RCR7: Adjuvant radiation therapy of soft-tissue sarcoma achieves good results in elderly patients: The RMH experience, aged 80-94 years,1991-2014.
1The Royal Marsden NHS Foundation Trust, London, UK
High-risk soft-tissue sarcomas are definitively treated with surgery and adjuvant radiation. There are concerns that older patients are less likely to receive radiotherapy because of issues regarding fitness. We report treatment outcomes in patients ?80 years age treated in our centre with adjuvant radiotherapy.
Patients ?80 years age receiving radiotherapy for non-advanced non-GIST STS January 1991- January 2014 at the Royal Marsden Hospital were identified from a prospectively collected database.
80 patients (49 males) with a median age of 83 (range 80-94) presented with an ECOG of 1(85%), 2(13%), or ?3(2%). Patients had none(10%), 1(40%) or ?2(50%) co-morbidities.
Sites included lower limb (43%), upper limb (33%), trunk (14%), and head and neck (10%). Histological subtypes: pleomorphic (40%), leiomyosarcoma (18%), liposarcoma (8%) and others (35%).
Surgery included WLE (93%), enucleation (5%) or compartmentectomy (2%) and median post-operative inpatient stay was 7 days (range 1-70). R0(60%), R1(32%) or R2(8%) resections were performed ,with a median tumour size of 100mm (range 25-320) with mainly high grade (74%) tumours. Surgical complications (22%) included wound infections, haematomas and seromas.
Adjuvant radiotherapy was delivered following primary presentation (77%), or local recurrences (23%), mainly in the post-operative (94%) setting. Median time to radiotherapy following surgery was 49 days (range 27-141) and doses included 50 Gy/25# (6%),60-66 Gy/30-33#(70%), 72 Gy/60# (15%) and others (9%). All patients completed radiotherapy. Toxicity where documented included: G1/2 erythema , lymphoedema, fibrosis and joint stiffness.
Median follow-up was 20.3 months (range 3.4-151.6) with a local recurrence rate 26% , median time to recurrence 12 months (range 1.8- 54.6) following radiotherapy completion. Median overall survival following diagnosis was 22.4 months (range 5.3 to 156). 47% patients developed metastases (lung 85%).
Adjuvant radiotherapy appears to be an effective and well tolerated treatment in elderly patients.