Extremity soft tissue sarcoma in the elderly: Are we overtreating or undertreating this potentially vulnerable patient population?

Abstract

Background As the U.S. population ages, differences in oncologic outcomes among the elderly have been recognized. Our objective was to analyze the clinical, pathologic, and treatment outcomes for elderly soft tissue sarcoma (STS) patients, hypothesizing significant differences in the management and response to therapy. Methods Using the National Cancer Database, we identified 33 859 patients with nonmetastatic extremity STS. We defined elderly as ≥74 years in age and compared patient and treatment variables between adult and elderly patients. Cox‐proportional hazards analysis was used to determine predictors of overall survival (OS). Results We identified 8504 elderly patients. Significant differences in histologic subtype, grade, and facility type between elderly and nonelderly patients (P < 0.05) exist. Elderly patients were less likely to undergo R0 resection (P = 0.001) and had a higher 90‐day mortality (P = 0.001). Surgical elderly patients experienced superior OS compared with nonsurgical patients (P = 0.001). Among elderly patients, younger age, and female sex, lower Charlson‐Deyo score, lower grade, smaller tumors, surgical resection, negative surgical margins, and radiation therapy were associated with better OS. Conclusions Key differences exist in elderly extremity STS patients, including a narrower benefit/risk ratio with surgical management. These data highlight that elderly patients represent a distinct cohort for whom more careful selection appears indicated.

What are the predictors of emergency department utilization and readmission following extremity bone sarcoma resection?

“…The finding that elderly patients were noted to have a lower risk of readmission compared to younger patients was surprising as previous studies have found that elderly patients were more likely to experience morbidity and mortality within 90 days following surgery for a soft-tissue sarcoma. 19 One discrepancy between the study by Gingrich et al 19 is the authors used a cut off of ≥74 years old for the elderly, while in the current series we used a cut off of ≥65 years old for elderly patients, which is the classic Medicare definition, even with this difference, other series have shown a low rate of perioperative complications and preserved quality of life in elderly patients who undergoing sarcoma surgery. [20][21][22] One factor which could play a role in the lower readmission rate in the elderly population was the use of chemotherapy, which was found in the current series to be associated with readmission.…”

The Real-Life Journey of Elderly Patients in Soft Tissue and Bone Sarcomas: A Retrospective Analysis from a Sarcoma Referral Center

“…The central role of an aggressive potentially curative S in localized STS in the elderly population is confirmed by various retrospective analyses that rise the question of a suboptimal management of this population of patients despite a higher stage at a diagnosis [5,19,20].…”

Current Reality of Treating Advanced Soft Tissue Sarcoma as Illustrated by Case Studies

“…Elderly patients had lower rates of R0 resection (59.7% vs. 70%; p = 0.001) and higher 90-day postoperative mortality (4.3% vs. 1.2%; p = 0.001) than younger patients. Irrespective of tumour grade, elderly patients who underwent surgery had significantly ( p = 0.001) prolonged survival compared with those without surgery (Table 2) [23]. Nevertheless, data overall suggested a narrow risk/benefit ratio with surgical management of localised disease in elderly STS patients, emphasising the need for careful selection of candidates for resection.…”