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Age-based disparities in treatment and outcomes of retroperitoneal rhabdomyosarcoma

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Abstract

Background

Elderly patients (EPs) suffering from retroperitoneal rhabdomyosarcoma (RRMS) carry a considerably poorer prognosis compared to younger patients (YPs). We hypothesized that EPs received less aggressive and comprehensive treatment than YPs, resulting in poorer survival outcomes.

Materials and methods

All patients diagnosed with RRMS since 1998 in the National Cancer Data Base (NCDB) were reviewed for patient demographics, tumor characteristics, treatment modalities and survival outcomes.

Results

Of the 100 patients identified, 35 % were ≥65 years of age. EPs (aged ≥65 years), when compared to YPs (aged <65), were less likely to receive systemic chemotherapy (20 % EPs vs 71 % YPs, p < 0.001) and treatment at an academic center (34 % EPs vs 60 % YPs, p = 0.05), although the frequency of radiation (23 % EPs vs 31 % YPs, p = 0.40) and radical surgery (26 % EPs vs 22 % YPs, p = 0.55) were similar. EPs received treatment more frequently at comprehensive community cancer programs (57 %) and had a shorter median distance of travel for care (6.4 vs 13 miles, p = 0.009). After adjusting for gender and tumor size, EPs had a hazard ratio of 3.6 (95 % CI 1.8–7.2, p < 0.001), with a median survival of 2 months (interquartile range [IQR] 1–8 months) versus 17 months for YPs (IQR 8–43 months).

Conclusion

Altered practice patterns exist for EPs and include reduced use of systemic chemotherapy which may contribute to poorer outcomes for RRMS patients. Although regionalization of care poses challenges, this may offer benefit to the EP group.

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Acknowledgments

This research was funded by the Wadina Sarcoma Research Fund. The NCDB is a joint project of the Commission on Cancer of the American College of Surgeons and the American Cancer Society. The data used in the study are derived from a de-identified NCDB file. The American College of Surgeons and the Commission on Cancer have not verified and are not responsible for the analytic or statistical methodology employed, or the conclusions drawn from these data by the investigator.

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Authors and Affiliations

  1. Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, 9200 W Wisconsin Ave, Milwaukee, WI, 53226, USA

    Mark A. Kashtan, Thejus T. Jayakrishnan, Rahul Rajeev, Fabian Johnston, T. Clark Gamblin & Kiran K. Turaga

  2. Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI, USA

    John C. Charlson

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  1. Mark A. Kashtan
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  2. Thejus T. Jayakrishnan
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  3. Rahul Rajeev
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  5. Fabian Johnston
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  6. T. Clark Gamblin
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  7. Kiran K. Turaga
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Corresponding author

Correspondence to Kiran K. Turaga.

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Conflict of interest

JC received research funding from Threshold and CytRx. KT received honoraria from Caris Biosciences and Ethicon and is the Sharon K. Wadina Chair in Sarcoma Research.

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Kashtan, M.A., Jayakrishnan, T.T., Rajeev, R. et al. Age-based disparities in treatment and outcomes of retroperitoneal rhabdomyosarcoma. Int J Clin Oncol 21, 602–608 (2016). https://doi.org/10.1007/s10147-015-0918-0

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  • DOI: https://doi.org/10.1007/s10147-015-0918-0

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