title: Outcome for children with metastatic solid tumors over the last four decades.
abstract: BACKGROUND
  Outcomes for pediatric solid tumors have significantly improved over the last 30 years. However, much of this improvement is due to improved outcome for patients with localized disease. Here we evaluate overall survival (OS) for pediatric patients with metastatic disease over the last 40 years.
  
  
  METHODS
  The United States Surveillance, Epidemiology, and End Results (SEER) database was used to conduct this study. Patients diagnosed between 0 and 18 years of age with metastatic Ewings sarcoma, neuroblastoma, osteosarcoma, rhabdomyosarcoma or Wilms tumor were included in the analysis.
  
  
  RESULTS
  3,009 patients diagnosed between 1973-2010 met inclusion criteria for analysis. OS at 10 years for patients diagnosed between 1973-1979, 1980-1989, 1990-1999 and 2000-2010 was 28.3%, 37.2%, 44.7% and 49.3%, respectively (p<0.001). For patients diagnosed between 2000-2010, 10-year OS for patients with Ewing sarcoma, neuroblastoma, osteosarcoma, rhabdomyosarcoma and Wilms tumor was 30.6%, 54.4%, 29.3%, 27.5%, and 76.6%, respectively, as compared to 13.8%, 25.1%, 13.6%, 17.9% and 57.1%, respectively, for patients diagnosed between 1973-1979. OS for neuroblastoma significantly increased with each decade. For patients with osteosarcoma and Ewing sarcoma, there was no improvement in OS over the last two decades. There was no improvement in outcome for patients with rhabdomyosarcoma or Wilms tumor over the last 30 years.
  
  
  CONCLUSIONS
  OS for pediatric patients with metastatic solid tumors has significantly improved since the 1970s. However, outcome has changed little for some malignancies in the last 20-30 years. These data underscore the importance of continued collaboration and studies to improve outcome for these patients.
authors.affiliation: Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, Missouri, United States of America.
authors.forename: Stephanie M
authors.initials: SM
authors.lastname: Perkins
authors.affiliation: Department of Radiation Oncology, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America.
authors.forename: Eric T
authors.initials: ET
authors.lastname: Shinohara
authors.affiliation: Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, Missouri, United States of America.
authors.forename: Todd
authors.initials: T
authors.lastname: DeWees
authors.affiliation: Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America.
authors.forename: Haydar
authors.initials: H
authors.lastname: Frangoul
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D062665:Epidemiological Monitoring; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D008297:Male; D009362:Neoplasm Metastasis; D009369:Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology*; D011379:Prognosis; D016016:Proportional Hazards Models