Should we consider altering our patterns of care for elderly sarcoma patients?

Abstract

Background: An increasing proportion of elderly patients (pts) are now being seen at cancer centres, with an increasing incidence of sarcoma. This has become a growing challenge for health care providers, because of the worse prognosis of these pts and our poor knowledge from trials, were they are underrepresented or excluded. Method(s): We performed a retrospective review of elderly pts with soft tissue and bone sarcomas treated between 2012 and 2017 at Regina Elena National Cancer Institute. Overall, 124 pts, median age of 77 (range 70-92), were evaluated for: surgery, radiotherapy (RT), medical treatment and related toxicities. Result(s): The most common histological subtypes were: pleomorphic sarcoma (32%); liposarcoma (17%); leiomyosarcoma (13%); mixofibrosarcoma (9%); bone sarcoma (7%); and others (22%). A total of 107 pts had localized disease at diagnosis and 98 of them had surgical resection. 10 pts received adjuvant chemotherapy (CT) (8 Adriamicin (ADM), 1 Gemcitabine (Gem) and 1 Imatinib (IM)) and 35 pts adjuvant RT. 2 pts, unsuitable for surgery, were treated with RT, and 7 had best supportive care (BSC) (median age: 80, range: 73-85). Of the 17 metastatic pts, 13 were treated with palliative surgery. After surgery, 3 pts had RT and 3 had single agent CT (1 ADM, 1 Epirubicin (EPI) and 1 patient with GIST received IM followed by 2nd line Sunitinib). The remaining 3 pts had BSC due to age > 80 yr and PS 2. 10 non-metastatic pts had recurrent disease and were treated with 1st line CT (3 EPI, 1 Dacabarzine, 2 Gem, 1 Pazopanib, 1 ADM, 1 Docetaxel/Gem, 1 Bleomicine/Vinblastine). 6 received 2 lines of CT after progression (4 Trabectidin and 2 Gem). 13 of 21 pts treated with CT had no toxicities. The most common toxicities observed in 8 pts left were: haematological (37%); gastrointestinal (12%), and transaminitis (25%). Conclusion(s): In our analysis, "fit" elderly pts were treated with the same medical treatments as non-elderly pts. Tolerability was fairly good, without discontinuation or hospitalization. Only 8% were treated with BSC, a relevant result considering the median age of our pts. Future studies designed for elderly pts and rare tumours, such as sarcomas, are needed to improve survival rates and quality of life of this poorly represented group of pts.