json:string><json:string>severe reduction</json:string><json:string>adjuvant chemotherapy</json:string><json:string>significant difference</json:string><json:string>conventional radiotherapy</json:string><json:string>extremity sarcoma</json:string><json:string>eurj cancer</json:string><json:string>compartmental resection</json:string><json:string>hypofractionated radiotherapy</json:string><json:string>split skin graft</json:string><json:string>univariate analysis</json:string><json:string>poor range</json:string><json:string>significant prognostic factor</json:string><json:string>poor gait</json:string><json:string>independent prognostic factors</json:string><json:string>lower limb</json:string><json:string>sexual relationships</json:string><json:string>poor limb function</json:string><json:string>functional capacity</json:string><json:string>function loss</json:string><json:string>important factor</json:string><json:string>incisional biopsy</json:string><json:string>radiation therapy</json:string><json:string>arch phys</json:string><json:string>detectable lymphoedema</json:string><json:string>muscle groups</json:string><json:string>normal power</json:string><json:string>lower limb joints</json:string><json:string>normal range</json:string><json:string>lymph node status</json:string><json:string>biological prognostic factors</json:string><json:string>axillary node status</json:string></teeft></keywords><author><json:item><name>Martin H. Robinson</name><affiliations><json:string>Department of Radiotherapy, Sarcoma Unit, Royal Marsden Hospital, Fulham Road, London SW3 6JJ UK</json:string></affiliations></json:item><json:item><name>Louise Spruce</name><affiliations><json:string>Department of Physiotherapy, Sarcoma Unit, Royal Marsden Hospital, Fulham Road, London SW3 6JJ UK</json:string></affiliations></json:item><json:item><name>Ros Eeles</name><affiliations><json:string>Department of Radiotherapy, Sarcoma Unit, Royal Marsden Hospital, Fulham Road, London SW3 6JJ UK</json:string></affiliations></json:item><json:item><name>Ian Fryatt</name><affiliations><json:string>Department of Computing and Statistics, Sarcoma Unit, Royal Marsden Hospital, Fulham Road, London SW3 6JJ UK</json:string></affiliations></json:item><json:item><name>Clive L. Harmer</name><affiliations><json:string>Department of Radiotherapy, Sarcoma Unit, Royal Marsden Hospital, Fulham Road, London SW3 6JJ UK</json:string></affiliations></json:item><json:item><name>J.Meirion Thomas</name><affiliations><json:string>Academic Department of Surgery, Sarcoma Unit, Royal Marsden Hospital, Fulham Road, London SW3 6JJ UK</json:string></affiliations></json:item><json:item><name>G. Westbury</name><affiliations><json:string>Academic Department of Surgery, Sarcoma Unit, Royal Marsden Hospital, Fulham Road, London SW3 6JJ UK</json:string></affiliations></json:item></author><language><json:string>eng</json:string></language><originalGenre><json:string>Full-length article</json:string></originalGenre><abstract>Quality of life and limb function were studied in 54 patients who were disease-free 2 or more years after limb-conserving treatment for soft tissue sarcoma of the leg or pelvic girdle. Tumours of the thigh predominated (25 patients) and the mean tumour size was 9.9 cm. 41 patients had been treated with a combination of surgery and radiotherapy (29 with conventional and 12 with high dose), 12 with surgery alone and one with irradiation and intra-arterial doxorubicin. Only 15 patients had a normal range of movement in all lower limb joints and only 12 had normal power in all muscle groups; tumours of the lower leg were particularly unfavourable in this respect. Gait was normal in 42 patients but 8 required a walking aid and 4 a joint support. 16 had detectable lymphoedema but only 2 needed to wear compression hosiery. 35 patients still experienced pain at some time but only 6 required analgesia. However, when assessed by questionnaire for locomotion, grooming and home/leisure/vocational activities, 37 patients (68%) reported excellent function, and only 2 had moderate impairment. Function loss was most marked in leisure (25 patients) and vocational (8) activities, but was mild in 66% of cases. Multivariate analysis was carried out to determine the prognostic factors for poor limb function. The results suggested that overall functional score was predominantly determined by gait (P > 0.001), muscle power or range of movement (P > 0.001), with increasing age, female sex and the use of radiotherapy poor prognostic factors. Reduced muscle power or range of movement were the major factors determining gait (P > 0.02) with the use of radiotherapy the significant prognostic factor for both in the conventionally treated group. Doses in excess of 60 Gy resulted in increased fibrosis and a worse functional outcome. Extent of surgery was not an independent prognostic factor for limb function, although univariate analysis suggested an association with range of movement in the conventionally treated group (P > 0.025). Despite significant objective loss of range of movement and muscle power patients retain excellent limb function and quality of life following limb conserving treatment. For optimal function, radiotherapy should be given with small fractions to a dose not exceeding 60 Gy.</abstract><qualityIndicators><score>8</score><pdfVersion>1.2</pdfVersion><pdfPageSize>648 x 864 pts</pdfPageSize><refBibsNative>true</refBibsNative><keywordCount>0</keywordCount><abstractCharCount>2309</abstractCharCount><pdfWordCount>6030</pdfWordCount><pdfCharCount>37127</pdfCharCount><pdfPageCount>8</pdfPageCount><abstractWordCount>366</abstractWordCount></qualityIndicators><title>Limb function following conservation treatment of adult soft tissue sarcoma</title><pii><json:string>0277-5379(91)90417-C</json:string></pii><genre><json:string>research-article</json:string></genre><serie><title>Proceedings of British Oncological Association</title><language><json:string>unknown</json:string></language><conference><json:item><name>Proceedings of British Oncological Association - 1990</name></json:item></conference></serie><host><title>European Journal of Cancer and Clinical Oncology</title><language><json:string>unknown</json:string></language><publicationDate>1991</publicationDate><issn><json:string>0277-5379</json:string></issn><pii><json:string>S0277-5379(00)X0096-X</json:string></pii><volume>27</volume><issue>12</issue><pages><first>1567</first><last>1574</last></pages><genre><json:string>journal</json:string></genre></host><categories><inist><json:string>sciences appliquees, technologies et medecines</json:string><json:string>sciences biologiques et medicales</json:string><json:string>sciences medicales</json:string></inist></categories><publicationDate>1991</publicationDate><copyrightDate>1991</copyrightDate><doi><json:string>10.1016/0277-5379(91)90417-C</json:string></doi><id>D30975E7CEACB30FFB0C0BBBCA698FFE6048872E</id><score>1</score><fulltext><json:item><extension>pdf</extension><original>true</original><mimetype>application/pdf</mimetype><uri>https://api.istex.fr/document/D30975E7CEACB30FFB0C0BBBCA698FFE6048872E/fulltext/pdf</uri></json:item><json:item><extension>zip</extension><original>false</original><mimetype>application/zip</mimetype><uri>https://api.istex.fr/document/D30975E7CEACB30FFB0C0BBBCA698FFE6048872E/fulltext/zip</uri></json:item><istex:fulltextTEI uri="https://api.istex.fr/document/D30975E7CEACB30FFB0C0BBBCA698FFE6048872E/fulltext/tei"><teiHeader><fileDesc><titleStmt><title level="a">Limb function following conservation treatment of adult soft tissue sarcoma</title></titleStmt><publicationStmt><authority>ISTEX</authority><publisher>ELSEVIER</publisher><availability><p>ELSEVIER</p></availability><date>1991</date></publicationStmt><notesStmt><note type="content">Section title: Paper</note></notesStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a">Limb function following conservation treatment of adult soft tissue sarcoma</title><author xml:id="author-0000"><persName><forename type="first">Martin H.</forename><surname>Robinson</surname></persName><note type="correspondence"><p>Correspondence to M.H. Robinson.</p></note><affiliation>Department of Radiotherapy, Sarcoma Unit, Royal Marsden Hospital, Fulham Road, London SW3 6JJ UK</affiliation></author><author xml:id="author-0001"><persName><forename type="first">Louise</forename><surname>Spruce</surname></persName><affiliation>Department of Physiotherapy, Sarcoma Unit, Royal Marsden Hospital, Fulham Road, London SW3 6JJ UK</affiliation></author><author xml:id="author-0002"><persName><forename type="first">Ros</forename><surname>Eeles</surname></persName><affiliation>Department of Radiotherapy, Sarcoma Unit, Royal Marsden Hospital, Fulham Road, London SW3 6JJ UK</affiliation></author><author xml:id="author-0003"><persName><forename type="first">Ian</forename><surname>Fryatt</surname></persName><affiliation>Department of Computing and Statistics, Sarcoma Unit, Royal Marsden Hospital, Fulham Road, London SW3 6JJ UK</affiliation></author><author xml:id="author-0004"><persName><forename type="first">Clive L.</forename><surname>Harmer</surname></persName><affiliation>Department of Radiotherapy, Sarcoma Unit, Royal Marsden Hospital, Fulham Road, London SW3 6JJ UK</affiliation></author><author xml:id="author-0005"><persName><forename type="first">J.Meirion</forename><surname>Thomas</surname></persName><affiliation>Academic Department of Surgery, Sarcoma Unit, Royal Marsden Hospital, Fulham Road, London SW3 6JJ UK</affiliation></author><author xml:id="author-0006"><persName><forename type="first">G.</forename><surname>Westbury</surname></persName><affiliation>Academic Department of Surgery, Sarcoma Unit, Royal Marsden Hospital, Fulham Road, London SW3 6JJ UK</affiliation></author><idno type="istex">D30975E7CEACB30FFB0C0BBBCA698FFE6048872E</idno><idno type="DOI">10.1016/0277-5379(91)90417-C</idno><idno type="PII">0277-5379(91)90417-C</idno></analytic><monogr><title level="j">European Journal of Cancer and Clinical Oncology</title><title level="j" type="abbrev">EJCCO</title><idno type="pISSN">0277-5379</idno><idno type="PII">S0277-5379(00)X0096-X</idno><imprint><publisher>ELSEVIER</publisher><date type="published" when="1991"></date><biblScope unit="volume">27</biblScope><biblScope unit="issue">12</biblScope><biblScope unit="page" from="1567">1567</biblScope><biblScope unit="page" to="1574">1574</biblScope></imprint></monogr></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>1991</date></creation><langUsage><language ident="en">en</language></langUsage><abstract xml:lang="en"><p>Quality of life and limb function were studied in 54 patients who were disease-free 2 or more years after limb-conserving treatment for soft tissue sarcoma of the leg or pelvic girdle. Tumours of the thigh predominated (25 patients) and the mean tumour size was 9.9 cm. 41 patients had been treated with a combination of surgery and radiotherapy (29 with conventional and 12 with high dose), 12 with surgery alone and one with irradiation and intra-arterial doxorubicin. Only 15 patients had a normal range of movement in all lower limb joints and only 12 had normal power in all muscle groups; tumours of the lower leg were particularly unfavourable in this respect. Gait was normal in 42 patients but 8 required a walking aid and 4 a joint support. 16 had detectable lymphoedema but only 2 needed to wear compression hosiery. 35 patients still experienced pain at some time but only 6 required analgesia. However, when assessed by questionnaire for locomotion, grooming and home/leisure/vocational activities, 37 patients (68%) reported excellent function, and only 2 had moderate impairment. Function loss was most marked in leisure (25 patients) and vocational (8) activities, but was mild in 66% of cases. Multivariate analysis was carried out to determine the prognostic factors for poor limb function. The results suggested that overall functional score was predominantly determined by gait (P < 0.001), muscle power or range of movement (P < 0.001), with increasing age, female sex and the use of radiotherapy poor prognostic factors. Reduced muscle power or range of movement were the major factors determining gait (P < 0.02) with the use of radiotherapy the significant prognostic factor for both in the conventionally treated group. Doses in excess of 60 Gy resulted in increased fibrosis and a worse functional outcome. Extent of surgery was not an independent prognostic factor for limb function, although univariate analysis suggested an association with range of movement in the conventionally treated group (P < 0.025). Despite significant objective loss of range of movement and muscle power patients retain excellent limb function and quality of life following limb conserving treatment. For optimal function, radiotherapy should be given with small fractions to a dose not exceeding 60 Gy.</p></abstract></profileDesc><revisionDesc><change when="1991-05-24">Modified</change><change when="1991">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><extension>txt</extension><original>false</original><mimetype>text/plain</mimetype><uri>https://api.istex.fr/document/D30975E7CEACB30FFB0C0BBBCA698FFE6048872E/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="Elsevier, elements deleted: tail"><istex:xmlDeclaration>version="1.0" encoding="utf-8"</istex:xmlDeclaration><istex:docType PUBLIC="-//ES//DTD journal article DTD version 4.5.2//EN//XML" URI="art452.dtd" name="istex:docType"></istex:docType><istex:document><converted-article version="4.5.2" docsubtype="fla"><item-info><jid>EJCCO</jid><aid>9190417C</aid><ce:pii>0277-5379(91)90417-C</ce:pii><ce:doi>10.1016/0277-5379(91)90417-C</ce:doi><ce:copyright type="unknown" year="1991"></ce:copyright></item-info><head><ce:dochead><ce:textfn>Paper</ce:textfn></ce:dochead><ce:title>Limb function following conservation treatment of adult soft tissue sarcoma</ce:title><ce:author-group><ce:author><ce:given-name>Martin H.</ce:given-name><ce:surname>Robinson</ce:surname><ce:cross-ref refid="COR1"><ce:sup>∗</ce:sup></ce:cross-ref><ce:cross-ref refid="AFF1"><ce:sup>a</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>Louise</ce:given-name><ce:surname>Spruce</ce:surname><ce:cross-ref refid="AFF2"><ce:sup>b</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>Ros</ce:given-name><ce:surname>Eeles</ce:surname><ce:cross-ref refid="AFF1"><ce:sup>a</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>Ian</ce:given-name><ce:surname>Fryatt</ce:surname><ce:cross-ref refid="AFF3"><ce:sup>c</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>Clive L.</ce:given-name><ce:surname>Harmer</ce:surname><ce:cross-ref refid="AFF1"><ce:sup>a</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>J.Meirion</ce:given-name><ce:surname>Thomas</ce:surname><ce:cross-ref refid="AFF4"><ce:sup>d</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>G.</ce:given-name><ce:surname>Westbury</ce:surname><ce:cross-ref refid="AFF4"><ce:sup>d</ce:sup></ce:cross-ref></ce:author><ce:affiliation id="AFF1"><ce:label>a</ce:label><ce:textfn>Department of Radiotherapy, Sarcoma Unit, Royal Marsden Hospital, Fulham Road, London SW3 6JJ UK</ce:textfn></ce:affiliation><ce:affiliation id="AFF2"><ce:label>b</ce:label><ce:textfn>Department of Physiotherapy, Sarcoma Unit, Royal Marsden Hospital, Fulham Road, London SW3 6JJ UK</ce:textfn></ce:affiliation><ce:affiliation id="AFF3"><ce:label>c</ce:label><ce:textfn>Department of Computing and Statistics, Sarcoma Unit, Royal Marsden Hospital, Fulham Road, London SW3 6JJ UK</ce:textfn></ce:affiliation><ce:affiliation id="AFF4"><ce:label>d</ce:label><ce:textfn>Academic Department of Surgery, Sarcoma Unit, Royal Marsden Hospital, Fulham Road, London SW3 6JJ UK</ce:textfn></ce:affiliation><ce:correspondence id="COR1"><ce:label>∗</ce:label><ce:text>Correspondence to M.H. Robinson.</ce:text></ce:correspondence></ce:author-group><ce:date-revised day="24" month="5" year="1991"></ce:date-revised><ce:date-accepted day="22" month="7" year="1991"></ce:date-accepted><ce:abstract><ce:section-title>Abstract</ce:section-title><ce:abstract-sec><ce:simple-para>Quality of life and limb function were studied in 54 patients who were disease-free 2 or more years after limb-conserving treatment for soft tissue sarcoma of the leg or pelvic girdle. Tumours of the thigh predominated (25 patients) and the mean tumour size was 9.9 cm. 41 patients had been treated with a combination of surgery and radiotherapy (29 with conventional and 12 with high dose), 12 with surgery alone and one with irradiation and intra-arterial doxorubicin. Only 15 patients had a normal range of movement in all lower limb joints and only 12 had normal power in all muscle groups; tumours of the lower leg were particularly unfavourable in this respect. Gait was normal in 42 patients but 8 required a walking aid and 4 a joint support. 16 had detectable lymphoedema but only 2 needed to wear compression hosiery. 35 patients still experienced pain at some time but only 6 required analgesia. However, when assessed by questionnaire for locomotion, grooming and home/leisure/vocational activities, 37 patients (68%) reported excellent function, and only 2 had moderate impairment. Function loss was most marked in leisure (25 patients) and vocational (8) activities, but was mild in 66% of cases. Multivariate analysis was carried out to determine the prognostic factors for poor limb function. The results suggested that overall functional score was predominantly determined by gait (<ce:italic>P</ce:italic> < 0.001), muscle power or range of movement (<ce:italic>P</ce:italic> < 0.001), with increasing age, female sex and the use of radiotherapy poor prognostic factors. Reduced muscle power or range of movement were the major factors determining gait (<ce:italic>P</ce:italic> < 0.02) with the use of radiotherapy the significant prognostic factor for both in the conventionally treated group. Doses in excess of 60 Gy resulted in increased fibrosis and a worse functional outcome. Extent of surgery was not an independent prognostic factor for limb function, although univariate analysis suggested an association with range of movement in the conventionally treated group (<ce:italic>P</ce:italic> < 0.025). Despite significant objective loss of range of movement and muscle power patients retain excellent limb function and quality of life following limb conserving treatment. For optimal function, radiotherapy should be given with small fractions to a dose not exceeding 60 Gy.</ce:simple-para></ce:abstract-sec></ce:abstract></head></converted-article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo><title>Limb function following conservation treatment of adult soft tissue sarcoma</title></titleInfo><titleInfo type="alternative" contentType="CDATA"><title>Limb function following conservation treatment of adult soft tissue sarcoma</title></titleInfo><name type="personal"><namePart type="given">Martin H.</namePart><namePart type="family">Robinson</namePart><affiliation>Department of Radiotherapy, Sarcoma Unit, Royal Marsden Hospital, Fulham Road, London SW3 6JJ UK</affiliation><description>Correspondence to M.H. Robinson.</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Louise</namePart><namePart type="family">Spruce</namePart><affiliation>Department of Physiotherapy, Sarcoma Unit, Royal Marsden Hospital, Fulham Road, London SW3 6JJ UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Ros</namePart><namePart type="family">Eeles</namePart><affiliation>Department of Radiotherapy, Sarcoma Unit, Royal Marsden Hospital, Fulham Road, London SW3 6JJ UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Ian</namePart><namePart type="family">Fryatt</namePart><affiliation>Department of Computing and Statistics, Sarcoma Unit, Royal Marsden Hospital, Fulham Road, London SW3 6JJ UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Clive L.</namePart><namePart type="family">Harmer</namePart><affiliation>Department of Radiotherapy, Sarcoma Unit, Royal Marsden Hospital, Fulham Road, London SW3 6JJ UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">J.Meirion</namePart><namePart type="family">Thomas</namePart><affiliation>Academic Department of Surgery, Sarcoma Unit, Royal Marsden Hospital, Fulham Road, London SW3 6JJ UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">G.</namePart><namePart type="family">Westbury</namePart><affiliation>Academic Department of Surgery, Sarcoma Unit, Royal Marsden Hospital, Fulham Road, London SW3 6JJ UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="Full-length article"></genre><originInfo><publisher>ELSEVIER</publisher><dateIssued encoding="w3cdtf">1991</dateIssued><dateModified encoding="w3cdtf">1991-05-24</dateModified><copyrightDate encoding="w3cdtf">1991</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType></physicalDescription><abstract lang="en">Quality of life and limb function were studied in 54 patients who were disease-free 2 or more years after limb-conserving treatment for soft tissue sarcoma of the leg or pelvic girdle. Tumours of the thigh predominated (25 patients) and the mean tumour size was 9.9 cm. 41 patients had been treated with a combination of surgery and radiotherapy (29 with conventional and 12 with high dose), 12 with surgery alone and one with irradiation and intra-arterial doxorubicin. Only 15 patients had a normal range of movement in all lower limb joints and only 12 had normal power in all muscle groups; tumours of the lower leg were particularly unfavourable in this respect. Gait was normal in 42 patients but 8 required a walking aid and 4 a joint support. 16 had detectable lymphoedema but only 2 needed to wear compression hosiery. 35 patients still experienced pain at some time but only 6 required analgesia. However, when assessed by questionnaire for locomotion, grooming and home/leisure/vocational activities, 37 patients (68%) reported excellent function, and only 2 had moderate impairment. Function loss was most marked in leisure (25 patients) and vocational (8) activities, but was mild in 66% of cases. Multivariate analysis was carried out to determine the prognostic factors for poor limb function. The results suggested that overall functional score was predominantly determined by gait (P < 0.001), muscle power or range of movement (P < 0.001), with increasing age, female sex and the use of radiotherapy poor prognostic factors. Reduced muscle power or range of movement were the major factors determining gait (P < 0.02) with the use of radiotherapy the significant prognostic factor for both in the conventionally treated group. Doses in excess of 60 Gy resulted in increased fibrosis and a worse functional outcome. Extent of surgery was not an independent prognostic factor for limb function, although univariate analysis suggested an association with range of movement in the conventionally treated group (P < 0.025). Despite significant objective loss of range of movement and muscle power patients retain excellent limb function and quality of life following limb conserving treatment. For optimal function, radiotherapy should be given with small fractions to a dose not exceeding 60 Gy.</abstract><note type="content">Section title: Paper</note><relatedItem type="host"><titleInfo><title>European Journal of Cancer and Clinical Oncology</title></titleInfo><titleInfo type="abbreviated"><title>EJCCO</title></titleInfo><genre type="journal">journal</genre><originInfo><dateIssued encoding="w3cdtf">199112</dateIssued></originInfo><identifier type="ISSN">0277-5379</identifier><identifier type="PII">S0277-5379(00)X0096-X</identifier><part><date>199112</date><detail type="volume"><number>27</number><caption>vol.</caption></detail><detail type="issue"><number>12</number><caption>no.</caption></detail><extent unit="issue pages"><start>1537</start><end>1717</end></extent><extent unit="pages"><start>1567</start><end>1574</end></extent></part></relatedItem><identifier type="istex">D30975E7CEACB30FFB0C0BBBCA698FFE6048872E</identifier><identifier type="DOI">10.1016/0277-5379(91)90417-C</identifier><identifier type="PII">0277-5379(91)90417-C</identifier><recordInfo><recordContentSource>ELSEVIER</recordContentSource></recordInfo></mods></metadata></istex></record>Pour manipuler ce document sous Unix (Dilib)
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