Multimodality treatment of undifferentiated pleomorphic soft tissue sarcoma of the extremity (eUPS) in the elderly

Abstract

Introduction: This subgroup analysis of undifferentiated pleomorphic soft tissue sarcoma of the extremity (eUPS) from the PERSARC collaborative group aimed to achieve a more personalized multimodality treatment approach for primary eUPS in elderly patients. Material and methods: A multicenter retrospective study including primary high-grade eUPS surgically treated with curative intent between 2000 and 2016. Overall survival (OS), local recurrence (LR) and distant metastasis (DM) curves were calculated by Kaplan Meier analysis. Cox proportional hazard models were used to determine the effect of radiotherapy. Results: From a total of 2511 patients with extremity soft tissue sarcoma (eSTS) of the PERSARC study collaborative; 703 patients with eUPS were included in this study. In elderly patients with eUPS 5-year OS, LR and DM were 35.4 (95%CI 29.3e42.8), 17.7 (95%CI 12.7e22.6) and 24.6 (95%CI 19.1e30.1). eUPS was significantly less treated with radiotherapy compared with other eSTS, especially in elderly patients. Patients with R1-R2 margins treated with radiotherapy had about half the risk of developing LR compared with patients treated without radiotherapy (HR ¼ 0.454, p ¼ 0.033). Conclusion: Elderly patients with eUPS were less often treated with radiotherapy and showed higher LR. Nowadays, given an increasing life expectancy in elderly patients, multimodality treatment should be considered.

A Modification of the American Joint Committee on Cancer Nomogram for Undifferentiated Sarcoma With External Validation and Risk Stratification

“…The results of our study were consistent with previous studies. 7-9 Bleckman et al 12 revealed that the OS of older patients decreased significantly more than those of younger patients. Vodanovich et al 9 reported that older age, lower extremity location, and positive surgical margins were risk factors for OS of patients with undifferentiated sarcoma.…”

Managing spindle cell sarcoma with surgery and high-intensity focused ultrasound: A case report

“…The management of limb spindle cell sarcomas requires a comprehensive approach that considers the tumor’s behavior[ 8 ], individual patient factors, and the potential risks and benefits of various treatment options. Surgery is typically the primary treatment option[ 9 ].…”

Oncology

“…A group based in Leiden (the Netherlands) have used a subset of their cohort to describe a more focused approach in treating undifferentiated pleomorphic soft-tissue sarcoma of the extremity (eUPS) in the elderly population. 7 Overall, a large study cohort of 703 cases of eUPS in in older patients were identified and formed the basis of the study. From an outcomes perspective, the authors reported that the five-year overall survival was found to be 35.4%, with reported local recurrence occurring in 17.7% and distant metastases found in 24.6%.…”