SARCOMI NEI TESSUTI MOLLI DELLE ESTREMITÁ E DEI CINGOLI: QUALE TERAPIA OTTIMALE NEI PAZIENTI ANZIANI?
A. Comandone, A. Boglione, P. Bergnolo, M. L. Sartori, E. Giubellino, P. Pochettino
Vol.1 (2017), issue 3, pag. 12-23
|Accepted for pubblication||07/11/2016|
Soft tissue sarcomas (STS) are rare tumors with an annual incidence of 4-5 /100 000 people. About 50% of STS are diagnosed in patients older than 65 years of age. Available literature and guideliness always refer to yunger patients, in good Performance Status and without co morbidities. Our question is : can we adopt the same conlusions and recommendations in elderly people with STS of the extremities and girdle? In our review we found that STS in elderly people have a late diagnosis, a larger volume and a higher histological grading. Surgery solutions and techniques are the same we apply in younger people. With a higher morbidity. More complicated is the adoption of ancillary either neoadjuvant or adjuvant radio or chemotherapy. As a matter of fact, in the Literature analysis after radio or chemotherapy the toxicity is higher and many times it requests a decrease of the administered doses. The results on DFS and TTP is lower than in younger patients. Very dif cult is de ning the role of chemotherapy in advanced or metastatic disease. Polychemotherapy is not advisable, and monotherapy allows 6-8 months median survival. Best supportive care should always be considered as a valid alternative. In conclusion, the best results in elderly patients with STS, either localized or metastatic disease ,are found in elderly patient with good performance status, without co-morbidities. They should be always referred to high volume centers and the clinical case discussed in a mutidisciplinary setting.