Key clinical point: Perioperative radiation therapy is underused in patients age 70 and older with high-grade STS even though radiation therapy is associated with improved overall survival, and the effect is more notable in elderly patients.

Major finding: Of 6,978 elderly patients, 3549 (51%) underwent surgery alone, and 740 (11%) and 2,679 (38%) received pre- and postoperative radiation therapy, respectively. Elderly patients received radiation therapy less commonly than did nonelderly patients (49% vs 52%, P < .001) despite presenting with higher grade tumors (grade 3, 86% vs 80%, P less than .001) and experiencing more frequent positive surgical margins (23% vs 16%, P less than .001). Preoperative (hazard ratio = 0.64, 95% confidence interval: 0.54–0.77, P < .001) and postoperative (hazard ratio = 0.72, 95% confidence interval: 0.67–0.77, P < .001) radiation therapy was associated with improved overall survival compared with surgery alone. Radiation therapy use resulted in a greater magnitude of 5-year relative survival improvement in elderly than in nonelderly patients.

Study details: Patients age 70 or more with high-grade STS who underwent surgery with or without perioperative radiation therapy from 2004 to 2013 were identified from the National Cancer Database. A cohort under age 70 was identified for secondary comparative analyses.

Disclosures: The authors had no relevant disclosures.

Source: Venigalla S et al. Intl J Rad Oncology*Biology*Physics; September (102) 2018: 155-165. https://doi.org/10.1016/j.ijrobp.2018.05.019