Late complications of treatment for childhood pelvic sarcoma: A report from the Childhood Cancer Survivor Study (CCSS).

OBJECTIVE: Evaluate late effects in survivors of childhood pelvic sarcoma by disease origin (bony vs. soft-tissue) and local control modality (bone surgery, pelvic organ resection, radiotherapy). METHODS: Among 5-year pediatric pelvic sarcoma survivors, we assessed long-term outcomes including late (>5 years) mortality, graded chronic health conditions (CHCs), subsequent malignant neoplasms (SMNs), physical function/activity, cancer-related pain, and pregnancy/siring a pregnancy. Associations with disease origin and local control modality were analyzed using cumulative incidence and Cox or multivariable logistic regression. RESULTS: Among 745 eligible survivors, the 35-year cumulative incidence of late all-cause and health-related mortality was 25.7% (95%CI = 22.1%-29.3%) and 12.2% (95%CI = 9.4%-15.1%), vs. 2.5% (95%CI = 1.3%-3.7%) and 1.4% (95%CI = 0.5%-2.4%) in matched US population. Cumulative incidence of severe/life-threatening CHCs was 47.6% (95%CI = 43.0%-52.1%) for survivors vs. 12.2% (95%CI = 11.3%-13.2%) for siblings. Cumulative incidence of SMNs was 7.6% (95%CI = 5.0%-10.2%). Bone sarcomas were associated with increased all-cause mortality (HR = 1.92, 95%CI = 1.16-3.17), health-related mortality (HR = 2.12, 95%CI = 1.03-4.38), and CHCs (HR = 2.55, 95%CI = 1.65-3.95) vs. soft-tissue sarcomas. Analyzing all survivors, radiotherapy was associated with increased CHCs (HR = 2.42, 95%CI = 1.53-3.81), multiple CHCs (HR = 2.27, 95%CI = 1.03-4.97), functional impairment (OR = 2.21, 95%CI = 1.30-3.74), and pain (OR = 2.29, 95%CI = 1.33-3.93). Bone surgery was associated with functional impairment (OR = 2.64, 95%CI = 1.30-5.37), performance limitations (OR = 2.12, 95%CI = 1.19-3.79), and pain (OR = 2.59, 95%CI = 1.37-4.89). Pelvic organ resection was associated with decreased pregnancy (OR = 0.25, 95%CI = 0.10-0.63). CONCLUSIONS: Late effects differed by pelvic sarcoma origin (bone vs. soft-tissue) and local control modality. The associations between local control choices and late effects in this study can guide counseling of patients and families at the time of diagnosis, treatment, local control, or after completion of therapy. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT01120353.

Duke Scholars

Author Kevin Charles Oeffinger Medicine, Medical Oncology