title: Surgical outcome of malignant primary bone tumours in elderly and very elderly patients.
abstract: OBJECTIVE
  Elderly patients with bone cancer are thought to have poorer access to specialist treatment and therefore suboptimal outcome. The aim of this study was to review the clinical course, outcome and survivorship in geriatric patients with primary bone tumours.
  
  
  METHODS
  We analysed 66 consecutive patients aged 60 years or older who were surgically treated for primary bone tumours between 1997 and 2012. The cohort was divided into two groups: elderly (60-70 years, n = 31) and very elderly (>70 years, n = 35). Clinicopathologic characteristics, treatment, outcome and survival were analysed. The mean follow up was 58.5 months (range two to 188).
  
  
  RESULTS
  There were 51 chondrosarcomas (grade I, n = 29; grade II, n = 15; grade III, n = 7), ten osteosarcomas and four of other primary malignant bone tumours. Twenty-three prostheses for joint reconstruction were implanted; procedures involving the transposition of free vascularised flaps were performed in six patients. Seven patients had amputation as a primary procedure, four in the elderly and three in the very elderly group. Local recurrence was recorded in eight cases (12.1%). Secondary surgery was performed in nine (13.6%) patients (six recurrences, two haematomas, one deep infection). At final follow up, 77.3% of patients were alive (elderly 83.9%, very elderly 71.4%) and there was no significant difference in the five-year survival rates between both groups.
  
  
  CONCLUSIONS
  Elderly and very elderly patients with bone tumours receive satisfactory treatment and achieve good surgical outcome. Treatment decisions in the geriatric population should not be influenced by age alone.
authors.affiliation: Oxford Sarcoma Service, Nuffield Orthopaedic Centre, 150 Windmill Road, Oxford, OX3 7LD, UK.
authors.forename: Tom
authors.initials: T
authors.lastname: Cosker
authors.forename: Philipp
authors.initials: P
authors.lastname: Lechler
authors.forename: Aashish
authors.initials: A
authors.lastname: Gulati
authors.forename: Duncan
authors.initials: D
authors.lastname: Whitwell
authors.forename: Hank
authors.initials: H
authors.lastname: Giele
authors.forename: Sally
authors.initials: S
authors.lastname: Trent
authors.forename: Nick
authors.initials: N
authors.lastname: Athanasou
authors.forename: Christopher
authors.initials: C
authors.lastname: Gibbons
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016019:Survival Analysis; D016896:Treatment Outcome