Risk assessment of radio-chemotherapy in pediatric soft tissue sarcomas

Soft tissue sarcomas (STS) are a group of rare and heterogenous cancers, that diverse a wide spectrum of histology and varied clinical behavior. The aim was to study, retrospectively and prospectively the adverse effects of therapy in STS patients attending the Pediatric Oncology Clinic, National Cancer Institute (NCI), Cairo University during the last 10 years. Files of 106 STS patients were revised for history, staging, investigations, treatment modalities and side effects of therapy. Radiotherapy (RTH) and surgery remains the backbone of the multi-modality treatment plan. Chemo-radiotherapy (CRTH) induces acute and delayed toxicity in the form of hematological & gastrointestinal (GIT) toxicity and alopecia that occur in all patients. However, hepatic & genitourinary toxicity, cardiotoxicity, neurotoxicity and skin complications can be seen in 13.2%, 11.3%, 1.9% and 4.7% and 28.3% of patients respectively. Mucositis was noticed in 42.5% of patients, 15.1% of them were due to RTH, which can also cause dysphagia & dysphonia, impaired taste sensation and transient conjunctivitis in 4.7%, 1.9% and 6.6% of patients respectively. Additionally, 46.7% of post-pubertal patients were found to be azoospermic >5 years of end of treatments. However, 3.8% and 6.6% of patients developed ototoxicity and skin fibroses due to local irradiations. Furthermore, hypo- or hyperthyroidism and growth retardation was encountered in 7.5% and 6.6% of patients respectively. However, 5.7% of patients developed secondary malignancy, 7 years after the end of CRTH.Finally, the current study concluded that STS multidisciplinary management may cause early and late toxicity. Future approaches including radiation dose and volume reduction or application of new radiation technologies are needed. New strategies with reduction or elimination of chemotherapy (CTH) dose are also recommended for dealing with pediatric STS patients.