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. 2022 Dec 1;276(6):e969-e975.
doi: 10.1097/SLA.0000000000004579. Epub 2020 Nov 4.

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

Courtney J Harris  1   2 , Irene Helenowski  2 , Andrew J Murphy  3 , Sara A Mansfield  3 , Michael P LaQuaglia  4 , Todd E Heaton  4 , Michele Cavalli  4 , Joseph T Murphy  5 , Erika A Newman  6 , Richard E Overmen  6 , Tanvi T Kartal  6 , J Cooke-Barber  7 , Addison Donaher  7 , Marcus M Malek  8 , Ranjeet Kalsi  8 , Eugene S Kim  9 , Michael J Zobel  9 , Catherine J Goodhue  9 , Bindi J Naik-Mathuria  10 , Imory N Jefferson  10 , Jonathan P Roach  11 , Claudia Mata  11 , Nelson Piché  12 , Shahrzad Joharifard  12 , Serge Sultan  13 , Scott S Short  14 , Rebecka L Meyers  14 , Josh Bleicher  14 , Hau D Le  15 , Kevin Janek  15 , Andreana Bütter  16 , Jacob Davidson  16 , Jennifer H Aldrink  17 , Holden W Richards  17 , Elisabeth T Tracy  18 , Sarah J Commander  18 , Elizabeth A Fialkowski  19 , Misty Troutt  7 , Roshni Dasgupta  7 , Timothy B Lautz  1   2
Affiliations

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

Courtney J Harris et al. Ann Surg. .

Abstract

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 of 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 and 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 (interquartile range = 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 posteriorrib 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 after 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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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1:
Figure 1:
Recurrence-free survival for all patients stratified by diagnosis, p=0.39.
Figure 2:
Figure 2:
Recurrence-free survival among patients with Ewing sarcoma stratified by treatment approach, p=0.13
See this image and copyright information in PMC

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