Late side effects of neoadjuvant chemotherapy in patients treated for osteosarcoma and Ewing's sarcoma: An Italian Sarcoma Group study.

Abstract

9551 Background: We report data of long term follow up of 883 patients with localized osteosarcoma of the extremity and 493 patients with localized Ewing's sarcoma treated with neoadjuvant chemotherapy from 1983 to 2007 to find out late side effects (second malignancies, cardiomyopathy, sterility). Methods: We reviewed our database and we interviewed by phone the missing patients. Data are updated to Dec 2009. Results: Osteosarcoma patients: 883 patients are evaluable. Median overall survival (OS) is 108 months (range 1-306), female/male: 370/403, alive 563, dead 320. 28 second malignant neoplasms (SMN) were reported for a cumulative risk at 10 yrs of 3.02 ±1.0 (SE): 9 hematologic malignancies (7 leukemia and 2 myelodysplastic syndrome) after a median of 36 ms and 19 solid tumor (6 breast ca, 3 parotid ca, 2 CNS tumor, 2 skin cancers, 2 soft tissue sarcomas, 1 Ewing's sarcoma, 1 kidney cancer, 1 colon cancer, 1 ovarian cancer) 2 patients had 2 SMN. 18 patients had adriamycin–cardiomyopathy. 46 male did sperm analysis with 28 azospermia and 11 oligospermia, 7 normospermia. 13 male and 20 female pts became parents. No abnormalities in offsprings were recorded. Ewing's sarcoma patients: 493patients. Median age was 16 yrs (1-40) female/male: 183/310. Median OS is 69 ms (4-302). 220 are dead, 273 alive. 44 pts received HDCT + PBSCR. Eleven SMN were reported: 2 AMLeukemia, 2 parotid gland carcinoma, 1 melanoma, 1 thyroid cancer and 5 radioinduced osteosarcoma. 10 yrs cumulative risk of SMN is 2.9 ± 1.1 (SE). Four patient had adriamycin–cardiomyopathy; 20 women experienced postTx amenorrea: 7 pts received RT in pelvic area, 9 did HDCT, 3 pts were over 30 yrs old. Conclusions: Cumulative risk of SMN increase with time from about 3% at 10 years to about 6% at 20 years. Breast cancer and salivary glands cancer are the most common solid SMN. Sterility is more common in males and it is related to alkylators doses. Cardiomyopathy is related to antracyclines doses. Updated data will be presented. No significant financial relationships to disclose.