BackgroundThe perception that older cancer patients may be at higher risk than younger patients of toxic effects from cancer therapy but may obtain less clinical benefit from it may be based on the underrepresentation of older patients in clinical trials and the known toxic effects of cytotoxic chemotherapy. It is not known how older patients respond to targeted therapy.MethodsThis retrospective subgroup analysis of data from the phase 3, randomized Treatment Approach in Renal Cancer Global Evaluation Trial examined the safety and efficacy of sorafenib in older (age ≥70 years, n = 115) and younger patients (age <70 years, n = 787) who received treatment for advanced renal cell carcinoma. Patient demographics and progression-free survival were recorded. Best tumor response, clinical benefit rate (defined as complete response plus partial response plus stable disease), time to self-reported health status deterioration, and toxic effects were assessed by descriptive statistics. Health-related quality of life was assessed with a Cox proportional hazards model. Kaplan–Meier analyses were used to summarize time-to-event data.ResultsMedian progression-free survival was similar in sorafenib-treated younger patients (23.9 weeks; hazard ratio [HR] for progression compared with placebo = 0.55, 95% confidence interval [CI] = 0.47 to 0.66) and older patients (26.3 weeks; HR = 0.43, 95% CI = 0.26 to 0.69). Clinical benefit rates among younger and older sorafenib-treated patients were also similar (83.5% and 84.3%, respectively) and were superior to those of younger and older placebo-treated patients (53.8% and 62.2%, respectively). Adverse events were predictable and manageable regardless of age. Sorafenib treatment delayed the time to self-reported health status deterioration among both older patients (121 days with sorafenib vs 85 days with placebo; HR = 0.66, 95% CI = 0.43 to 1.03) and younger patients (90 days with sorafenib vs 52 days with placebo; HR = 0.69, 95% CI = 0.59 to 0.81) and improved quality of life over that time.ConclusionsAmong patients with advanced renal cell carcinoma receiving sorafenib treatment, outcomes of older (≥70 years) and younger (<70 years) patients were similar.

A positive surgical margin conveys increased risk for biochemical recurrence. Patients with AM+ experienced biochemical recurrence more frequently and rapidly than those with SM-. AM+ conveys a similar risk of recurrence compared with OM+ and MM+. Apical margin status did not independently predict biochemical recurrence.

York-Mason repair of recto-urinary fistula is an excellent approach to a rare and often confounding surgical complication. It provides nice exposure through unscarred planes and allows adequate closure. The success rate is excellent compared with that of other reported techniques. Postoperative recovery is rapid with minimal morbidity.

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