Late effects of osteosarcoma and its treatment in pediatric patients: A single-center experience

Abstract

Purpose: The success of osteosarcoma treatment strategies improved survival rates. The need of diagnosing and managing adverse effects is increasing. We aimed to investigate the outcomes and late results of pediatric osteosarcoma treatment in the survivors.

Methods: Out of osteosarcoma patients (n=54), we assessed the long-term outcomes of survivors (n=39) diagnosed from 2002-2018. We compared the survivors' (n=39) health status (cardiac, renal, neurologic, psychiatric, physical limitations), pain, and psychosocial outcomes (education level, smoking history, and alcohol consumption, marital status, parenthood, health care services usage) with their siblings (n=77). The quality of life and overall survival of amputee and nonamputee survivors are also compared. We provided the retrospective data from the files and phone calls and used Kaplan Meier survival analysis, Ki-Kare, and t-test. Results The overall survival (OS) of children with osteosarcoma (n=54) who survived at 2 years and 5 years from the diagnosis was 90.7 and 77.8%, respectively. These patients achieved 2- year event-free survival (EFS) of 70.4% and 5-year EFS of 57.4%. Thirty-nine survivors of osteosarcoma were compared with 77 sibling controls. Osteosarcoma survivors were more likely than the sibling cohort to report adverse health status containing nephrotoxicity (5.1 vs 0%) (p=0.045), cardiotoxicity (10.3 vs 0%)(p<0.01), neurotoxicity (5.1 vs 1.7%) (p=0.045), activity limitations (64 vs 1.3%)(p<0.01) and pain (12.8 vs 0%) (p=0.002). Survivors' educational status (p=0.014), marital status (5.1 vs 32.5%)(p=0.001), employment (2.6 vs 28.6)(p < 0.001), parenthood (0 vs 29.9%)(p < 0.001) were negatively affected compared with the control group. The prevalence of smoking, alcohol use, psychiatric treatment, and deafness were similar. The amputees (n=9) had an OS rate of 55.6%, and the nonamputees (n=45) had 75.6%. We found similar quality of life results between them.

Conclusion: Long-term survivors of pediatric osteosarcoma are at significant risk of chronic health conditions, physical limitations, and pain up to 16 years follow up. Follow-up clinics and clinical guidelines are required for the survivors of children with osteosarcoma.