Posters— Surgical Treatment of Sarcomas

SOFT TISSUE SARCOMAS AFTER 80 YEARS OF AGE. STUDY OF A SERIES OF 22 PATIENTS

Turcotte R, Barabas D, Isler M, Doyon J, Normandin D. (Division of Orthopaedic Surgery, Maisonneuve-Rosemont Hospital, Montreal Qc, H1T 4B3 Canada)

Aim of the study: The management of older patients who have soft tissue sarcomas (STS) is one of the most challenging problems in oncology. The aim of this retrospective study was to report the results of the treatment for the STS in 22 patients over 80 years of age.

Patients and Methods: Twenty two patients ( 10 men and 12 women) with STS treated between 1991 and 1999 in our department were studied. The histologic appearance and grade were correlated with subsequent treatment and clinical behavior. Based on the type of therapy, 4 groups were analized: in the first group patients were treated exclusively by surgical resection (4 patients), in the second group patients were treated only by radiotherapy (2 patients), in the third group surgical resection was completed by radiotherapy (12 patients) and finally the fourth group patients without therapy ( 4 patients).

Results: The patients age at diagnosis ranged from 80 to 91 years (average 84,8 years). Tumor were located in the lower limb in 14 patients, in the upper limb in 7 patients, and in the back in 1 patient. The histologic type of tumor were the followings: malignant fibro- histiocytoma (10), leiomyosarcoma (7), liposarcoma (3), synovial-sarcoma (1), and malignant schwannoma (1). Nineteen patients had a histologically high grade tumor (grade III 15/22 and grade IV 4/22). Three patients had a low grade tumor (grade II). The mean survival of patients after diagnosis was 26,3 months (range 1 to 113 months) . Ten patients died during the follow-up, 4 deaths were related to the disease and 6 were not. Metastases were found in 6 patients, in four of them at the time of diagnosis.

In the first group (surgically treated patients) the mean survival was 15,5 months and one patient died of unrelated cause. Local recurrence occured in 1 patient.

In the second group (2 patients with radiotherapy only) the mean survival was 5,5 months, both patients developped diffuse metastases, and both died.

In the third group (12 patients with surgical resection and radiotherapy) the mean survival was 31,3 months. Six patients died: one of lung metastasis and 5 death were not related with the tumor. Three local reccurrence occurred.

In the fourth group (4 patients without treatment) all patients died, three of them related to the disease and one of unrelated cause. The mean survival was 3 months.

Conclusion: Patients older than 80 years with STS, remain a high risk group. Nevertheless, age is not a limitating factor in the surgical treatment ot STS. These data suggest that an aggressive approach including surgical resection and radiotherapy is appropriate in management of older patients with STS.