Morbidity and mortality after treatment of Ewing sarcoma: A single-institution experience

Danielle Novetsky Friedman, Katherine Chastain, Joanne F. Chou, Chaya S. Moskowitz, Roberto Adsuar, Leonard H. Wexler, Alexander Ja-Ho Chou, Amelia DeRosa, Joanne Candela, Heather Magnan, Shawn Pun, Tamara Kahan, Suzanne L. Wolden, Paul A. Meyers, Kevin C. Oeffinger

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background: Children, adolescents, and young adults treated for Ewing sarcoma (ES) are at risk for disease-related and treatment-related complications. We aimed to describe early and late overall mortality, cause-specific mortality, and key adverse health outcomes in a large, single-institutional cohort of patients with ES. Methods: Patients with ES diagnosed at age less than 40 years and treated at Memorial Sloan Kettering between 1974 and 2012 were included. Overall survival was estimated using Kaplan–Meier methods. Cox proportional hazards were used to examine the association of clinical and pathologic variables with overall survival. Cause-specific mortality was evaluated with the cumulative incidence function accounting for competing risks. Results: Three hundred patients with ES (60.3% male; median age at diagnosis: 16.8 years [range: 0.3–39]; 30.0% with metastatic disease at diagnosis) were followed for a median of 7.8 years (range: 0.2–37). Five-year overall survival was 65.2% (95% confidence interval [95% CI], 59.8–71.1%) for the entire cohort; 78.6% for those with localized disease; 40.1% for those with isolated pulmonary metastases; and 28.1% for those with extrapulmonary metastases. In multivariable analysis, older age at diagnosis, minority race/ethnicity, and metastatic disease at diagnosis were associated with inferior survival. Ten-year cumulative incidence of relapse/progression was 40.1%, with eight late relapses occurring at a median of 6.3 years after diagnosis (range: 5–14). Seventeen patients developed subsequent neoplasms (treatment-related myelodysplastic syndrome/acute myelogenous leukemia = 9; solid tumors = 6; nonmelanoma skin cancer [NMSC] = 4). Excluding NMSC and melanoma in situ, the cumulative incidence of subsequent malignant neoplasms at 25 years was 15% (95% CI, 4.8–25.1%). Conclusion: Patients with ES are at high risk for relapse/progression and second cancers.

Original languageEnglish (US)
Article numbere26562
JournalPediatric Blood and Cancer
Volume64
Issue number11
DOIs
StatePublished - Nov 1 2017
Externally publishedYes

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Ewing's Sarcoma
Morbidity
Mortality
Survival
Second Primary Neoplasms
Skin Neoplasms
Recurrence
Incidence
Confidence Intervals
Neoplasm Metastasis
Therapeutics
Myelodysplastic Syndromes
Acute Myeloid Leukemia
Young Adult
Melanoma
Neoplasms
Lung
Health

Keywords

  • Ewing sarcoma
  • risk
  • second cancers
  • survivors

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Hematology
  • Oncology

Cite this

Friedman, D. N., Chastain, K., Chou, J. F., Moskowitz, C. S., Adsuar, R., Wexler, L. H., ... Oeffinger, K. C. (2017). Morbidity and mortality after treatment of Ewing sarcoma: A single-institution experience. Pediatric Blood and Cancer, 64(11), [e26562]. https://doi.org/10.1002/pbc.26562

Morbidity and mortality after treatment of Ewing sarcoma : A single-institution experience. / Friedman, Danielle Novetsky; Chastain, Katherine; Chou, Joanne F.; Moskowitz, Chaya S.; Adsuar, Roberto; Wexler, Leonard H.; Chou, Alexander Ja-Ho; DeRosa, Amelia; Candela, Joanne; Magnan, Heather; Pun, Shawn; Kahan, Tamara; Wolden, Suzanne L.; Meyers, Paul A.; Oeffinger, Kevin C.

In: Pediatric Blood and Cancer, Vol. 64, No. 11, e26562, 01.11.2017.

Research output: Contribution to journalArticle

Friedman, DN, Chastain, K, Chou, JF, Moskowitz, CS, Adsuar, R, Wexler, LH, Chou, AJ-H, DeRosa, A, Candela, J, Magnan, H, Pun, S, Kahan, T, Wolden, SL, Meyers, PA & Oeffinger, KC 2017, 'Morbidity and mortality after treatment of Ewing sarcoma: A single-institution experience', Pediatric Blood and Cancer, vol. 64, no. 11, e26562. https://doi.org/10.1002/pbc.26562
Friedman DN, Chastain K, Chou JF, Moskowitz CS, Adsuar R, Wexler LH et al. Morbidity and mortality after treatment of Ewing sarcoma: A single-institution experience. Pediatric Blood and Cancer. 2017 Nov 1;64(11). e26562. https://doi.org/10.1002/pbc.26562
Friedman, Danielle Novetsky ; Chastain, Katherine ; Chou, Joanne F. ; Moskowitz, Chaya S. ; Adsuar, Roberto ; Wexler, Leonard H. ; Chou, Alexander Ja-Ho ; DeRosa, Amelia ; Candela, Joanne ; Magnan, Heather ; Pun, Shawn ; Kahan, Tamara ; Wolden, Suzanne L. ; Meyers, Paul A. ; Oeffinger, Kevin C. / Morbidity and mortality after treatment of Ewing sarcoma : A single-institution experience. In: Pediatric Blood and Cancer. 2017 ; Vol. 64, No. 11.
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abstract = "Background: Children, adolescents, and young adults treated for Ewing sarcoma (ES) are at risk for disease-related and treatment-related complications. We aimed to describe early and late overall mortality, cause-specific mortality, and key adverse health outcomes in a large, single-institutional cohort of patients with ES. Methods: Patients with ES diagnosed at age less than 40 years and treated at Memorial Sloan Kettering between 1974 and 2012 were included. Overall survival was estimated using Kaplan–Meier methods. Cox proportional hazards were used to examine the association of clinical and pathologic variables with overall survival. Cause-specific mortality was evaluated with the cumulative incidence function accounting for competing risks. Results: Three hundred patients with ES (60.3{\%} male; median age at diagnosis: 16.8 years [range: 0.3–39]; 30.0{\%} with metastatic disease at diagnosis) were followed for a median of 7.8 years (range: 0.2–37). Five-year overall survival was 65.2{\%} (95{\%} confidence interval [95{\%} CI], 59.8–71.1{\%}) for the entire cohort; 78.6{\%} for those with localized disease; 40.1{\%} for those with isolated pulmonary metastases; and 28.1{\%} for those with extrapulmonary metastases. In multivariable analysis, older age at diagnosis, minority race/ethnicity, and metastatic disease at diagnosis were associated with inferior survival. Ten-year cumulative incidence of relapse/progression was 40.1{\%}, with eight late relapses occurring at a median of 6.3 years after diagnosis (range: 5–14). Seventeen patients developed subsequent neoplasms (treatment-related myelodysplastic syndrome/acute myelogenous leukemia = 9; solid tumors = 6; nonmelanoma skin cancer [NMSC] = 4). Excluding NMSC and melanoma in situ, the cumulative incidence of subsequent malignant neoplasms at 25 years was 15{\%} (95{\%} CI, 4.8–25.1{\%}). Conclusion: Patients with ES are at high risk for relapse/progression and second cancers.",
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T1 - Morbidity and mortality after treatment of Ewing sarcoma

T2 - A single-institution experience

AU - Friedman, Danielle Novetsky

AU - Chastain, Katherine

AU - Chou, Joanne F.

AU - Moskowitz, Chaya S.

AU - Adsuar, Roberto

AU - Wexler, Leonard H.

AU - Chou, Alexander Ja-Ho

AU - DeRosa, Amelia

AU - Candela, Joanne

AU - Magnan, Heather

AU - Pun, Shawn

AU - Kahan, Tamara

AU - Wolden, Suzanne L.

AU - Meyers, Paul A.

AU - Oeffinger, Kevin C.

PY - 2017/11/1

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N2 - Background: Children, adolescents, and young adults treated for Ewing sarcoma (ES) are at risk for disease-related and treatment-related complications. We aimed to describe early and late overall mortality, cause-specific mortality, and key adverse health outcomes in a large, single-institutional cohort of patients with ES. Methods: Patients with ES diagnosed at age less than 40 years and treated at Memorial Sloan Kettering between 1974 and 2012 were included. Overall survival was estimated using Kaplan–Meier methods. Cox proportional hazards were used to examine the association of clinical and pathologic variables with overall survival. Cause-specific mortality was evaluated with the cumulative incidence function accounting for competing risks. Results: Three hundred patients with ES (60.3% male; median age at diagnosis: 16.8 years [range: 0.3–39]; 30.0% with metastatic disease at diagnosis) were followed for a median of 7.8 years (range: 0.2–37). Five-year overall survival was 65.2% (95% confidence interval [95% CI], 59.8–71.1%) for the entire cohort; 78.6% for those with localized disease; 40.1% for those with isolated pulmonary metastases; and 28.1% for those with extrapulmonary metastases. In multivariable analysis, older age at diagnosis, minority race/ethnicity, and metastatic disease at diagnosis were associated with inferior survival. Ten-year cumulative incidence of relapse/progression was 40.1%, with eight late relapses occurring at a median of 6.3 years after diagnosis (range: 5–14). Seventeen patients developed subsequent neoplasms (treatment-related myelodysplastic syndrome/acute myelogenous leukemia = 9; solid tumors = 6; nonmelanoma skin cancer [NMSC] = 4). Excluding NMSC and melanoma in situ, the cumulative incidence of subsequent malignant neoplasms at 25 years was 15% (95% CI, 4.8–25.1%). Conclusion: Patients with ES are at high risk for relapse/progression and second cancers.

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