Osteosarcoma Arising as a Secondary Malignancy following Treatment for Hematologic Cancer: A Report of 33 Affected Patients from the Cooperative Osteosarcoma Study Group (COSS)

Author:

Bielack Stefan S.12ORCID,Mettmann Vanessa1,Baumhoer Daniel3,Blattmann Claudia1,Burkhardt Birgit2ORCID,Deinzer Christoph K. W.4ORCID,Kager Leo56ORCID,Kevric Matthias1,Mauz-Körholz Christine78ORCID,Müller-Abt Peter9,Reinhardt Dirk10ORCID,Sabo Alexandru-Anton1ORCID,Schrappe Martin11,Sorg Benjamin1,Windhager Reinhard12,Hecker-Nolting Stefanie1

Affiliation:

1. Klinikum Stuttgart—Olgahospital, Stuttgart Cancer Center, Zentrum für Kinder-, Jugend- und Frauenmedizin, Pädiatrie 5 (Onkologie, Hämatologie, Immunologie), 70174 Stuttgart, Germany

2. Klinik für Kinder- und Jugendmedizin, Pädiatrische Hämatologie und Onkologie, Universitätsklinikum Münster, 48149 Münster, Germany

3. Knochentumor Referenzzentrum, Institut für Medizinische Genetik und Pathologie, Universitätsspital und Universität Basel, 4031 Basel, Switzerland

4. Abteilung Innere Medizin VIII—Medizinische Onkologie und Pneumologie, Universitätsklinikum Tübingen, 72076 Tübingen, Germany

5. St. Anna Kinderspital, Universitätsklinik für Kinder- und Jugendheilkunde der Medizinischen Universität Wien, 1090 Vienna, Austria

6. St. Anna Children’s Cancer Research Institute (CCRI), 1090 Vienna, Austria

7. Pädiatrische Hämatologie und Onkologie, Zentrum für Kinderheilkunde der Justus-Liebig-Universität, 35390 Gießen, Germany

8. Medizinische Fakultät der Martin-Luther-Universität Halle-Wittenberg, 06120 Halle, Germany

9. Radiologisches Institut (Kinderradiologie), Zentrum für Kinder-, Jugend- und Frauenmedizin, Klinikum Stuttgart—Olgahospital, 70174 Stuttgart, Germany

10. Klinik für Kinderheilkunde III, Zentrum für Kinder- und Jugendmedizin, Universitätsmedizin Essen, 45147 Essen, Germany

11. Klinik für Kinder- und Jugendmedizin I, Campus Kiel, Universitätsklinikum Schleswig-Holstein, 24105 Kiel, Germany

12. Universitätsklinik für Orthopädie und Unfallchirurgie, Klinische Abteilung für Orthopädie, Medizinische Universität Wien, 1090 Vienna, Austria

Abstract

Purpose: Osteosarcoma may arise as a secondary cancer following leukemias or lymphomas. We intended to increase the knowledge about such rare events. Patients and methods: We searched the Cooperative Osteosarcoma Study Group’s database for individuals who developed their osteosarcoma following a previous hematological malignancy. The presentation and treatment of both malignancies was investigated, and additional neoplasms were noted. Outcomes after osteosarcoma were analyzed and potential prognostic factors were searched for. Results: A total of 33 eligible patients were identified (male: 23, female: 10; median age: 12.9 years at diagnosis of hematological cancer; 20 lymphomas, 13 leukemias). A cancer predisposition syndrome was evident in one patient only. The hematological cancers had been treated by radiotherapy in 28 (1 unknown) and chemotherapy in 26 cases, including bone-marrow transplantation in 9. The secondary bone sarcomas (high-grade central 27, periosteal 2, extra-osseous 2, undifferentiated pleomorphic sarcoma of bone 2) arose after a median lag-time of 9.4 years, when patients were a median of 19.1 years old. Tumors were considered radiation-related in 26 cases (1 unknown). Osteosarcoma-sites were in the extremities (19), trunk (12), or head and neck (2). Metastases at diagnosis affected eight patients. Information on osteosarcoma therapy was available for 31 cases. All of these received chemotherapy. Local therapy involved surgery in 27 patients, with a good response reported for 9/18 eligible patients. Local radiotherapy was given to three patients. The median follow-up was 3.9 (0.3–12.0) years after bone tumor diagnosis. During this period, 21 patients had developed events as defined, and 15 had died, resulting in 5-year event-free and overall survival rates of 40% (standard error: 9%) and 56% (10%), respectively. There were multiple instances of additional neoplasms. Several factors were found to be of prognostic value (p < 0.05) for event-free (osteosarcoma site in the extremities) or overall (achievement of a surgical osteosarcoma-remission, receiving chemotherapy for the hematologic malignancy) survival. Conclusions: We were able to prove radiation therapy for hematological malignancies to be the predominant risk factor for later osteosarcomas. A resulting overrepresentation of axial and a tendency towards additional neoplasms affects prognosis. Still, selected patients may become long-term survivors with appropriate therapies, which is an argument against therapeutic negligence.

Funder

Förderkreis krebskranke Kinder e. V. Stuttgart

Publisher

MDPI AG

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