Children with Ewing’s sarcoma, astrocytoma most likely to experience late recurrence

A retrospective analysis of patients treated for pediatric cancers indicated that Ewing’s sarcoma and astrocytoma were the types most likely to recur within 20 years.

Researchers reviewed data collected on 12,795 patients, of whom 806 experienced recurrence five or more years after diagnosis. The median age at original diagnosis was 8.3 years; it was 26 years at follow-up. Most late recurrences occurred five to 10 years following diagnosis (69.1%).

The cumulative incidence of recurrence from five to 20 years was 6.2%. At the time of follow-up, 49.1% of patients who had late recurrence were alive compared with 92.9% of survivors who did not have disease recurrence.

At 20 years, patients with Ewing’s sarcoma (13%; 95% CI, 9.4%-16.5%) and astrocytoma (14.4%; 95% CI, 12.3%-16.6%) were the most likely to recur. Survivors of kidney cancer had the lowest risk for recurrence after 20 years (0.9%; 95% CI, 0.4%-1.5%).

Adjusted rate ratio (RR) for recurrence among survivors of Ewing’s sarcoma was 1.7 (95% CI, 1.2-2.4) and it was 4.5 (95% CI, 3.4-5.9) for patients with astrocytoma. In comparison, the risk was lower for survivors of Wilms’ tumors (RR=0.2; 95% CI, 0.1-0.3) and non-Hodgkin’s lymphoma (RR=0.3; 95% CI, 0.2-0.5).

Multivariate analysis showed the greatest risk factors for late recurrence were diagnosis of Ewing’s sarcoma or central nervous system tumors.

Wasilewski-Masker K. J Natl Cancer Inst. 2009;101:1709-1720.