Older age impacts radiotherapy-related outcomes in soft tissue sarcoma

Research output: Contribution to journalArticle

4 Citations (Scopus)

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 < 0.01). Patients ≥65 y derived greater improvements in OS and DSS compared with patients <65 y. These benefits were most notable after neoadjuvant RT 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.

Original languageEnglish (US)
Pages (from-to)494-504
Number of pages11
JournalJournal of Surgical Research
Volume199
Issue number2
DOIs
StatePublished - Dec 1 2015

Fingerprint

Sarcoma
Radiotherapy
Survival
Neoadjuvant Therapy
Marital Status
Histology
Marital Therapy
Confidence Intervals
Background Radiation
Survival Analysis
Proportional Hazards Models
Epidemiology
Demography

Keywords

  • Age
  • Radiotherapy
  • Soft tissue sarcoma
  • Surgery

ASJC Scopus subject areas

  • Surgery

Cite this

Older age impacts radiotherapy-related outcomes in soft tissue sarcoma. / Yuen, Noah K.; Li, Chin-Shang; Monjazeb, Arta M; Borys, Dariusz; Bold, Richard J; Canter, Robert J.

In: Journal of Surgical Research, Vol. 199, No. 2, 01.12.2015, p. 494-504.

Research output: Contribution to journalArticle

@article{f1920b0165334369acfd0cf107ade657,
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 < 0.01). Patients ≥65 y derived greater improvements in OS and DSS compared with patients <65 y. These benefits were most notable after neoadjuvant RT 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.",
keywords = "Age, Radiotherapy, Soft tissue sarcoma, Surgery",
author = "Yuen, {Noah K.} and Chin-Shang Li and Monjazeb, {Arta M} and Dariusz Borys and Bold, {Richard J} and Canter, {Robert J}",
year = "2015",
month = "12",
day = "1",
doi = "10.1016/j.jss.2015.06.020",
language = "English (US)",
volume = "199",
pages = "494--504",
journal = "Journal of Surgical Research",
issn = "0022-4804",
publisher = "Academic Press Inc.",
number = "2",

}

TY - JOUR

T1 - Older age impacts radiotherapy-related outcomes in soft tissue sarcoma

AU - Yuen, Noah K.

AU - Li, Chin-Shang

AU - Monjazeb, Arta M

AU - Borys, Dariusz

AU - Bold, Richard J

AU - Canter, Robert J

PY - 2015/12/1

Y1 - 2015/12/1

N2 - 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 < 0.01). Patients ≥65 y derived greater improvements in OS and DSS compared with patients <65 y. These benefits were most notable after neoadjuvant RT 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.

AB - 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 < 0.01). Patients ≥65 y derived greater improvements in OS and DSS compared with patients <65 y. These benefits were most notable after neoadjuvant RT 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.

KW - Age

KW - Radiotherapy

KW - Soft tissue sarcoma

KW - Surgery

UR - http://www.scopus.com/inward/record.url?scp=84956742314&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84956742314&partnerID=8YFLogxK

U2 - 10.1016/j.jss.2015.06.020

DO - 10.1016/j.jss.2015.06.020

M3 - Article

VL - 199

SP - 494

EP - 504

JO - Journal of Surgical Research

JF - Journal of Surgical Research

SN - 0022-4804

IS - 2

ER -