Study Comparing Negative Pressure Dressing vs Conventional in Patients With Resected STS After Radiotherapy

Study Overview
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Brief Summary
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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
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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.

Official Title
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Randomized Study Comparing Negative Pressure Dressing Versus Conventional Dressing in Patients With Resected Limb or Trunk Soft Tissue Sarcoma (STS) After External Radiotherapy

Conditions
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Soft Tissue Sarcoma

Intervention / Treatment
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* Device: Prevena


Participation Criteria
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Eligibility Criteria
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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 Planned no wound-closure and skin graft after resection Patient requiring authorship or curators or patient deprived of liberty.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Other
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional 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).
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Arm A : Surgery for STS and prevena<br>The surgery for the STS lesion will be performed according to standard practices. PREVENA™ Incision Management System should be applied immediately post-surgery to clean surgically closed wounds. It should be continuously applied for a minimum of 2 days and up to a maximum of 7 days (as per PREVENA user manual) | Device: Prevena<br>* 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.<br>|
| No Intervention: Arm B : Surgery for STS and standard postoperative wound management<br>The surgery for the STS lesion will be performed according to standard practices. The dressing and drainage of the wound will be performed according to usual practices, with the exception of negative pressure dressings. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The efficacy of negative pressure therapy (PREVENA) versus standard postoperative wound management on the wound healing after surgery for previously irradiated STS | Assessed by major wound complications rate | At 3 months post-surgery visit | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Three month deep infection rate | Assessed by the proportion of patients experiencing a second surgery for wound healing problem within 3 postoperative months | At 3 months post-surgery visit | 
| Three months secondary surgery for wound healing problem rate | Assessed by the proportion of patients experiencing a second surgery for wound healing problem within 3 postoperative months | At 3 months post-surgery visit | 
| Hospitalization duration | Defined as the number of hospitalization days from the date of surgery to the date of discharge | At 3 months post-surgery visit | 
| Time to complete wound healing | Defined as the interval from surgery to 100% healing (total wound closure with no need for dressing and any local care) | Up to 27 months | 
| Number and types of major wound complications (MWCs) | Assessed by a number and differens types of a major wound complications | Up to 27 months | 
| Quality of life using EQ-5D-5L | 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. | At 28 days and 3 months after surgery for each patients | 
| Incidence of Adverse Events | Defined by the number of patients with Adverse Events (any type and any grade using the NCI-CTC AE scale version 5.0) | Up to 27months | 
| Quality of life using FACT-G | 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. | At 28 days and 3 months after surgery for each patients | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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STS, Negative Pressure Wound Therapy, Surgery with preoperative irradiation