Older age impacts radiotherapy-related outcomes in soft tissue sarcoma Journal Article

Authors: Yuen, N. K.; Li, C. S.; Monjazeb, A. M.; Borys, D; Bold, R. J.; Canter, R. J.
Article Title: Older age impacts radiotherapy-related outcomes in soft tissue sarcoma
Abstract: BACKGROUND: Radiation therapy (RT) is a standard component in the multimodality management of localized soft tissue sarcoma (STS). Increasing studies are focusing on biological modifiers that may influence the host's response to RT, including immunologic mechanisms known to change with the aging process. We hypothesized that the effects of RT would be influenced by age, contributing to differences in treatment outcome. METHODS: Using Surveillance, Epidemiology, and End Results (1990-2011), we identified 30,898 adult patients (>18 y) with nonmetastatic STS undergoing initial surgery. We compared patient demographics, tumor characteristics, and treatments by age. Multivariable analyses were used to analyze overall survival (OS) and disease-specific survival (DSS). Hazard ratios (HRs) were calculated based on multivariable Cox proportional hazards models. RESULTS: Mean age at diagnosis was 56.6 +/- 16.8 y, and 33.6% of patients were >/=65 y. Of the total, 52.1% of patients were male and 67% were white; 59.9% of patients underwent surgery alone, 33.3% received adjuvant RT, and 6.8% neoadjuvant RT. On multivariable analysis, age, sex, year of diagnosis, histology, grade, size, marital status, and RT predicted OS, whereas age, year of diagnosis, ethnicity, histology, site, grade, RT, size, and marital status predicted DSS. In all patients, RT was associated with improved OS and DSS compared to surgery alone (median OS 136 +/- 13 mo with RT versus 118 +/- 9 mo without RT and 5-y OS 63.2 +/- 1.4% with RT versus 60.5 +/- 1.2% without, P /=65 y derived greater improvements in OS and DSS compared with patients /=65 y having significantly better OS (HR = 0.63; 95% confidence interval = 0.53-0.75), whereas patients 65 y did not (HR = 0.96; 95% confidence interval = 0.83-1.10). In addition, interaction testing demonstrated a significant modifier effect between RT and age (P 0.05). CONCLUSIONS: RT is associated with improved survival in patients with STS undergoing surgical treatment, but improvements in oncologic outcome with RT were greatest among older patients. Further studies into the mechanism of these age-related effects are needed.
Journal Title: The Journal of surgical research
ISSN: 1095-8673; 0022-4804
Publisher: Unknown  
Date Published: 2015
Language: ENG
Notes: LR: 20150715; CI: Copyright (c) 2015; JID: 0376340; OTO: NOTNLM; 2015/04/06 [received]; 2015/05/27 [revised]; 2015/06/10 [accepted]; aheadofprint