Twenty years of follow‐up of survivors of childhood osteosarcoma

Abstract

BACKGROUND: Osteosarcoma survivors have received significant chemotherapy and have undergone substantial surgeries. Their very long-term outcomes (20 year) are reported here. METHODS: The authors assessed the longterm outcomes of 733 5-year survivors of childhood osteosarcoma diagnosed from 1970 to 1986 to provide a comprehensive evaluation of medical and psychosocial outcomes for survivors enrolled in the Childhood Cancer Survivor Study (CCSS). Outcomes evaluated included overall survival, second malignant neoplasms (SMNs), recurrent osteosarcoma, chronic health conditions, health status (general and mental health and functional limitations), and psychosocial factors. Outcomes of osteosarcoma survivors were compared with general-population statistics, other CCSS survivors, and CCSS siblings. RESULTS: Survivors had a mean follow-up of 21.6 years. The overall survival of children diagnosed with osteosarcoma who survived 5 years at 20 years from original diagnosis was 88.6% (95% confidence interval [CI], 86.6%-90.5%). The cumulative incidence of SMNs at 25 years was 5.4%, with a standardized incidence ratio of 4.79 (95% CI, 3.54-6.33; P<.01). Overall, 86.9% of osteosarcoma survivors experienced at least 1 chronic medical condition, and >50% experienced 2 conditions. Compared with survivors of other cancers, osteosarcoma survivors did not differ in their reported general health status (odds ratio [OR], 0.9; 95% CI, 0.7-1.2), but were more likely to report an adverse health status in at least 1 domain (OR, 1.9; 95% CI, 1.6-2.2), with activity limitations (29.1%) being the most common. CONCLUSIONS: Childhood osteosarcoma survivors in this cohort did relatively well, considering their extensive treatment, but are at risk of experiencing chronic medical conditions and adverse health status. Survivors warrant life-long follow-up. Cancer 2011;117:625-34.

Common Musculoskeletal Tumors of Childhood and Adolescence

“…Examples are cardiac toxicity from anthracyclines, hearing loss or tinnitus from cisplatin, infertility from alkylator therapy or radiation to the pelvis, endocrine complications usually from radiation to reproductive organs or the hypothalamic-pituitary axis, bladder dysfunction from chemotherapy and radiation, and second malignant neoplasms due to radiation and/or chemotherapy. [88][89][90][91][92] Postpubertal boys should be offered semen cryopreservation before initiation of therapy. Cryopreservation of oocytes or embryos (the latter requires use of donor sperm) is possible for postpubertal females but may delay treatment initiation.…”

Adolescent and Young Adult Oncology

“…122 Among long-term survivors of bone cancers at 25 years after diagnosis, the cumulative incidence of subsequent cancers is higher for those diagnosed with Ewing sarcoma than for those diagnosed with osteosarcoma (9.0% and 5.4%, respectively). 142,143 Clinicians who provide care for most AYA cancer survivors must implement and evaluate methods for improving awareness of secondary cancers. They must also implement appropriate surveillance strategies for early detection of these malignancies.…”

Methods to Assess Adverse Health-Related Outcomes in Cancer Survivors

“…Notably, the findings were remarkably similar between the 2 populations, one using primarily patient-reported outcomes and the other clinician-measured outcomes (89). Both CCSS and the Dutch investigators have since used this approach to characterize the magnitude of risk for different cancer types, treatment exposures, and affected organ systems and identified high risk groups (20,(90)(91)(92)(93)(94)(95)(96)(97)(98)(99)(100)(101)(102).…”