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, Irene Helenowski, Andrew J. Murphy, Sara A. Mansfield, Michael P. Laquaglia, Todd E. Heaton, Michele Cavalli, Joseph T. Murphy, Erika A. Newman, Richard E. Overmen, Tanvi T. Kartal, J. Cooke-Barber, Addison Donaher, Marcus M. Malek, Ranjeet Kalsi, Eugene S. Kim, Michael J. Zobel, Catherine J. Goodhue, Bindi J. Naik-Mathuria, Imory N. JeffersonJonathan P. Roach, Claudia Mata, Nelson Piché, Shahrzad Joharifard, Serge Sultan, Scott S. Short, Rebecka L. Meyers, Josh Bleicher, Hau D. Le, Kevin Janek, Andreana Bütter, Jacob Davidson, Jennifer H. Aldrink, Holden W. Richards, Elisabeth T. Tracy, Sarah J. Commander, Elizabeth A. Fialkowski, Misty Troutt, Roshni Dasgupta, Timothy B. Lautz

Research output: Contribution to journalArticlepeer-review

5 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)E969-E975
JournalAnnals of surgery
Volume276
Issue number6
DOIs
StatePublished - Dec 1 2022

Keywords

  • ewing sarcoma
  • functional outcomes
  • local recurrence
  • margin status
  • pediatric chest wall sarcoma
  • scoliosis

ASJC Scopus subject areas

  • Surgery

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