Abstract
Background: In recent years, modifications of treatment protocols introduced in pediatric oncology have resulted in a significant improvement in treatment outcomes. Unfortunately, the probability of subsequent malignant neoplasm (SMN) in this group of patients is 3 to 6 times higher than the general age-matched population. In this study, we sought to evaluate the treatment options for patients with secondary bone tumors after prior anti-cancer therapy. Materials and Methods: Twenty-four patients (median age 12.9 years) with subsequent malignant bone tumors were treated according to oncological guidelines for bone sarcoma during the period 1991–2020. All patients had a standard tumor imaging and laboratory evaluation. All toxicities were documented. Results: The median time from the first neoplasm to SMN was 7.6 years (range 2.4 to 16.3 years). All patients received chemotherapy and underwent surgery as a local control procedure. Two patients with Ewing sarcoma had additional radiation on the tumor bed. A complete response was achieved in 20 patients. With a median follow-up of 18.3 years (range 5.7 to 40.3 years), 18 patients (75%) are alive. The estimated 5-year post-subsequent bone malignant neoplasm survival was 74.5% (95% CI 55–95%). Fourteen patients required chemotherapy dose modification, and doxorubicin was discontinued in seven patients. One patient required a renal transplant two years after treatment. There were no other significant toxicities. Conclusions: The treatment of bone SMNs can be effective, although in many patients it is necessary to reduce the doses of drugs. Early detection and aggressive treatment can improve the outcome.
Highlights
Improvements in multidisciplinary care for childhood cancer have resulted in a significant improvement in treatment outcomes
All in all, compared to the population risk, the probability of subsequent malignant neoplasm (SMN) in the group of patients treated in childhood with cancer increases 3–6 times [4]
The following chemotherapy guidelines were the mainstay of treatment: for Ewing sarcoma (ES) patients—the Euro-Ewing regimen; for osteosarcoma patients—European Osteosarcoma Intergroup protocol; for chondrosarcoma patients— European Organization for Research and Treatment of Cancer (EORTC) regimen; and for undifferentiated pleomorphic sarcoma (UPS) and pleomorphic sarcoma patients—PACE regimen
Summary
Improvements in multidisciplinary care for childhood cancer have resulted in a significant improvement in treatment outcomes. While in the 1960s the chance of 5-year overall survival for a child diagnosed with cancer was 20–30%, it is estimated to be 80% [1] These improvements translate directly to a growing population of childhood cancer survivors; the late effects of cancer treatment are reported in about two-thirds of patients, and in one-fourth of them they are health- or life-threatening [2,3]. In the studies published so far, the risk of SMN is estimated at 2 to 12% and is related to the type of treatment used, the patient’s age during therapy, sex, and time since the end of the treatment [4,5,6,7,8,9,10,11,12]. We perform an analysis of treatment options and outcomes for a cohort of patients with secondary bone tumors after prior anti-cancer treatment
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