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The Influence of Age on Morbidity in Primary High Grade Sarcoma of the Extremity

The Influence of Age on Morbidity in Primary High Grade Sarcoma of the Extremity. K. Alektiar, M. Brennan, S. Singer Memorial Sloan-Kettering Cancer Center. Introduction: STS & Age. Wibmer C et al. Ann Oncol 2009. Local Recurrence & Age. Cahlon O et al. ASTRO 2008.

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The Influence of Age on Morbidity in Primary High Grade Sarcoma of the Extremity

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  1. The Influence of Age on Morbidity in Primary High Grade Sarcoma of the Extremity K. Alektiar, M. Brennan, S. Singer Memorial Sloan-Kettering Cancer Center

  2. Introduction: STS & Age Wibmer C et al. Ann Oncol 2009

  3. Local Recurrence & Age Cahlon O et al. ASTRO 2008

  4. Use of RT and Older Age:MSKCC Data (n = 1459) Odds Ratio 95% CI p value Limb sparing surgery13 7-25 < 0.001 High grade3.6 2.4-4.7 < 0.001 Deep tumor 2.5 1.8-3.4 < 0.001 Size ≥ 5 cm2.21.7-2.9 < 0.001 Positive margin1.6 1.2-2.1 0.004 Age ≥ 700.6 0.5-0.9 0.005 Ashman et al. ASTRO 2006

  5. Purpose To determine whether older age, defined as ≥ 70 years, influences morbidity in pts with primary HG extremity STS who received adjuvant RT at MSKCC

  6. Patient Population • # of pts: 433 • Period: 8/82- 02/06 • Presentation: Primary, N0M0 • Mean age: 53 (range: 16-89) • Grade: High only • Deep: 89% (n = 387) • Size > 5 cm: 74% (n = 322) • Lower extremity: 72% (n = 310)

  7. Extent of SurgeryAll pts had limb-sparing surgery at MSKCC ♠: Periosteal stripping/bone resection ♦: Neurolysis/nerve resection

  8. RT TypeAll pts had their RT MSKCC *: Median dose Adjuvant chemotherapy: 139/433 (32%).

  9. Distribution of Variables < 70 ≥ 70 p

  10. Extent of Surgery & Age Groups ♠: Periosteal stripping/bone resection ♦: Neurolysis/nerve resection

  11. RT Type & Age Groups:For the purpose of this analysis, BRT and BRT+EBRT were combined 0.18

  12. RT “Conventional” Dose & Age GroupsConventional: BRT 45 Gy EBRT 60-70 Gy BRT+EBRT 15-20 and 45-50 Gy *: BRT and BRT+EBRT

  13. MorbidityMedian F/U: 53 months ♠:Those with nerve resection were excluded

  14. Morbidity & Age ♠:Those with nerve resection were excluded

  15. Joint Stiffness

  16. Grade of Stiffness & Age Groups

  17. Edema

  18. Grade of Edema & Age Groups

  19. Grade of Nerve Damage:(n = 377/433)♠ ♠:Those with nerve resection were excluded

  20. Grade of Nerve♠ Damage & Age Groups ♠:Those with nerve resection were excluded

  21. Conclusion • Older age (≥ 70 years) is not associated with increased morbidity from treatment with the exception of edema • Strategies to minimize the risk of edema are warranted • Withholding adjuvant RT solely based on older age, for fear of potential morbidity doesn’t seem to be justified

  22. Influence of Age on BRT Morbidity ♠:Those with nerve resection were excluded

  23. Influence of Age on EBRT Morbidity ♠:Those with nerve resection were excluded

  24. Morbidity & Type of RT in < 70 ♠:Those with nerve resection were excluded

  25. Morbidity & Type of RT in ≥ 70 ♠:Those with nerve resection were excluded

  26. RT Type & Age Groups

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