Intestinal Obstruction in Survivors of Childhood Cancer: A Report From the Childhood Cancer Survivor Study

Abstract

Purpose For adult survivors of childhood cancer, knowledge about the long-term risk of intestinal obstruction from surgery, chemotherapy, and radiotherapy is limited. Methods Intestinal obstruction requiring surgery (IOS) occurring 5 or more years after cancer diagnosis was evaluated in 12,316 5-year survivors in the Childhood Cancer Survivor Study (2,002 with and 10,314 without abdominopelvic tumors) and 4,023 sibling participants. Cumulative incidence of IOS was calculated with second malignant neoplasm, late recurrence, and death as competing risks. Using piecewise exponential models, we assessed the associations of clinical and demographic factors with rate of IOS. Results Late IOS was reported by 165 survivors (median age at IOS, 19 years; range, 5 to 50 years; median time from diagnosis to IOS, 13 years) and 14 siblings. The cumulative incidence of late IOS at 35 years was 5.8% (95% CI, 4.4% to 7.3%) among survivors with abdominopelvic tumors, 1.0% (95% CI, 0.7% to 1.4%) among those without abdominopelvic tumors, and 0.3% (95% CI, 0.1% to 0.5%) among siblings. Among survivors, abdominopelvic tumor (adjusted rate ratio [ARR], 3.6; 95% CI, 1.9 to 6.8; P < .001) and abdominal/pelvic radiotherapy within 5 years of cancer diagnosis (ARR, 2.4; 95% CI, 1.6 to 3.7; P < .001) increased the rate of late IOS, adjusting for diagnosis year; sex; race/ethnicity; age at diagnosis; age during follow-up (as natural cubic spline); cancer type; and chemotherapy, radiotherapy, and surgery within 5 years of cancer diagnosis. Developing late IOS increased subsequent mortality among survivors (ARR, 1.8; 95% CI, 1.1 to 2.9; P = .016), adjusting for the same factors. Conclusion The long-term risk of IOS and its association with subsequent mortality underscore the need to promote awareness of this complication among patients and providers.

The use of interval‐compressed chemotherapy with the addition of vincristine, irinotecan, and temozolomide for pediatric patients with newly diagnosed desmoplastic small round cell tumor

“…There have been few studies examining the association of WART dose with toxicity; however, studies have found higher doses of radiation to the abdomen and pelvis correlates with greater long-term toxicity. 36,37 Future studies are needed to understand the optimal WART dose for patients with DSRCT that balance toxicity with achieving disease control. In one instance, maintenance pazopanib was added for a patient with toxicity that prevented completion of planned cycles.…”

“…In this setting, these toxicities precluded some patients from completing planned adjuvant chemotherapy regardless of whether HIPEC was utilized. There have been few studies examining the association of WART dose with toxicity; however, studies have found higher doses of radiation to the abdomen and pelvis correlates with greater long‐term toxicity 36,37 . Future studies are needed to understand the optimal WART dose for patients with DSRCT that balance toxicity with achieving disease control.…”

Laparoscopic resection of neuroblastomas in low- to high-risk patients without image-defined risk factors is safe and feasible

“…Another advantage of laparoscopic surgery is a reduced risk of intestinal obstruction, which is critical for pediatric oncology patients, especially if they receive radiotherapy [ 25 ]. In our study, all patients in the laparoscopy group started oral feeding within 3 days after surgery and no patients presented symptoms of ileus.…”

New Agents, Emerging Late Effects, and the Development of Precision Survivorship

“…Relative to open operations, laparoscopy and thoracoscopy can minimize long-term effects by improving functional outcomes (eg, improved chest wall growth/function), limiting psychosocial impact (eg, smaller scars/less disfiguration), and minimizing the frequency of late complications (eg, late intestinal obstructions known to occur in 5% of children with abdominopelvic tumors). 40,41 In addition, advancements in limb salvage techniques, now possible in . 80% of cases of osteosarcoma at specialized centers, may improve long-term function for children with extremity tumors.…”