Morbidity and mortality after treatment of Ewing sarcoma: A single-institution experience Journal Article

Authors: Novetsky Friedman, D.; Chastain, K.; Chou, J. F.; Moskowitz, C. S.; Adsuar, R.; Wexler, L. H.; Chou, A. J.; DeRosa, A.; Candela, J.; Magnan, H.; Pun, S.; Kahan, T.; Wolden, S. L.; Meyers, P. A.; Oeffinger, K. C.
Article Title: Morbidity and mortality after treatment of Ewing sarcoma: A single-institution experience
Abstract: Background: Children, adolescents, and young adults treated for Ewing sarcoma (ES) are at risk for disease-related and treatment-related complications. We aimed to describe early and late overall mortality, cause-specific mortality, and key adverse health outcomes in a large, single-institutional cohort of patients with ES. Methods: Patients with ES diagnosed at age less than 40 years and treated at Memorial Sloan Kettering between 1974 and 2012 were included. Overall survival was estimated using Kaplan–Meier methods. Cox proportional hazards were used to examine the association of clinical and pathologic variables with overall survival. Cause-specific mortality was evaluated with the cumulative incidence function accounting for competing risks. Results: Three hundred patients with ES (60.3% male; median age at diagnosis: 16.8 years [range: 0.3–39]; 30.0% with metastatic disease at diagnosis) were followed for a median of 7.8 years (range: 0.2–37). Five-year overall survival was 65.2% (95% confidence interval [95% CI], 59.8–71.1%) for the entire cohort; 78.6% for those with localized disease; 40.1% for those with isolated pulmonary metastases; and 28.1% for those with extrapulmonary metastases. In multivariable analysis, older age at diagnosis, minority race/ethnicity, and metastatic disease at diagnosis were associated with inferior survival. Ten-year cumulative incidence of relapse/progression was 40.1%, with eight late relapses occurring at a median of 6.3 years after diagnosis (range: 5–14). Seventeen patients developed subsequent neoplasms (treatment-related myelodysplastic syndrome/acute myelogenous leukemia = 9; solid tumors = 6; nonmelanoma skin cancer [NMSC] = 4). Excluding NMSC and melanoma in situ, the cumulative incidence of subsequent malignant neoplasms at 25 years was 15% (95% CI, 4.8–25.1%). Conclusion: Patients with ES are at high risk for relapse/progression and second cancers. © 2017 Wiley Periodicals, Inc.
Keywords: risk; survivors; ewing sarcoma; second cancers
Journal Title: Pediatric Blood and Cancer
Volume: 64
Issue: 11
ISSN: 1545-5009
Publisher: Wiley Periodicals, Inc  
Date Published: 2017-11-01
Start Page: e26562
Language: English
DOI: 10.1002/pbc.26562
PROVIDER: scopus
PUBMED: 28417551
Notes: Article -- Export Date: 4 October 2017 -- Source: Scopus
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MSK Authors
  1. Joanne Fu-Lou Chou
    164 Chou
  2. Suzanne L Wolden
    428 Wolden
  3. Leonard H Wexler
    135 Wexler
  4. Alexander Ja-Ho Chou
    55 Chou
  5. Chaya S. Moskowitz
    177 Moskowitz
  6. Kevin Oeffinger
    266 Oeffinger
  7. Paul Meyers
    248 Meyers
  8. Heather Magnan
    25 Magnan
  9. Roberto Adsuar
    9 Adsuar
  10. Shawn Clinton Pun
    9 Pun
  11. Amelia DeRosa
    1 DeRosa
  12. Tamara Kahan
    1 Kahan