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Coombs RA, Jebastin Thangaiah J, Siontis BL, Robinson SI, Okuno SH, Houdek MT, Xu-Welliver M, Ho TP. Tolerability and Outcomes for Treatment of Older Myxoid Liposarcoma Population. Cancers (Basel) 2024; 16:3233. [PMID: 39335204 PMCID: PMC11430764 DOI: 10.3390/cancers16183233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2024] [Revised: 09/19/2024] [Accepted: 09/20/2024] [Indexed: 09/30/2024] Open
Abstract
BACKGROUND Myxoid liposarcoma predominantly affects young and middle-aged individuals, and little is known regarding treatment tolerability and outcomes in older patients. This study aims to better understand this older patient population. METHODS This single institution retrospective study included patients aged 70 years and older with localized (non-metastatic) myxoid liposarcoma. RESULTS Sixteen patients were included. The median age was 75 years, and 9 (56%) were female. Fourteen (88%) were extremity tumors and two (12%) were trunk. The median tumor size was 10.4 cm (range, 3.6 to 28 cm). Five (31%) tumors had a round cell component. All patients had surgery. Fourteen (88%) had perioperative radiation, and three (19%) had perioperative chemotherapy. One patient had postoperative infection, and one patient had neutropenic fever from preoperative chemotherapy. The median follow up from surgery was 6.3 years. Eight (50%) patients died from MLPS. The median relapse-free survival and overall survival were 34 months and 75 months, respectively. CONCLUSIONS Most older patients with localized MLPS received perioperative radiation therapy with surgery, and few serious toxicities were reported. Even with treatment, half of the patients relapsed.
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Affiliation(s)
- Reilly A Coombs
- School of Medicine, Medical College of Wisconsin-Central Wisconsin, Wausau, WI 54401, USA
- Department of Research and Innovation, Mayo Clinic Health System, Rochester, MN 55905, USA
| | | | - Brittany L Siontis
- Department of Oncology, Division of Medical Oncology, Mayo Clinic, Rochester, MN 55905, USA
| | - Steven I Robinson
- Department of Oncology, Division of Medical Oncology, Mayo Clinic, Rochester, MN 55905, USA
| | - Scott H Okuno
- Department of Oncology, Division of Medical Oncology, Mayo Clinic, Rochester, MN 55905, USA
| | - Matthew T Houdek
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Meng Xu-Welliver
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, USA
| | - Thanh P Ho
- Department of Oncology, Division of Medical Oncology, Mayo Clinic, Rochester, MN 55905, USA
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Nakamura T, Sudo A. Treatment Strategy for Elderly Patients with Soft Tissue Sarcoma. Curr Oncol Rep 2022; 24:563-571. [PMID: 35192116 DOI: 10.1007/s11912-022-01244-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2021] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW Surgical resection is the standard treatment for localized soft tissue sarcoma (STS), while systemic chemotherapy for advanced STS may be considered. However, less aggressive treatment is often administered to elderly patients with STS. Undertreatment may compromise the cure rate and survival of these individuals. We review the literatures and emphasize the importance of standard treatment for STS in elderly patients. RECENT FINDINGS The outcome of surgical resection of STS in older individuals is comparable to that of younger ones, as long as patients are selected based on American Society of Anesthesiologists Physical Status (ASA-PS). Likewise, systemic treatment may prove beneficial as long as the risk of complications is estimated with a geriatric assessment. Elderly patients with STS benefit from standard treatment as long as the risks of surgical and systemic complications are assessed respectively with the ASA-PS and GA. Novel clinical trials with broader eligibility criteria are also necessary for elderly patients because of the increasing population of the elderly patients in the future.
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Affiliation(s)
- Tomoki Nakamura
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu-city, Mie, 514-8507, Japan.
| | - Akihiro Sudo
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu-city, Mie, 514-8507, Japan
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Prognostic Nomogram and a Risk Classification System for Predicting Overall Survival of Elderly Patients with Fibrosarcoma: A Population-Based Study. JOURNAL OF ONCOLOGY 2021; 2021:9984217. [PMID: 34589127 PMCID: PMC8476268 DOI: 10.1155/2021/9984217] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 09/02/2021] [Accepted: 09/11/2021] [Indexed: 12/23/2022]
Abstract
Background The objective of this study was to develop a nomogram model and risk classification system to predict overall survival in elderly patients with fibrosarcoma. Methods The study retrospectively collected data from the Surveillance, Epidemiology, and End Results (SEER) database relating to elderly patients diagnosed with fibrosarcoma between 1975 and 2015. Independent prognostic factors were identified using univariate and multivariate Cox regression analyses on the training set to construct a nomogram model for predicting the overall survival of patients at 3, 5, and 10 years. The receiver operating characteristic (ROC) curves and calibration curves were used to evaluate the discrimination and predictive accuracy of the model. Decision curve analysis was used for assessing the clinical utility of the model. Result A total of 357 elderly fibrosarcoma patients from the SEER database were included in our analysis, randomly classified into a training set (252) and a validation set (105). The multivariate Cox regression analysis of the training set demonstrated that age, surgery, grade, chemotherapy, and tumor stage were independent prognostic factors. The ROC showed good model discrimination, with AUC values of 0.837, 0.808, and 0.806 for 3, 5, and 10 years in the training set and 0.769, 0.779, and 0.770 for 3, 5, and 10 years in the validation set, respectively. The calibration curves and decision curve analysis showed that the model has high predictive accuracy and a high clinical application. In addition, a risk classification system was constructed to differentiate patients into three different mortality risk groups accurately. Conclusion The nomogram model and risk classification system constructed by us help optimize patients' treatment decisions to improve prognosis.
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Ibarra Estupiñán A, Fernández Garrido M, Olivares Domínguez L, Zamora Alarcón P, Riba Vílchez J, Gómez Carrillo A, Torrano Romero L, Masiá Ayala J, Vega García C. Lower limb salvage in patients older than 75 years old affected of soft tissue sarcoma: beyond the limits. EUROPEAN JOURNAL OF PLASTIC SURGERY 2021. [DOI: 10.1007/s00238-020-01768-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ferraresi V, Vari S, Rossi B, Maggi G, Giannarelli D, Persichetti A, Petrongari MG, Cercato MC, Annovazzi A, Anelli V, Pescarmona E, Baldi J, Zoccali C, Pellegrini D, Cognetti F, Biagini R. The Real-Life Journey of Elderly Patients in Soft Tissue and Bone Sarcomas: A Retrospective Analysis from a Sarcoma Referral Center. J Clin Med 2020; 9:jcm9082503. [PMID: 32759634 PMCID: PMC7465593 DOI: 10.3390/jcm9082503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 07/19/2020] [Accepted: 07/28/2020] [Indexed: 11/16/2022] Open
Abstract
The high complexity of multimodality treatment frequently results in undertreatment of elderly sarcoma patients, and this may be one of the factors that influence their prognosis. We describe the real-life approach to a population of patients aged over 70 with both soft tissue (STS) and bone sarcomas (BS) followed by our Sarcoma Disease Management Team from 2012 to 2017. One-hundred and twenty-three patients with a median age of 77 years (range: 70–92) were identified. STS were the most common histological subtypes (94%) and the grade was high in 79/123 patients (64%). At diagnosis, 88% of patients had localized disease (LD) and 12% were metastatic (MD). Overall, 96% of patients with LD underwent surgery, 46/54 (85%) with high grade STS patients underwent complementary radiotherapy, and 10/54 (19%) received adjuvant treatments. Twelve out of 33 patients who relapsed (36%) underwent local therapies. Seventeen (52%) and eight (24%) patients were treated with first-line and second-line medical treatments, respectively. Tolerability to systemic treatments was fairly good. Overall, 21% of the patients with advanced disease were candidates for best supportive care alone. Our case series of elderly patients with both STS and BS shows that personalized multidisciplinary treatment can nevertheless be offered to this frail population in order to control the evolution of disease.
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Affiliation(s)
- Virginia Ferraresi
- First Division of Medical Oncology, IRCCS-Regina Elena National Cancer Institute, 00161 Rome, Italy; (S.V.); (D.P.); (F.C.)
- Correspondence: ; Tel.: +39-06-52666919
| | - Sabrina Vari
- First Division of Medical Oncology, IRCCS-Regina Elena National Cancer Institute, 00161 Rome, Italy; (S.V.); (D.P.); (F.C.)
| | - Barbara Rossi
- Oncological Orthopaedics Unit, IRCCS-Regina Elena National Cancer Institute, 00161 Rome, Italy; (B.R.); (A.P.); (J.B.); (C.Z.); (R.B.)
| | - Gabriella Maggi
- Psychology Unit, IRCCS-Regina Elena National Cancer Institute, 00161 Rome, Italy;
| | - Diana Giannarelli
- Biostatistic Unit—Scientific Direction, IRCCS-Regina Elena National Cancer Institute, 00161 Rome, Italy;
| | - Agnese Persichetti
- Oncological Orthopaedics Unit, IRCCS-Regina Elena National Cancer Institute, 00161 Rome, Italy; (B.R.); (A.P.); (J.B.); (C.Z.); (R.B.)
| | - Maria Grazia Petrongari
- Department of Radiation Oncology, IRCCS-Regina Elena National Cancer Institute, 00161 Rome, Italy;
| | - Maria Cecilia Cercato
- Epidemiology and Cancer Registry Unit, IRCCS-Regina Elena National Cancer Institute, 00161 Rome, Italy;
| | - Alessio Annovazzi
- Nuclear Medicine Unit, IRCCS-Regina Elena National Cancer Institute, 00161 Rome, Italy;
| | - Vincenzo Anelli
- Radiology and Diagnostic Imaging Unit, IRCCS-Regina Elena National Cancer Institute, 00161 Rome, Italy;
| | - Edoardo Pescarmona
- Pathology, IRCCS-Regina Elena National Cancer Institute, 00161 Rome, Italy;
| | - Jacopo Baldi
- Oncological Orthopaedics Unit, IRCCS-Regina Elena National Cancer Institute, 00161 Rome, Italy; (B.R.); (A.P.); (J.B.); (C.Z.); (R.B.)
| | - Carmine Zoccali
- Oncological Orthopaedics Unit, IRCCS-Regina Elena National Cancer Institute, 00161 Rome, Italy; (B.R.); (A.P.); (J.B.); (C.Z.); (R.B.)
| | - Domenicangela Pellegrini
- First Division of Medical Oncology, IRCCS-Regina Elena National Cancer Institute, 00161 Rome, Italy; (S.V.); (D.P.); (F.C.)
| | - Francesco Cognetti
- First Division of Medical Oncology, IRCCS-Regina Elena National Cancer Institute, 00161 Rome, Italy; (S.V.); (D.P.); (F.C.)
| | - Roberto Biagini
- Oncological Orthopaedics Unit, IRCCS-Regina Elena National Cancer Institute, 00161 Rome, Italy; (B.R.); (A.P.); (J.B.); (C.Z.); (R.B.)
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Okamoto M, Kito M, Yoshimura Y, Aoki K, Suzuki S, Tanaka A, Takazawa A, Yoshida K, Ido Y, Ishida T, Kawasaki K, Kato H. Using the Barthel Index to Assess Activities of Daily Living after Musculoskeletal Tumour Surgery: A Single-centre Observational Study. Prog Rehabil Med 2019; 4:20190010. [PMID: 32789257 DOI: 10.2490/prm.20190010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 03/06/2019] [Indexed: 12/19/2022] Open
Abstract
Objective The objective of the current study was to find the factors affecting the activities of daily living, as evaluated by the Barthel Index, at the end of rehabilitation after musculoskeletal tumour surgery. Further, we evaluated whether the Barthel Index correlates with functional scores that are specific to musculoskeletal tumours at final follow-up. Methods The activities of daily living of 190 patients who underwent postoperative rehabilitation after surgery to treat musculoskeletal tumours were evaluated at the end of the program using the Barthel Index. Functional evaluation at the time of final follow-up observation was evaluated using the Musculoskeletal Tumour Society Score and the Toronto Extremity Salvage Score. Results The post-rehabilitation Barthel Index was significantly lower in elderly patients aged more than 60 years and in those with malignant tumours and tumours larger than 10 cm. Malignancy and large tumour size were risk factors for a low Barthel Index. There was significant correlation between the Musculoskeletal Tumour Society Score/Toronto Extremity Salvage Score at final functional evaluation and the Barthel Index at the end of rehabilitation. Conclusion The Barthel Index is a simple method to assess the activities of daily living and can potentially predict disease-specific health-related quality of life at final functional evaluation after musculoskeletal tumour surgery.
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Affiliation(s)
- Masanori Okamoto
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Munehisa Kito
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yasuo Yoshimura
- Department of Rehabilitation Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Kaoru Aoki
- Department of Applied Physical Therapy, Shinshu University School of Health Sciences, Matsumoto, Japan
| | - Shuichiro Suzuki
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Atsushi Tanaka
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Akira Takazawa
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Kazushige Yoshida
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yoshikazu Ido
- Department of Rehabilitation Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Takaaki Ishida
- Department of Rehabilitation Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Keiko Kawasaki
- Department of Rehabilitation Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Hiroyuki Kato
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
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Okamoto M, Kito M, Yoshimura Y, Aoki K, Suzuki S, Tanaka A, Takazawa A, Yoshida K, Kato H. The status quo of treatment and clinical outcomes for patients over 80 years of age with high-grade soft tissue sarcoma: report from the soft tissue tumor registry in Japan. Jpn J Clin Oncol 2018; 48:900-905. [DOI: 10.1093/jjco/hyy118] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 07/31/2018] [Indexed: 12/21/2022] Open
Affiliation(s)
- Masanori Okamoto
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Munehisa Kito
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Yasuo Yoshimura
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Kaoru Aoki
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Shuichiro Suzuki
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Atsushi Tanaka
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Akira Takazawa
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Kazushige Yoshida
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Hiroyuki Kato
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
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Tsuchie H, Emori M, Nagasawa H, Miyakoshi N, Murahashi Y, Mizushima E, Yamashita T, Shimada Y. The prognostic significance of surgical treatment for excessive elderly patients with soft tissue sarcoma. Int J Clin Oncol 2018; 23:775-782. [DOI: 10.1007/s10147-018-1255-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 02/20/2018] [Indexed: 10/17/2022]
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