Outcomes of soft-tissue sarcoma in nonagenarians

Abstract

Aims Current literature suggests that survival outcomes and local recurrence rates of primary soft-tissue sarcoma diagnosed in the very elderly age range, (over 90 years), are comparable with those in patients diagnosed under the age of 75 years. Our aim is to quantify these outcomes with a view to rationalizing management and follow-up for very elderly patients. Methods Retrospective access to our prospectively maintained oncology database yielded a cohort of 48 patients across 23 years with a median follow-up of 12 months (0 to 78) and mean age at diagnosis of 92 years (90 to 99). Overall, 42 of 48 of 48 patients (87.5%) were managed surgically with either limb salvage or amputation. Results A lower overall local recurrence rate (LRR) was seen with primary amputations compared with limb salvage (p > 0.050). The LRR was comparable between free (R0), microscopically (R1), and macroscopically positive (R2) resection margins in the limb salvage group. Amputation was also associated with longer survival times (p < 0.050). Overall median survival time was limited to 20 months (0 to 80). Conclusion Early and aggressive treatment with appropriate oncological surgery confers the lowest LRR and a survival advantage versus conservative treatment in this cohort of patients. With limited survival, follow-up can be rationalized on a patient-by-patient basis using alternative means, such as GP, local oncology, and/or patient-led follow-up. Cite this article: Bone Joint J 2022;104-B(1):177–182.

Emerging innovations and advancements in the treatment of extremity and truncal soft tissue sarcomas

“…168 In a retrospective database review, the impact of age showed an overall lower local recurrence rate in primary amputations of elderly patients (over 90 years) when compared to limb salvage. 169 Patient-reported outcomes are another important aspect of clinical considerations, as they often guide a multidisciplinary approach to improving physical function 170 and quality of life through functional rehabilitation. 171 Importantly, a discussion on the importance of awareness and education among healthcare providers, as postulated in a review, 172 is a necessary step to improving the multidisciplinary approach of cancer care, including early and accurate referral to specialized sarcoma centers, critical for improving patient outcomes.…”

What’s New in Musculoskeletal Tumor Surgery

“…Table II shows a number of recent studies on soft-tissue tumors [46][47][48][49][50][51][52][53][54][55][56][57][58][59][60][61][62][63][64][65] .…”

“…Hartley 47 In this large database study, the authors used propensity score matching to compare outcomes between patients with a softtissue sarcoma of the extremity who had an unplanned excision followed by a re-excision and patients who only had a primary planned excision, and found that there was no difference in mortality or local failure. The authors reviewed the outcomes of 1,775 patients with sarcoma referred to a large national referral center before and after the issuance of the NICE guidelines in the United Kingdom in 2006.…”

“…Analyses of the impact of patient age on surgical management and oncologic outcomes have demonstrated similar rates of limb-salvage surgery with significant differences in the choice of systemic therapies 65 . Hartley et al reported on the outcomes of nonagenarians undergoing a surgical procedure for soft-tissue sarcomas and advocated for curative management for nonagenarian patients on a case-by-case basis 47 .…”

“…There is ongoing interest in identifying patient, tumor, and perioperative factors that impact both surgical and oncologic outcomes in patients with soft-tissue tumors [46][47][48][49]57,61,65 . Analyses of the impact of patient age on surgical management and oncologic outcomes have demonstrated similar rates of limbsalvage surgery with significant differences in the choice of systemic therapies 65 .…”