Multimodality treatment of undifferentiated pleomorphic soft tissue sarcoma of the extremity (eUPS) in the elderly

Roos F Bleckman,Ibtissam Acem,Veroniek M Van Praag,Desirée M.J Dorleijn,Cornelis Verhoef,Yvonne M Schrage,Rick M.L Haas,Michiel A.J Van De Sande,The Collaborative Persarc Research Group The Collaborative Persarc Research Group,Han Bonenkamp,Robert J Van Ginkel,Dirk J Grünhagen,Lee M Jeys,Johnny Keller,Emelie Styring,Joanna Szkandera,Olga Zaikova

doi:10.1016/j.ejso.2021.12.008

Abstract

IntroductionThis subgroup analysis of undifferentiated pleomorphic soft tissue sarcoma of the extremity (eUPS) from the PERSARC collaborative group aimed to achieve a more personalized multimodality treatment approach for primary eUPS in elderly patients. Material and methodsA multicenter retrospective study including primary high-grade eUPS surgically treated with curative intent between 2000 and 2016. Overall survival (OS), local recurrence (LR) and distant metastasis (DM) curves were calculated by Kaplan Meier analysis. Cox proportional hazard models were used to determine the effect of radiotherapy. ResultsFrom a total of 2511 patients with extremity soft tissue sarcoma (eSTS) of the PERSARC study collaborative; 703 patients with eUPS were included in this study. In elderly patients with eUPS 5-year OS, LR and DM were 35.4 (95%CI 29.3–42.8), 17.7 (95%CI 12.7–22.6) and 24.6 (95%CI 19.1–30.1). eUPS was significantly less treated with radiotherapy compared with other eSTS, especially in elderly patients. Patients with R1-R2 margins treated with radiotherapy had about half the risk of developing LR compared with patients treated without radiotherapy (HR = 0.454, p = 0.033). ConclusionElderly patients with eUPS were less often treated with radiotherapy and showed higher LR. Nowadays, given an increasing life expectancy in elderly patients, multimodality treatment should be considered.

Highlights

This subgroup analysis of undifferentiated pleomorphic soft tissue sarcoma of the extremity from the PERSARC collaborative group aimed to achieve a more personalized multimodality treatment approach for primary eUPS in elderly patients
In this study cohort a total of 2511 patients with extremity soft tissue sarcoma (eSTS) were analysed using data form 12 specialized Sarcoma centers participating in the PERSARC study group, including 703 patients with eUPS and 1808 patients with other eSTS
EUPS were seen more often in males (55.6%), this was similar for European Journal of Surgical Oncology xxx (xxxx) xxx other eSTS (54.3%). eUPS were significantly less often deep-seated (63.5%) compared with other eSTS (70.2%)

Summary

Introduction

This subgroup analysis of undifferentiated pleomorphic soft tissue sarcoma of the extremity (eUPS) from the PERSARC collaborative group aimed to achieve a more personalized multimodality treatment approach for primary eUPS in elderly patients. Results: From a total of 2511 patients with extremity soft tissue sarcoma (eSTS) of the PERSARC study collaborative; 703 patients with eUPS were included in this study. EUPS was significantly less treated with radiotherapy compared with other eSTS, especially in elderly patients. Conclusion: Elderly patients with eUPS were less often treated with radiotherapy and showed higher LR. Given an increasing life expectancy in elderly patients, multimodality treatment should be considered. Soft tissue sarcomas of the extremities (eSTS) are malignant tumours of mesodermal origin that constitute less than 1% of all malignant tumours [1].

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