BACKGROUND: We assessed the number and causes of treatment-related deaths (TRDs) in childhood cancer over time and correlated them with adherence to therapeutic guidelines. PROCEDURE: We compared two cohorts of children of the Childhood Cancer Registry of the Rhône-Alpes Region: Cohort I (1987-1992, 909 patients) and Cohort II (1996-1999, 648 patients). RESULTS: In all cancers together, 75 TRDs were reported in Cohort I and 24 in Cohort II (P = 0.001). Cumulative incidence at 5 years declined from 7.9% to 4.1%, and overall survival (OS) increased from 71.0% to 77.2%. TRDs declined by nearly 10-fold in patients with solid malignant tumors (P = 0.02) and central nervous system tumors (P = 0.001), but OS improved for patients with solid malignant tumors only (P = 0.01). No difference was observed in treatment- and transplantation-related deaths in patients with acute lymphoblastic leukemia (ALL) and acute myeloblastic leukemia (AML), but OS was better in patients with AML (P = 0.02). Between the two cohorts, transplantation-related mortality did not decrease and was higher at 5 years in patients with ALL who received unrelated-matched donor transplants (41.3%) than in those receiving sibling-matched donor transplants (18.7%). OS improved in the respective transplant groups (37.0% and 64.2%). Severe graft-versus-host disease was also observed among patients with ALL (P = 0.036). The decrease in TRDs was correlated with compliance to therapeutic guidelines. CONCLUSION: Although mortality declined, improved adherence to therapeutic guidelines and more restricted indications of allograft are needed to preclude further treatment- and transplantation-related deaths, particularly among those with leukemia. (c) 2007 Wiley-Liss, Inc.
BACKGROUND: We assessed the number and causes of treatment-related deaths (TRDs) in childhood cancer over time and correlated them with adherence to therapeutic guidelines. PROCEDURE: We compared two cohorts of children of the Childhood Cancer Registry of the Rhône-Alpes Region: Cohort I (1987-1992, 909 patients) and Cohort II (1996-1999, 648 patients). RESULTS: In all cancers together, 75 TRDs were reported in Cohort I and 24 in Cohort II (P = 0.001). Cumulative incidence at 5 years declined from 7.9% to 4.1%, and overall survival (OS) increased from 71.0% to 77.2%. TRDs declined by nearly 10-fold in patients with solid malignant tumors (P = 0.02) and central nervous system tumors (P = 0.001), but OS improved for patients with solid malignant tumors only (P = 0.01). No difference was observed in treatment- and transplantation-related deaths in patients with acute lymphoblastic leukemia (ALL) and acute myeloblastic leukemia (AML), but OS was better in patients with AML (P = 0.02). Between the two cohorts, transplantation-related mortality did not decrease and was higher at 5 years in patients with ALL who received unrelated-matched donor transplants (41.3%) than in those receiving sibling-matched donor transplants (18.7%). OS improved in the respective transplant groups (37.0% and 64.2%). Severe graft-versus-host disease was also observed among patients with ALL (P = 0.036). The decrease in TRDs was correlated with compliance to therapeutic guidelines. CONCLUSION: Although mortality declined, improved adherence to therapeutic guidelines and more restricted indications of allograft are needed to preclude further treatment- and transplantation-related deaths, particularly among those with leukemia. (c) 2007 Wiley-Liss, Inc.
Authors: Antoine Lurkin; Francoise Ducimetière; Dominique Ranchère Vince; Anne-Valérie Decouvelaere; Dominic Cellier; François N Gilly; Dimitri Salameire; Pierre Biron; Guy de Laroche; Jean Yves Blay; Isabelle Ray-Coquard Journal: BMC Cancer Date: 2010-04-19 Impact factor: 4.430
Authors: I Ray-Coquard; M C Montesco; J M Coindre; A P Dei Tos; A Lurkin; D Ranchère-Vince; A Vecchiato; A V Decouvelaere; S Mathoulin-Pélissier; S Albert; P Cousin; D Cellier; L Toffolatti; C R Rossi; J Y Blay Journal: Ann Oncol Date: 2012-02-13 Impact factor: 32.976