Treatment Results In Elderly Patients (Pts) Diagnosed With Locally Advanced Soft Tissue Sarcoma (Sts)

Older pts constitute a significant proportion of pts treated for STS. In this age group, special consideration should be given to coexisting diseases, often not allowing aggressive treatment methods, such as chemotherapy (CHT). We aimed to present treatment results of pts >75 years of age treated with radical intent. 237 pts (51% male) with locally advanced STS treated in 2012-2019 were included in this retrospective analysis. Data on tumor characteristic and long-term survival were collected. The competing risk analysis was performed using Aalen-Johansen estimate and Fine-Gray model to distinguish risk of death of disease (DOD) and of other causes (DOOC). The mean age was 80 years (SD:4). 46% pts had ≥ 3 comorbidities. The median follow-up was 48 months(m) (95%CI:42-57). The most common subtypes were pleomorphic sarcoma, liposarcoma, myxofibrosarcoma, and leiomyosarcoma. 59% had primary tumors, 30% had a local recurrence (LR), and the remaining had a scar resection after previous treatment. The mean tumor size was 10 cm. 73% had high-grade tumors. The most common tumor localization was lower limbs (50%). 15 pts (6%) received adjuvant CHT (1/3 of them diagnosed with angiosarcoma). 73% had perioperative radiotherapy. 85% of the pts had an R0 resection. 10 pts required limb amputation. 110 pts died (46%)(82-DOD; 28-DOOC); median overall survival (OS) was 47m (95%CI: 42-62). 108 pts (45%) had disease recurrence (DR), median DFS was 27.5m (range: 19-43). 26% pts had a distant recurrence in majority to the lungs. 69 pts received treatment for DR, most often anthracycline-based CHT (35pts), 24 pts underwent surgery for DR with curative intent. The 4-year probability of DOD was 37% and of DOOC–14%. In a multivariable analysis, age, tumor size, and male sex increased risk of DOOC. The same factors plus tumor grade had impact on DOD. STS is the main cause of death in older pts, therefore age as an only factor should not limit treatment. The disease stage was associated with DOOC (e.g. probably due to complications). Thus, not all adjuvant treatment options can be used in the context of the frailty of older pts. In the case of DR, salvage therapy is less often feasible when compared to a younger population.