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Implications of Tumor Characteristics and Treatment Modality on Local Recurrence and Functional Outcomes in Children with Chest Wall Sarcoma: A Pediatric Surgical Oncology Research Collaborative Study
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12 01 2022
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Source: Ann Surg. 276(6):e969-e975
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Alternative Title:Ann Surg
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Description:OBJECTIVE
To determine the impact of tumor characteristics and treatment approach on (1) local recurrence, (2) scoliosis development and (3) patient-reported quality of life in children with sarcoma of the chest wall.
SUMMARY BACKGROUND DATA
Children with chest wall sarcoma require multimodal therapy including chemotherapy, surgery and/or radiation. Despite aggressive therapy which places them at risk for functional impairment and scoliosis, these patients are also at significant risk for local recurrence.
METHODS
A multi-institutional review of 175 children (median age 13 years) with chest wall sarcoma treated at seventeen Pediatric Surgical Oncology Research Collaborative institutions between 2008–2017 was performed. Patient-reported quality of life was assessed prospectively using PROMIS surveys.
RESULTS
The most common diagnoses were Ewing sarcoma (67%) and osteosarcoma (9%). Surgical resection was performed in 85% and radiation in 55%. A median of 2 ribs were resected (IQR=1–3), and number of ribs resected did not correlate with margin status (p=0.36). Local recurrence occurred in 23% and margin status was the only predictive factor (HR 2.24, p=0.039). With a median follow-up of 5 years, 13% developed scoliosis (median Cobb angle 26) and 5% required corrective spine surgery. Scoliosis was associated with posterior rib resection (HR 8.43; p=0.003) and increased number of ribs resected (HR 1.78; p=0.02). Overall, patient-reported quality of life is not impaired following chest wall tumor resection.
CONCLUSIONS
Local recurrence occurs in one-quarter of children with chest wall sarcoma and is independent of tumor type. Scoliosis occurs in 13% of patients, but patient-reported quality of life is excellent.
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Pubmed ID:33156070
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Pubmed Central ID:PMC8093319
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