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Long-term Outcomes and Complications in Pediatric Ewing Sarcoma
Sarah N Hamilton1, Ryan Carlson, Haroon Hasan
1*Department of Surgery, Faculty of Medicine, University of British Columbia †Department of Radiation Oncology, British Columbia Cancer Agency-Vancouver Centre ∥Division of Pediatric Hematology/Oncology/BMT, British Columbia Children's Hospital, Vancouver, BC ‡Department of Oncology, Northeast Cancer Centre, Sudbury, ON, Canada §Pediatric Oncology Group of Ontario, Toronto, ON, Canada.
Insights
Pediatric Ewing sarcoma patients with localized disease showed excellent survival rates. However, most survivors experienced long-term complications, highlighting the need for ongoing follow-up care.
Area of Science:
- Pediatric Oncology
- Cancer Epidemiology
- Clinical Outcomes Research
Background:
- Ewing sarcoma is a rare bone cancer primarily affecting children and adolescents.
- Understanding long-term outcomes and complications is crucial for improving survivorship care.
Purpose of the Study:
- To evaluate treatment outcomes and identify long-term complications in pediatric patients with Ewing sarcoma.
- To assess prognostic factors influencing survival in this population.
Main Methods:
- Retrospective chart review of 101 pediatric patients diagnosed between 1960 and 2005.
- Kaplan-Meier survival analysis and Cox regression for prognostic factor assessment.
- Analysis of overall survival (OS) and event-free survival (EFS).
Main Results:
- Localized Ewing sarcoma showed 5-year OS of 85% and EFS of 73%.
- Metastatic disease was a significant predictor of lower OS and EFS.
- Most long-term survivors (77%) experienced complications, including musculoskeletal issues and cardiac toxicity.
Conclusions:
- Localized Ewing sarcoma treatment yields excellent outcomes at the British Columbia Cancer Agency.
- The high incidence of chronic complications necessitates long-term follow-up for Ewing sarcoma survivors.
- This study underscores the importance of managing late effects of cancer treatment.
Objectives:
The objective of this study was to determine treatment outcomes and long-term complications in pediatric patients with Ewing Sarcoma treated at the British Columbia Cancer Agency (BCCA).
Methods:
A retrospective chart review of 101 pediatric patients (<19 y old) with Ewing Sarcoma diagnosed between 1960 and 2005 was performed. The Kaplan-Meier survival analysis and Cox regression multivariate analysis were used to assess prognostic factors for overall survival (OS) and event-free survival (EFS).
Results:
The median age at diagnosis was 11 years and the median follow-up for nondeceased patients was 13.5 years. The most common primary tumor locations were lower extremity (33%), pelvis (24%), and thorax (18%). Fifty percent of patients received surgery, 79% radiotherapy and 94% chemotherapy. The 5-year OS and EFS for patients with localized disease was 85% and 73% and for metastatic disease was 27% (P<0.0001) and 28% (P<0.0001), respectively. Metastatic disease was an independent predictor of lower OS (hazard ratio [HR], 9.5; 95% confidence interval [CI],4.7-19.4; P<0.0001) and EFS (HR, 4.9; 95% CI, 2.7-8.8; P<0.0001). Extremity tumor location was an independent predictor for improved OS (HR, 0.4; 95% CI, 0.2-0.9; P=0.03). The majority (77%) of long-term survivors (≥5 y) had long-term complications; the most common were musculoskeletal abnormalities (50%) and cardiac toxicity (28%). The actuarial second neoplasm risk was 5% at 10 years.
Conclusions:
Ewing sarcoma patients with localized disease had excellent treatment outcomes at the BCCA. However, the majority of patients had chronic complications from treatment. This study validates the need for long-term follow-up of Ewing Sarcoma survivors for management of late effects.
