title: External-beam radiation therapy combined with limb-sparing surgery in elderly patients (>70 years) with primary soft tissue sarcomas of the extremities : A retrospective analysis.
abstract: OBJECTIVE
  To report our experience with EBRT combined with limb-sparing surgery in elderly patients (>70 years) with primary extremity soft tissue sarcomas (STS).
  
  
  METHODS
  Retrospectively analyzed were 35 patients (m:f 18:17, median 78 years) who all presented in primary situation without nodal/distant metastases (Charlson score 0/1 in 18 patients; ≥2 in 17 patients). Median tumor size was 10 cm, mainly located in lower limb (83%). Stage at presentation (UICC7th) was Ib:3%, 2a:20%, 2b:20%, and 3:57%. Most lesions were high grade (97%), predominantly leiomyosarcoma (26%) and undifferentiated pleomorphic/malignant fibrous histiocytoma (23%). Limb-sparing surgery was preceded (median 50 Gy) or followed (median 66 Gy) by EBRT.
  
  
  RESULTS
  Median follow-up was 37 months (range 1-128 months). Margins were free in 26 patients (74%) and microscopically positive in 9 (26%). Actuarial 3‑ and 5‑year local control rates were 88 and 81% (4 local recurrences). Corresponding rates for distant control, disease-specific survival, and overall survival were 57/52%, 76/60%, and 72/41%. The 30-day mortality was 0%. Severe postoperative complications were scored in 8 patients (23%). Severe acute radiation-related toxicity was observed in 2 patients (6%). Patients with Charlson score ≥2 had a significantly increased risk for severe postoperative complications and acute radiation-related side effects. Severe late toxicities were found in 7 patients (20%), including fractures in 3 (8.6%). Final limb preservation rate was 97%.
  
  
  CONCLUSIONS
  Combination of EBRT and limb-sparing surgery is feasible in elderly patients with acceptable toxicities and encouraging but slightly inferior outcome compared to younger patients. Comorbidity correlated with postoperative complications and acute toxicities. Late fracture risk seems slightly increased.
authors.affiliation: Department of Radiation Oncology, University Hospital of Munich (LMU), Marchioninistr. 15, 81377, Munich, Germany. Claudia.Andrae@med.uni-muenchen.de.
authors.forename: Claudia
authors.identifier: http://orcid.org/0000-0003-1457-9474
authors.initials: C
authors.lastname: Andrä
authors.affiliation: Department of Orthopedics, University Hospital of Munich (LMU), Munich, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Klein
authors.affiliation: Department of Orthopedics, University Hospital of Munich (LMU), Munich, Germany.
authors.forename: Hans Roland
authors.initials: HR
authors.lastname: Dürr
authors.affiliation: Department of Radiation Oncology, University Hospital of Munich (LMU), Marchioninistr. 15, 81377, Munich, Germany.
authors.forename: Josefine
authors.initials: J
authors.lastname: Rauch
authors.affiliation: Deparment of Internal Medicine, University Hospital of Munich (LMU), Munich, Germany.
authors.forename: Lars Hartwin
authors.initials: LH
authors.lastname: Lindner
authors.affiliation: Institute of Pathology, University Hospital of Munich (LMU), Munich, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Knoesel
authors.affiliation: Department of Surgery, University Hospital of Munich (LMU), Munich, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Angele
authors.affiliation: Department of Radiology, University Hospital of Munich (LMU), Munich, Germany.
authors.forename: Andrea
authors.initials: A
authors.lastname: Baur-Melnyk
authors.affiliation: Department of Radiation Oncology, University Hospital of Munich (LMU), Marchioninistr. 15, 81377, Munich, Germany.
authors.forename: Claus
authors.initials: C
authors.lastname: Belka
authors.affiliation: Department of Radiation Oncology, University Hospital of Munich (LMU), Marchioninistr. 15, 81377, Munich, Germany.|CCU Molecular Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
authors.forename: Falk
authors.initials: F
authors.lastname: Roeder
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy / Q000401:mortality; D005121:Extremities / Q000528:radiation effects / Q000601:surgery; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D023821:Limb Salvage / Q000401:mortality* / Q000706:statistics & numerical data; D008137:Longitudinal Studies; D008297:Male; D059351:Organ Sparing Treatments / Q000401:mortality; D011183:Postoperative Complications / Q000401:mortality* / Q000517:prevention & control; D015995:Prevalence; D011832:Radiation Injuries / Q000401:mortality* / Q000517:prevention & control; D011879:Radiotherapy Dosage; D020266:Radiotherapy, Conformal / Q000401:mortality* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D012509:Sarcoma / Q000401:mortality* / Q000628:therapy*; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Elderly patients; Extremity; Limb-sparing surgery; Radiation therapy; Soft-tissue sarcoma