Study Comparing Negative Pressure Dressing vs Conventional in Patients With Resected STS After Radiotherapy (TPN-RAD)

Léon Bérard Center

Status: Enrolling

Conditions: Soft Tissue Sarcoma

Treatments: Device: Prevena

Study type: Interventional

Funder types: Other

Identifiers

NCT05944913

ET22-146

Details and patient eligibility

About

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)

Full 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.

Enrollment: 166 estimated patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

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.

Trial design

Primary purpose: Other

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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166 participants in 2 patient groups

Arm A : Surgery for STS and prevena

Experimental group

Description:

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)

Treatment:

Device: Prevena

Arm B : Surgery for STS and standard postoperative wound management

No Intervention group

Description:

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.