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

Background

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.

Methods

Retrospective review of AYA (15-29 years) patients with cancer, except leukemias, referred for multidisciplinary treatment (1992-2014). Baseline characteristics, pathological type and stage, 1^st -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 

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). 1^st-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).

Conclusions

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.

Clinical trial identification

Legal entity responsible for the study

Hospital Universitario La Fe

Funding

N/A

Disclosure

All authors have declared no conflicts of interest.