Predictors of Chemotherapy Induced Adverse Events in Pediatric Osteosarcoma Patients.

Phitjira Sanguanboonyaphong,Jukapun Yoodee,Suthan Chanthawong,Suphat Subongkot,Kunanya Suwannaying,Manit Saeteaw,Patcharee Komvilaisak

doi:10.31557/apjcp.2022.23.1.93

Abstract

Objective:To investigate the prevalence of chemotherapy-induced adverse events and the associated risk factors in pediatric patients with osteosarcoma. Methods:This retrospective cross-sectional study enrolled 90 pediatric osteosarcoma patients (with 1,017 chemotherapy cycles) treated at Srinagarind Medical Center, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand, between January 1, 2008 and December 31, 2018. The prevalence of major adverse events and a correlation between baseline characteristics and adverse events were analyzed using a generalized estimating equation model. Result:The prevalence of adverse events in 90 pediatric osteosarcoma patients (with 1,017 chemotherapy cycles) was determined as chemotherapy-induced nausea and vomiting (29.2%; n=296), hepatotoxicity (21.2%; n=215), anemia (70.69%; n=719), neutropenia (26.65%; n=271), and thrombocytopenia (13.65%; n=139). Factors associated with chemotherapy-induced hepatotoxicity included methotrexate dose ≥ 12 g/m2 (odds ratio [OR] 1.30; 95% confidence interval [CI] 1.22–1.39; P<0.001), plasma concentration of methotrexate at 72 hours >0.1 μM (OR 1.22; 95% CI 1.19–1.25; P<0.001), and pre-hydration rate ≤ 125 mL/m2/h (OR 1.10; 95% CI 1.07–1.12; P<0.001). Conclusion:Major adverse events are becoming more common in pediatric osteosarcoma patients, and risk factors include larger chemotherapy doses, higher plasma methotrexate concentrations, and a slower pre-hydration rate. The outcomes of the study could aid in the better treatment of toxicity in children with osteosarcoma.

Highlights

Osteosarcoma is a common primary bone tumor of childhood and primarily located in the metaphysis of long bones (Jackson et al, 2016; Noah et al, 2016; Ksontini et al, 2018)
Chemotherapy regimen and IV hydration strategy Pediatric patients with osteosarcoma were treated according to Thai Pediatric Oncology Group (TPOG) protocol (Thai Pediatric Oncology Group, 2016), which constitutes of neoadjuvant chemotherapy starting 10 to 14 weeks before surgery and adjuvant chemotherapy starting 1 to 3 weeks after surgery and continuing for 9 to 10 weeks
Ninety pediatric patients with osteosarcoma who were treated during the study period were included and 1,017 chemotherapy cycles were reviewed

Summary

Introduction

Osteosarcoma is a common primary bone tumor of childhood and primarily located in the metaphysis of long bones (Jackson et al, 2016; Noah et al, 2016; Ksontini et al, 2018). It is ranked as the tenth most common pediatric malignancy in Thailand (Wiangon et al, 2011). A multimodal treatment combining surgery and chemotherapy has been reported to increase a 5-year survival rate from 20% to 60% in patients with osteosarcoma (Jain and Kapoor, 2016)

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Results

Conclusion