Abstract
Background
To evaluate short- and long-term results after curative surgery for a retroperitoneal sarcoma (RPS) in elderly patients.
Methods
We retrospectively analyzed data of all patients operated in our single, tertiary care center for a nonmetastatic RPS and identified patients aged 70 years and older.
Results
Among 296 patients with an RPS treated between 1994 and 2015, 60 (20%) were aged 70 years and older (median age 74 years; range 70–85). The median tumor size was 24 cm (range 6–46). Forty-six patients (77%) had mass-related symptoms at the time of diagnosis. The most frequent histological subtypes were de-differentiated liposarcoma (53%, n = 32) and well-differentiated liposarcoma (35%, n = 21). Twenty-two patients (37%) had perioperative radiotherapy and/or chemotherapy. Fifty-eight patients (97%) had macroscopically complete resection. The postoperative mortality was 8% and severe morbidity (Dindo/Clavien ≥ 3) was 32%. A reoperation was required for ten patients (17%). After a median follow-up of 20 months (range 1–121), the 5-year overall survival (OS) rate was 90% (95% confidence interval [CI] 79–100%), and median OS was not reached. The cancer-specific death rate was 88%. No prognostic factor for disease-specific survival was detected. The 5-year disease-free survival (DFS) rate was 52% (95% CI 33–84%) and 5-year locoregional recurrence-free survival rate was 52% (95% CI 33–84%). Median DFS was 94 months (95% CI 35–NA). Reoperation after inappropriate surgery and postoperative morbidity were independent predictive factors of locoregional relapse. No predictive factors of distant metastasis were found.
Conclusions
Curative surgery is feasible in selected elderly patients but with higher mortality and morbidity rates than in younger patients. It enables a prolonged survival. Future studies should focus on selection process to minimize postoperative mortality and morbidity.
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References
La situation du cancer en France en 2010 collection rapport et synthèses. Ouvrage collectif édité par l’INCa, Boulogne-Bilancourt. 2010;193–195. Available at www.e-cancer.fr on 05/01/2016 [in French].
Ducimitiere F, Lurkin A, Ranchere-Vince D, et al. Incidence of sarcoma histotypes and molecular subtypes in a prospective epidemiological study with central pathology review and molecular testing. PLoS One. 2011;6:e20294.
ESMO/European Sarcoma Network Working Group. Soft tissue and visceral sarcomas: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2014;25:iii102–112.
Gronchi A, Strauss DC, Miceli R, et al. Variability in Patterns of Recurrence After Resection of Primary Retroperitoneal Sarcoma (RPS): A Report on 1007 Patients From the Multi-institutional Collaborative RPS Working Group. Ann Surg. 2016;263:1002–9.
Bonvalot S, Raut CP, Pollock RE, et al. Technical considerations in surgery for retroperitoneal sarcomas: position paper from E-surge, a master class in sarcoma surgery, and EORTC-STBSG. Ann Surg Oncol. 2012;19:2981–91.
Dindo D, Demartines N, Clavien P. Classification of surgical complications: a new proposal with evaluation in a cohort pf 6336 patients and results of a surgery. Ann Surg. 2004;240:205–13.
Sobin LH, Wittekind C. Tumours of bone and soft tissues. TNM classification of malignant tumours. New York: Wiley-Liss; 2002.
Gronchi A, Miceli R, Shurell E, et al. Outcome prediction in primary resected retroperitoneal soft tissue sarcoma: histology-specific overall survival and disease-free survival nomograms built on major sarcoma center data sets. J Clin Oncol. 2013;31:1649–55.
Rusell WO, Cohen J, Enzinger F, et al. A clinical and pathological staging system for soft tissue sarcomas. Cancer. 1977;40:1562–70.
Trojani M, Contesso G, Coindre JM, et al. Soft tissue sarcomas of adults; study of pathological prognosis variables and definition of a histopathological grading system. Int J Cancer. 1984; 33:37–42.
[Évolution de l’espérance de vie à divers âges jusqu’en 2015] Accessed online at www.insee.fr/fr/themes/tableau.asp?reg_id=0&ref_id=NATnon02229 on 05/01/2016. [in French].
Leon O. [Projections départementales et régionales de population à l’horizon 2040] Available at http://www.insee.fr/fr/themes/detail.asp?reg_id=99&ref_id=proj-dep-population-2010 on 05/01/2016 [in French].
Mohile SG, Hurria A, Cohen HJ, et al. Improving the quality of survivorship for older adults with cancer. Cancer. 2016. https://doi.org/10.1002/cncr.30053. [Epub ahead of print].
Honoré C, Méeus P, Stoeckle E, Bonvalot S. Soft tissue sarcoma in France in 2015: Epidemiology, classification and organization of clinical care. J Visc Surg. 2015;152:223–30.
Charpin, J. [Perspectives démographiques et financières de la dépendance.2011] Accessed online at www.social-sante.gouv.fr/IMG/pdf/Rapport_G2_DEF.pdf on 05/01/2016. [in French].
Brighi N, Balducci L, Biasco G. Cancer in the elderly: is it time for palliative care in geriatric oncology? J Geriatr Oncol. 2014;5:197–203.
Charlson ME, Pompei P, Ales KL, Mackenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chron Dis. 1987;40:373–83.
Yourman LC, Lee SJ, Shomberg MA, et al. Prognostic indices for older adults. JAMA. 2012;307:182–92.
Hurria A. Embracing the complexity of comorbidity. J Clin Oncol. 2011;32:4217–18.
Extermann M, Boler I, Reich RR, et al. Predicting the risk of chemotherapy toxicity in older patients: the Chemotherapy Risk Assessment Scale for High-Age Patients (CRASH) score. Cancer. 2012;13:3377–86.
Extermann M, Overcash J, Lyman GH, et al. Comorbidity and functional status are independent in older cancer patients. J Clin Oncol. 1998;16:1582–7.
Repetto L, Fratino L, Audisio RA, et al. Comprehensive geriatric assessment adds information to Eastern Cooperative Oncology Group performance status in elderly cancer patients: an Italian Group for Geriatric Oncology Study. J Clin Oncol. 2002;20:494–502.
Pamoukdjian F, Paillaud E, Zelek L et al. Measurement of gait speed in older adults to identify complications associated with frailty: a systematic review. J Geriatric Oncol. 2015;6:484–96.
Bonvalot S, Miceli R, Berselli M et al. Aggressive surgery in retroperitoneal soft tissue sarcoma carried out at high-volume centers is safe and is associated with improved local control. Ann Surg Oncol. 2010;17(6):1507–14.
Lahat G, Dhuka AR, Lahat S et al. Complete soft tissue sarcoma resection is a viable treatment option for select elderly patients. Ann Surg Oncol. 2009;9:2579–86.
Landi F, Vallribera F, Rivera JP, et al. Morbidity after laparoscopic and open rectal cancer surgery: a comparative analysis of morbidity in octogenarians and younger patients. Colorectal Dis. 2016;5:459–67.
Kim DB, Gray R, Li Z, et al. Effect of nephrectomy for retroperitoneal sarcoma on post-operative renal function. J Surg Oncol. 2017 Oct 16. [Epub ahead of print].
Cho CW, Lee KW, Park H, et al. Clinical benefit and residual kidney function of en bloc nephrectomy for perirenal retroperitoneal sarcoma. Asia-Pac J Clin Oncol. 2017;1–7.
Mir O, Domont J, Cioffi A, et al. Feasibility of metronomic oral cyclophosphamide plus prednisolone in elderly patients with inoperable or metastatic soft tissue sarcoma. Eur J Cancer. 2011;4:515–9.
O’Connell JB, Maggard MA, Ko CY. Cancer-directed surgery for localized disease: decreased use in the elderly. Ann Surg Oncol. 2004;11:962–9.
Desbat NH, Levy A, Auberdiac P, et al. Curative-intended treatment of squamous cell anal carcinoma in elderly adults. J Am Geriatr Soc. 2012;60:1993–4.
[Esperance-de-vie-statistique-calcul-viager] Accessed online at http://www.viager-rentable.com/esperance-de-vie-statistique-calcul-viager/ on 05/01/2016. [Article in French].
Judson I, Verweij J, Gelderblom H, et al. Doxorubicin alone versus intensified doxorubicin plus ifosfamide for first-line treatment of advanced or metastatic soft-tissue sarcoma: a randomised controlled phase 3 trial. European Organisation and Treatment of Cancer Soft Tissue and Bone Sarcoma Group. Lancet Oncol. 2014;4:415–23.
Jensen SA, Vilmar A, Sørensen JB. Adjuvant chemotherapy in elderly patients (≥ 75 year) completely resected for colon cancer stage III compared to younger patients. Med Oncol. 2006;4:512–31.
Serizawa I, Kagei K, Kamada T, et al. Carbon ion radiotherapy for unresectable retroperitoneal sarcomas. Int J Radiat Oncol Biol Phys. 2009;75:1105–10.
Paumier A, Le Péchoux C, Beaudré A, et al. IMRT or conformal radiotherapy for adjuvant treatment of retroperitoneal sarcoma? Radiother Oncol. 2011;99:73–8.
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Sourrouille, I., Macovei, R., Faron, M. et al. Long-Term Outcome After Surgery for a Localized Retroperitoneal Soft Tissue Sarcoma in Elderly Patients: Results from a Retrospective, Single-Center Study. Ann Surg Oncol 25, 2201–2208 (2018). https://doi.org/10.1245/s10434-018-6529-z
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DOI: https://doi.org/10.1245/s10434-018-6529-z