Long-term explerience in the management of adolescents and young adults with cancer referred to a regional tertiary center for multidisciplinary care

Abstract

Background/Objectives: Adolescents and Young Adults (AYA) with cancer constitute a heterogeneous group in which improvements in survival rates (OS) have not kept pace with those achieved in younger patients. Design/Methods: Retrospective review of AYA (15-29 years) patients with cancer, except leukaemias, referred for multidisciplinary treatment (1992-2014). Baseline characteristics, pathological type and stage, 1st -line treatments and OS were reviewed. Differences between three age groups (15-19, 20-24, 25-29 years) assessed with Chi-square and log-rank tests. A p-value < 0.05 was considered significant. Results: 286 patients. Median age 23 years (15-29); 33.1% (15-19 years), 23.6% (20-24 years) and 43.3% (25-29 years). Tumour types (% in age-groups): Paediatric-bone tumours 15.7% (28.7-13.4-7.3), germ-cell tumours (both sexes) 15.5% (11.7-17.9-17.1), adult-type epithelial tumours 14.1% (6.4-10.4- 22.0), Hodgkin lymphoma 12% (11.7-11.9-12.2), non-rhabdomyosarcoma soft-tissue tumours 9.5% (4.3-10.4-13.0), glial-derived brain tumours 7.7% (9.6-7.5-6.5), paediatric-type brain tumours 7.7% (8.5-9.0-6.5), non-Hodgkin lymphoma 4.9% (5.3-6-4.1%), endocrine tumours 2.8% (3.2-1.5-3.3), paediatric-type solid tumours 2.1% (4.3-3.0-0.0), other bone tumours 2.1% (0-4.5.0-2.4), melanoma 2.1% (1.1-1.5-3.3), liver tumours 1.8% (1.1-1.5-2.4) and rhabdomyosarcoma 1.8% (4.3-1.5-0.0). Locally advanced or metastases: 43.7% (45.8-37.3-45.6). 1st-line treatment: 62.5% surgery, 73.7% chemotherapy and 32.5% radiotherapy; 2.1% included in clinical trials. Median follow-up: 110 months (6-314 months). 5 and 10-year OS: 64 and 57%. No differences between age-groups in treatment patterns and pathology, except in incidence of paediatric bone tumours and adult-type epithelial tumours. There was a trend for worse OS in the 25-29 age group; 5 and 10-year OS were 68 and 64%, 66 and 53% and 56 and 36%, respectively (p 0.06). Conclusion: Patients in the 25-29 years-group fared worse than younger patients. More biologically aggressive presentations and a higher rate of adult-type epithelial neoplasms could justify these findings. Inclusion in clinical trials remains disappointingly low. Closer collaboration with Paediatric Oncology Departments and better knowledge of the biology of these rare tumour presentations are needed.