High incidence of secondary malignant neoplasms observed among young sarcoma survivors
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Childhood, adolescent and young adult survivors of bone and soft tissue sarcomas had an increased risk for second malignant neoplasms, according to study results in Cancer.
The findings indicate a need for lifelong follow-up and effective aftercare for this patient population, researchers noted.
Rationale and methods
“The challenge of modern cancer therapy is still to cure but also to prevent late effects, especially in children, adolescents and young adults for whom the perspective of an adequate quality of life is a prerequisite of management,” Stefanie J. Kube, MD, researcher in the department of pediatrics at Klinikum Stuttgart Olgahospital in Germany, and colleagues wrote.
Investigators sought to assess incidence of second malignant neoplasms, as well as latency, histiotype and outcome, among 7,079 young survivors of sarcoma (median age at diagnosis, 17.5 years) included in clinical trials or in registries with a primary sarcoma. Researchers used descriptive analysis, the Kaplan-Meier method, and the Gray, Fine-Gray and Cox regression models for statistical analyses.
Key findings
Overall, 159 (2.2%) patients had a recorded second malignant neoplasm, of which researchers noted 104 (65%) solid second malignant neoplasms and 56 (35%) hematologic second malignant neoplasms. Median age at diagnosis of second malignant neoplasm was 17.5 years (range, 2.1-43.4).
Median time from first diagnosis of sarcoma to the diagnosis of second malignant neoplasm was 6.8 years, and researchers found a cumulative incidence of second malignant neoplasm of 8.8% after 30 years.
Moreover, all patients had a 5-year survival rate of 67.1% (95% CI, 66-68.2) compared with 45.1% (95% CI, 36.2-53.6) after the second malignant neoplasm diagnosis among the subcohort of 159 patients.
Implications
“There is a remarkable high cumulative incidence of second malignant neoplasms after bone and soft tissue sarcomas in children, adolescents and young adults. Therefore, effective transition, as well as risk adapted long-term follow-up care programs, should be developed and offered to young sarcoma survivors,” Kube and colleagues wrote. “Our findings provide a basis to counsel young sarcoma survivors on their individual risk [for] subsequent malignant tumors. Moreover, these data can help to establish recommendations for aftercare in young sarcoma survivors.”
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