title: High prevalence of late adverse events in malignant bone tumour survivors diagnosed at adult age.
abstract: BACKGROUND
  Late treatment-related adverse events are particularly prevalent in survivors of childhood bone cancer because of the combination of cytotoxic drugs, major surgery and radiotherapy. Existing studies for late toxicity in survivors of Ewing's sarcoma (ES) and osteosarcoma (OS) diagnosed at adult age have focused on specific sequelae. We investigated a broad spectrum of potential late effects in these patients.
  
  
  METHODS
  Relapse-free OS and ES patients aged &#8805; 16 at diagnosis and treated at the Radboud University Medical Centre (1982-2007) were invited for systematic late toxicity screening. This included history taking, physical examination, echocardiogram, bone densitometry, audiogram, and serum and urine screening for renal toxicity and infertility. Adverse events were graded according to the Common Terminology Criteria for Adverse Events version 3.0.
  
  
  RESULTS
  In 24 survivors (63% male, mean age at screening 45.7 years, mean follow-up 10.9 years, 70% OS) we found a median of eight adverse events. Frequent findings included abnormal gait, osteoporosis, pain, left ventricular systolic dysfunction, obesity and nephropathy. The maximum grade of any adverse event was mild in four (17%), moderate in 11 (46%), severe in six (25%), and disabling in three cases (13%). There was a trend towards more events in patients diagnosed at an older age.
  
  
  CONCLUSIONS
  The incidence of late adverse events in this study of survivors of bone tumours diagnosed at adult age is higher than in any previously published childhood cancer survivorship study. Older patients seem to be particularly at risk. Our findings underscore the need for systematic screening of late effects in bone cancer survivors of adult age at diagnosis.
authors.affiliation: Department of Medical Oncology, Radboud University Medical Centre, Nijmegen, the Netherlands.
authors.forename: A C M
authors.initials: AC
authors.lastname: van de Luijtgaarden
authors.forename: L
authors.initials: L
authors.lastname: Kapusta
authors.forename: L
authors.initials: L
authors.lastname: Bellersen
authors.forename: J P M
authors.initials: JP
authors.lastname: Bokkerink
authors.forename: S E J
authors.initials: SE
authors.lastname: Kaal
authors.forename: Y M H
authors.initials: YM
authors.lastname: Versleijen-Jonkers
authors.forename: H W B
authors.initials: HW
authors.lastname: Schreuder
authors.forename: W T A
authors.initials: WT
authors.lastname: van der Graaf
mesh_terms: D000046:Academic Medical Centers; D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents / Q000009:adverse effects*; D001859:Bone Neoplasms / Q000150:complications* / Q000628:therapy; D009202:Cardiomyopathies / Q000453:epidemiology / Q000209:etiology*; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000453:epidemiology / Q000209:etiology*; D009426:Netherlands / Q000453:epidemiology; D012516:Osteosarcoma / Q000150:complications* / Q000628:therapy; D015995:Prevalence; D012512:Sarcoma, Ewing / Q000150:complications* / Q000628:therapy; D017741:Survivors; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents; D004317:Doxorubicin