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1304 Experience of a monocentric center: Soft-tissue sarcoma in elderly
Abstracts Results: In enrolled 24 patients with median age of 78 years (75−84 years), a majority of patients had good performance status (62.5% with KPS=80, 37.5% with KPS=70) and low Charlson comorbidity index score (58.3% with CCI=0, 37.5% with CCI=1, and 4.2% with CCI=2). (70.8%) and 3 (12.5%) patients developed grade 2 or grade 3 acute toxicity, respectively. Radiation dermatitis, gastrointestinal side effects, leukopenia and fatigue were the most common observed acute toxicities. DLTs were seen in one of six patients at each dose level of 1200 mg/m2 /d, 1350 mg/m2 /d and 1650 mg/m2 /d. The MTD was not reached. Only 11 patients underwent surgery, 3 (27.3%) had pathologic complete response (pCR), the left 8 (72.7%) were overall downstaged. No treatment related death occurred. Three patients (27.3%) had grade 2 or 3 postoperative complications. With a median follow-up of 23 months, the 2-year overall survival rate and 2-year cancer-specific survival rate was 67.4% and 74.9%, respectively. No significant differences were found between the outcomes of patients with or without surgery. Conclusions: In selected elderly patients aged 75 years with locally advanced rectal cancer, preoperative CRT with capecitabine at the dose of 1650 mg/m2 /d was acceptable. Although the pathologic results appeared encouraging, only half of patients received the subsequent surgery. (ClinicalTrials.gov number, NCT01584544.) No conflict of interest. 1304 POSTER Experience of a monocentric center: Soft-tissue sarcoma in elderly P. Boudou-Rouquette1 , S. Kreps2 , D. Biau3 , C. Tlemsani1 , A. Rouquette4 , A. Babinet3 , V. Dumaine3 , V. Audard4 , A. Cessot1 , J. Even3 , J. Alexandre1 , A. Chahwakilian5 , M. Housset2 , F. Larousserie4 , F. Goldwasser1 , P. Anract3 . 1 Cochin Port-Royal Teaching Hospital, Paris Descartes University, AP-HP, Oncology, Paris, France; 2 HEGP Teaching Hospital, Paris Descartes University, AP-HP, Radiotherapy, Paris, France; 3 Cochin Port-Royal Teaching Hospital, Paris Descartes University, AP-HP, Orthopedic Surgery, Paris, France; 4 Cochin Port-Royal Teaching Hospital, Paris Descartes University, AP-HP, Pathology, Paris, France; 5 Broca Teaching Hospital, Paris Descartes University, AP-HP, Gerontology, Paris, France Background: As our population ages, elderly cancer care has become a growing challenge to the worldhealth care systems. Our current understanding of soft-tissue sarcoma care in an otherwise expandingpopulation of older patients aged over 80 years remains very limited, and deserves continued investigation. Methods: Using our local pathological register, we reviewed data concerning patients 80 years old, with primary soft-tissue sarcoma, referred to Orthopaedic or Oncology departments from 01/01/2009 to 31/12/2014. Results: Sixty-seven patients were included in this study population. This represented 13.6% of all the patients with soft-tissue sarcoma during this period. The median age was 84 years (range 80−99), 58% women (n = 38), 22.4% with synchronous metastasis (n = 15). Median comorbidities was 3 (range 1−6). Most common histology subtypes were: undifferentiated pleomorphic sarcoma (n = 26, 38.8%), myxofibrosarcoma (n = 8, 12%), leiomyosarcoma (n = 7, 10.4%), atypical lipomatous tumor (n = 6, 9%) and dedifferentiated liposarcoma (n = 4, 6%). At diagnosis, mean tumor size was 12.5 cm (ext: 2−40) and 40 tumors (60%) were histologic FNLCC grade 3. Median delay between symptoms and diagnosis was 5 months (range 1– 120), 10 pts (15%) were referred to our center after an unplanned marginal resection (for “abscess”, “lipoma”, “hematoma” or “inguinal hernia repair”). Thirty-one (46%) pts underwent surgery and radiotherapy (RT; 8 pts in the neo-adjuvant setting); 24 (36%) pts underwent surgery only, 4 (6%) ptschemotherapy CT only, 6 (9%) pts received a combination of RT-CT and/or surgery and 5 (7.4%) pts beneficed from best supportive care. Six (9%) pts presented macroscopic residual disease (R2) after surgery. Seven (10.4%) pts presented local recurrence after a 30 months median interval after diagnosis (range 4−61) and 9 (13.4%) pts metastatic recurrence after a 10 months median interval after diagnosis (range 4−18). At the time of analysis, 29 (43%) pts were alive without disease with a median follow-up of 17 months (range 1–143). Conclusions: Sarcoma of the elderly are associated with pejorative factors but benefit from multidisciplinary discussion in highly-specialized centers. No conflict of interest.
S189 1305 POSTER Management of older patients with newly diagnosed gastric and oesophageal cancers (GOC) M. Jafri1 , S. Madan1 , J. Callan1 , J. Thompson1 . 1 Heartlands Hospital, Oncology, Birmingham, United Kingdom Background: Patients with GOC often present late with symptomatic disease. Optimal treatment of GOC includes chemotherapy, radiotherapy and surgery. As the population ages, active oncological interventions can become difficult. We describe the management of those >70 yrs with newly diagnosed GOC. Materials and Methods: The records of patients with GOC presenting between Sept 2013 and Sept 2014 were retrospectively reviewed. Demographic data, pathological data, treatment and survival were evaluated. Results: 120 patients aged >70 yrs were included, median age 79 yrs (70−96). 80 patients (45%) were >80 yrs, 33 (27.5%) 75−79 yrs and 33 (27.5%) between 70−74 yrs. Patients presented via primary care 77 (64%), emergency dept. (ED) 30 (25%) or internal referral 13 (11%). ED admissions in those >70 (14%) were higher than the overall UK figure. 66 oesophageal and 54 gastric cancers were identified. >97% had a CT scan, compared with 90% in the UK overall. 20% had all routine staging investigations (endoscopy,CT Scan, PET, EUS and staging laparotomy). 96% had a histological diagnosis: 85 (71%) were adenocarcinoma, 28 (23%) squamous carcinoma, 2 (1.6%) small cell carcinoma and 5 (4%) undiagnosed. 21% had metastatic disease. 54% received active treatment: 26 (22%) neoadjuvant chemotherapy and surgery, 10 (8%) surgery alone, 13 (11%) chemoradiotherapy, 14 (12%) palliative chemotherapy, 2 (2%) palliative radiotherapy. 18 (15%) had endoscopic palliation. 45% of patients received best supportive care (BSC); reasons for this were poor PS (21%), co-morbidity (20%) or patient choice (4%). Compared to the UK overall, the proportion treated with curative intent was similar. However, fewer patients received palliative chemotherapy/radiotherapy (14% vs. 28% overall). Patients presenting via primary care, ED and internal referral had 1 year survivals (1YS) of 60%, 38%, and 43%. Age and T stage did not influence survival. Node positivity was a poor prognostic sign; 1YS of N0, N1, N2, Nx disease was 79%, 50%, 30% and 33%. The therapeutic modality utilised had a significant effect on 1YS; neoadjuvant chemotherapy and surgery, surgery alone, chemoradiotherapy, palliative chemotherapy and BSC had 1YS of 86%, 80%, 67%, 36%, and 33%. Conclusions: Treatment of older patients with GOC is challenging with a lack of prospective data regarding the appropriate management. In this review, patients >70 were more likely to be admitted via ED and this was associated with a poorer prognosis. Patients were investigated and, if appropriate, offered curative approaches, these patients had comparable survival to all GOC patients. Better education is necessary to prevent presentations via ED. Research to address the problem of frail and elderly patients being under-represented in oncology trials, but treated using evidence derived from those trials, has resulted in the GO2 trial, a large RCT for patients with advanced GOC. No conflict of interest. 1306 POSTER Management of early stage breast cancer in older patients − An international comparison of standard care versus oncogeriatric care M. Kiderlen1 , E. Bastiaannet1 , K. Egan2 , W. Van de Water1 , A. De Craen3 , L. Balducci4 , C. Van de Velde1 , G.J. Liefers1 , M. Extermann4 . 1 Leiden University Medical Center, Surgical Oncology, Leiden, Netherlands; 2 H. Lee Moffitt Cancer Center, Cancer Epidemiology, Tampa, USA; 3 Leiden University Medical Center, Gerontology and geriatrics, Leiden, Netherlands; 4 H. Lee Moffitt Cancer Center, Senior Adult Oncology, Tampa, USA Introduction: Forty percent of all breast cancer cases occur in older women. Whether a treatment program tailored to the elderly patient population improves cancer outcomes has not been well studied. The purpose of this study was to identify the impact of an oncogeriatric care program on treatment approach and recurrence risk in older patients with early stage breast cancer. Material and Methods: Patients aged 70 years of older with a diagnosis of early stage hormone receptor positive breast cancer (T1−2 N0−1) diagnosed between 1997 and 2004 were eligible for this study. Consecutive patients meeting the inclusion criteria were identified from the FOCUS cohort, comprising a geographically defined region in the South Western part of The Netherlands (the ‘Standard Care’ cohort) and from the Moffitt Cancer Center in Tampa, Florida in which the majority of patients were treated within the Senior Adult Oncology Program (the “SAOP” cohort).
S189 1305 POSTER Management of older patients with newly diagnosed gastric and oesophageal cancers (GOC) M. Jafri1 , S. Madan1 , J. Callan1 , J. Thompson1 . 1 Heartlands Hospital, Oncology, Birmingham, United Kingdom Background: Patients with GOC often present late with symptomatic disease. Optimal treatment of GOC includes chemotherapy, radiotherapy and surgery. As the population ages, active oncological interventions can become difficult. We describe the management of those >70 yrs with newly diagnosed GOC. Materials and Methods: The records of patients with GOC presenting between Sept 2013 and Sept 2014 were retrospectively reviewed. Demographic data, pathological data, treatment and survival were evaluated. Results: 120 patients aged >70 yrs were included, median age 79 yrs (70−96). 80 patients (45%) were >80 yrs, 33 (27.5%) 75−79 yrs and 33 (27.5%) between 70−74 yrs. Patients presented via primary care 77 (64%), emergency dept. (ED) 30 (25%) or internal referral 13 (11%). ED admissions in those >70 (14%) were higher than the overall UK figure. 66 oesophageal and 54 gastric cancers were identified. >97% had a CT scan, compared with 90% in the UK overall. 20% had all routine staging investigations (endoscopy,CT Scan, PET, EUS and staging laparotomy). 96% had a histological diagnosis: 85 (71%) were adenocarcinoma, 28 (23%) squamous carcinoma, 2 (1.6%) small cell carcinoma and 5 (4%) undiagnosed. 21% had metastatic disease. 54% received active treatment: 26 (22%) neoadjuvant chemotherapy and surgery, 10 (8%) surgery alone, 13 (11%) chemoradiotherapy, 14 (12%) palliative chemotherapy, 2 (2%) palliative radiotherapy. 18 (15%) had endoscopic palliation. 45% of patients received best supportive care (BSC); reasons for this were poor PS (21%), co-morbidity (20%) or patient choice (4%). Compared to the UK overall, the proportion treated with curative intent was similar. However, fewer patients received palliative chemotherapy/radiotherapy (14% vs. 28% overall). Patients presenting via primary care, ED and internal referral had 1 year survivals (1YS) of 60%, 38%, and 43%. Age and T stage did not influence survival. Node positivity was a poor prognostic sign; 1YS of N0, N1, N2, Nx disease was 79%, 50%, 30% and 33%. The therapeutic modality utilised had a significant effect on 1YS; neoadjuvant chemotherapy and surgery, surgery alone, chemoradiotherapy, palliative chemotherapy and BSC had 1YS of 86%, 80%, 67%, 36%, and 33%. Conclusions: Treatment of older patients with GOC is challenging with a lack of prospective data regarding the appropriate management. In this review, patients >70 were more likely to be admitted via ED and this was associated with a poorer prognosis. Patients were investigated and, if appropriate, offered curative approaches, these patients had comparable survival to all GOC patients. Better education is necessary to prevent presentations via ED. Research to address the problem of frail and elderly patients being under-represented in oncology trials, but treated using evidence derived from those trials, has resulted in the GO2 trial, a large RCT for patients with advanced GOC. No conflict of interest. 1306 POSTER Management of early stage breast cancer in older patients − An international comparison of standard care versus oncogeriatric care M. Kiderlen1 , E. Bastiaannet1 , K. Egan2 , W. Van de Water1 , A. De Craen3 , L. Balducci4 , C. Van de Velde1 , G.J. Liefers1 , M. Extermann4 . 1 Leiden University Medical Center, Surgical Oncology, Leiden, Netherlands; 2 H. Lee Moffitt Cancer Center, Cancer Epidemiology, Tampa, USA; 3 Leiden University Medical Center, Gerontology and geriatrics, Leiden, Netherlands; 4 H. Lee Moffitt Cancer Center, Senior Adult Oncology, Tampa, USA Introduction: Forty percent of all breast cancer cases occur in older women. Whether a treatment program tailored to the elderly patient population improves cancer outcomes has not been well studied. The purpose of this study was to identify the impact of an oncogeriatric care program on treatment approach and recurrence risk in older patients with early stage breast cancer. Material and Methods: Patients aged 70 years of older with a diagnosis of early stage hormone receptor positive breast cancer (T1−2 N0−1) diagnosed between 1997 and 2004 were eligible for this study. Consecutive patients meeting the inclusion criteria were identified from the FOCUS cohort, comprising a geographically defined region in the South Western part of The Netherlands (the ‘Standard Care’ cohort) and from the Moffitt Cancer Center in Tampa, Florida in which the majority of patients were treated within the Senior Adult Oncology Program (the “SAOP” cohort).