Young adults with extremity soft tissue sarcoma were more likely to receive chemotherapy and less likely to receive radiation compared with their older counterparts, according to research published in JAMA Network Open.
Researchers conducted a retrospective study of 8953 patients from the National Cancer Database and compared the use of definitive treatment between 2004 and 2014.
The cohort included 1280 young adults (aged 18-39 years), 3937 patients aged 40-64 years, and 3756 patients age 65 and older.
The researchers noted that the young adult patients were more likely than their older counterparts to have tumors smaller than 5 cm and moderately differentiated tumor types.
“These findings suggest that the disease may not be as aggressive in the younger population,” the researchers wrote. “However, these findings are complicated by the fact that more young adults than older adults underwent amputation.”
Amputation was done in 8.1% of young adults, 5.5% of patients aged 40-64 years, and 5.3% of those age 65 or older. However, the odds of undergoing amputation rather than limb-sparing surgery were not significantly different across the age groups in a multivariable analysis.
Chemotherapy was more commonly given to young adults (39.4%) than to patients aged 40-64 (29.5%) and those age 65 and older (9.3%). When compared with young adults, the odds ratio (OR) for receiving chemotherapy was 0.52 for patients aged 40-64 (95% CI, 0.45-0.60; P =.001) and 0.16 for patients age 65 and older (95% CI, 0.12-0.20; P =.001).
On the other hand, radiation was given less commonly to young adults (59.3%) than to patients aged 40-64 (69.1%) and those age 65 or older (63.4%). When compared with young adults, the OR for receiving radiation was 1.40 for patients aged 40-64 (95% CI, 1.22-1.61; P =.001) and 1.33 for patients age 65 and older (95% CI, 1.11-1.61; P =.003).
The researchers pointed out that, unique to young adults, clinical stage II disease vs stage I disease and positive surgical margins were not associated with the use of radiation.
“Further study is warranted to identify the clinical outcomes of these practice disparities,” the researchers concluded.
Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.
Seldon C, Shrivastava G, Al-Awady A, et al. Variation in management of extremity soft-tissue sarcoma in younger vs older adults. JAMA Netw Open. Published online August 20, 2021. doi:10.1001/jamanetworkopen.2021.20951