ESTRO 38 Abstract book

S888 ESTRO 38

EP-1649 Patterns of care and survival in elderly patients with advanced soft-tissue sarcoma D. Greto 1 , S. Calogero 2 , M. Lo Russo 1 , D. Pezzulla 1 , M. Loi 1 , M.A. Teriaca 1 , V. Maragna 1 , S. Lucidi 1 , D.A. Campanacci 3 , G. Beltrami 3 , G. Scoccianti 3 , L. Livi 1 1 University of Florence-Azienda Ospedaliera Universitaria Careggi AOUC, Department of Biomedical- Experimental- and Clinical Sciences, Firenze, Italy ; 2 Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute ISPO, Florence, Italy ; 3 University of Florence-Azienda Ospedaliera Universitaria Careggi AOUC, Department of Orthopaedic Oncology and Reconstructive Surgery, Firenze, Italy Purpose or Objective Elderly people represent more than 50% of sarcoma patients and they often present many differences compared to younger patients. In fact, older patients experience increased cancer-related morbidity and mortality compared to younger patients: this is shown in several studies pointing out that older age is associated to poorer outcomes. Nowadays, there are no data regarding the management of advanced soft-tissue sarcoma (STS) in elderly patients. The aim of this study is to analyze clinical outcome and treatment related toxicity of elderly STS patients in a single Institution. Material and Methods We retrospectively collected data of patients ≥65 years old diagnosed with localized advanced STS between 1998 and 2017 in a single institution. Results The study included 111 patients. Mean Charlson Index was 7.5 (2-12). One hundred five (94.6%) patients underwent surgery, ninety-one patients (82%) received radiotherapy, 23 (20.7%) patients received concurrent radiochemotherapy and 20 (18.1%) patients received chemotherapy alone. Grade >3 acute skin toxicity was recorded in 38 (52.8%) patients out of 72 patients who received postoperative radiotherapy, age > 80 years correlated with higher incidence of toxicity compared to younger patients (63.6% vs 33.3%, p=0.02). Late fibrosis, late edema and joint stiffness occurred in 10.4%, 11.8% and 4% of patients, respectively. Age did not correlate to late toxicity incidence. At a mean follow up of 4.1 years (0.1-17.7) twenty-four (22%) patients recurred, 3- and 5- year local recurrence free survival was 80.3% and 75.7%, respectively. At statistical analysis no treatments and patients characteristics affected local recurrence. Fifty- five (52.9%) patients developed distant metastasis, 3- and 5-year distant metastasis free survival (DMFS) was 59.6% and 44.6%, respectively. At univariate analysis no delivered of adjuvant radiotherapy and no surgery correlated with higher local recurrence (p=0.043 and p=0.002). On multivariate analysis, undifferentiated pleomorphic sarcoma histology was the only independent factors associated with DMFS (p=0.026). Overall survival (OS) was 62% and 46.6% at 3 and 5 years, respectively. On multivariate analysis, surgery was the only independent factor associated with OS (p=0.006). Conclusion Older patients have worse outcomes because they tend to present with worse tumors and are treated less aggressively. In this study elderly STS patients were treated with a tailored treatment comprising surgery, radiotherapy and/or chemotherapy resulted in a good efficacy and safe. EP-1650 Elderly glioblastoma patients:role of multidimensional assessment of frailty in predicting outcomes L. Giaccherini 1 , P. Ciammella 1 , M. Galaverni 1 , M. Manicone 1 , I. Renna 1 , M. Galeandro 1 , G. Timon 1 , F. Bellafiore 1 , D. Ramundo 1 , F. Vigo 1 , A. Rosca 1 , T. Palmieri 1 , M.P. Ruggieri 1 , A. Botti 2 , R. Sghedoni 2 , E. Cagni 2 , M. Orlandi 2 , M. Iori 2 , M. Russo 3 , C. Iotti 1

1 Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy ; 2 Medical Physics Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy ; 3 Clinical Neurology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy Purpose or Objective To evaluate the impact of comorbidities, clinical and biological factors on outcomes in elderly glioblastoma (GBM) patients (pts) treated with surgery followed by concurrent radiation (RT) and Temozolomide (TMZ). Material and Methods Elderly pts with GBM treated from January 2013 to December 2017 were included in the study. We collected data regarding age, extension of surgery, use of current medications, Karnofsky Performance Status (KPS), presenting symptoms, Prognostic Nutritional Index (PNI), Charlson Co-morbidity Index (CCI) and Frailty Index (FI). All of these parameters, measured before the start of RT- TMZ, were linked to clinical outcomes. Results Thirty four pts (male/female: 23/11; median age: 70 years), were retrospectively analysed. After a median follow-up of 9.7 months (range 2.0 – 30.6), the median OS was 12.1 months (range 6.7-14.3), and 1-year OS was 50% (range 31-64%). Median PFS was 12.1 months (range 10.3 + NA), 1-year PFS was 48% (range 30-73%). Four pts (11,76%) experienced G1-2 neurological symptoms during RT. No pts showed G3 events. At univariate analysis high KPS and total surgery were significantly associated with better OS (p=0.0339 and p=0.00782) and only the type of surgery with PFS (p=0.0182).. Using log rank test we identified as the optimal PNI cut-off level the value of 42; the best cut-off value of CCI was 2 for OS and 3 for PFS. Univariate analysis showed that 14 pts with a PNI< 42 had a median survival of 13.10 months versus 8.38 months for those pts with a PNI ≥ 42 (p=0.63). The 1 year OS rate for pts with a PNI < 42 was 25% while the corresponding value for pts with PNI > 42 was 54%. Univariate analysis showed that pts with a CCI >2 had a median OS of 8 months versus 14.2 months for pts with CCI<2 (p= 0.076). The 1-year OS rate was 33% and 54% for pts with CCI<2 and ≥ 2, respectively. Pts with CCI≥ 3 showed a median PFS of 5.9 months versus 12.3 months for those with CCI<3 (p=0.0113). The 1-year PFS rate for pts with a CCI<3 was 52%, while no pts with CCI > 3 was alive at one year. At the multivariate analysis FI alone remained significant in predicting OS: presenting with a FI >2 compared with FI<2 was significantly associated with an increased risk of death [(p= 0.023, HR = 3.330 (1.96 – 5.66)]. At multivariate analysis KPS, type of surgery and FI remained a significant predictors of OS and, based on these parameters, we generated a prognostic score that, dividing pts into three risk categories, has proven to be a survival predictor, with an increase of the risk of death by 2.2 times for each increment of the score (HR 2.2, p=0.0004).