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J Adolesc Young Adult Oncol. 2019 Jun;8(3):272-280. doi: 10.1089/jayao.2018.0136. Epub 2019 Mar 1.

Management of Sarcoma in Adolescents and Young Adults: An Australian Population-Based Study.

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1 Center for Behavioral Research in Cancer, Cancer Council Victoria, Melbourne, Australia.
2 School of Psychology, Deakin University, Melbourne, Australia.
3 Children's Cancer Center, The Royal Children's Hospital, Melbourne, Australia.
4 Peter MacCallum Cancer Center, Melbourne, Australia.
5 School of Psychology and Public Health, La Trobe University, Melbourne, Australia.
6 Olivia Newton-John Cancer Wellness & Research Center, Austin Health, Heidelberg, Australia.
7 Children's Health Queensland Hospital and Health Service, Brisbane, Australia.
8 Royal Adelaide Hospital, Adelaide, Australia.
9 Perth Children's Hospital, Perth, Australia.
10 Royal Hobart Hospital, Hobart, Australia.
11 Princess Alexandra Hospital, Brisbane, Australia.
12 Kids Cancer Center, Sydney Children's Hospital, Sydney, Australia.
13 Nelune Comprehensive Cancer Center, Prince of Wales Hospital, Randwick, Australia.
14 School of Women's and Children's Health, University of New South Wales, Kensington, Australia.


Background: While overall survival (OS) for cancer in adolescents and young adults (AYA) has improved, there has been little change in AYA survival for several types of sarcomas. Using national data for Australia we describe (1) the treatment centers caring for AYA sarcoma, (2) treatments provided, and (3) survival outcomes. Procedure: National population-based study assessing treatment of 15-24 year-olds diagnosed with soft tissue sarcoma (STS), bone sarcoma (BS), and Ewing family tumors (ET) between 2007 and 2012. Treatment details were abstracted from hospital medical records. Treatment centers were classified as pediatric or adult specialist AYA/sarcoma center, or other adult. Cox proportional hazard regression analyses examined associations between type of treatment center and OS. Results: Sixty-one hospitals delivered treatment to 318 patients (135 STS; 91 BS, 92 ET), with 9%, 22%, and 17% of STS, BS, and ET, respectively, treated at pediatric and 62%, 59%, and 71% at adult specialist hospitals. Of 18-24 year-olds, 82% of BS, 90% of ET, and 73% of rhabdomyosarcomas at adult specialist centers were on a trial or standard protocol, compared with 42%, 89%, and 100%, respectively, at nonspecialist adult hospitals. After adjusting for disease and patient characteristics, survival was not associated with treatment center type for any disease type. However, ET survival was poorer for patients not receiving a standard chemotherapy protocol. Conclusions: Around 10% of AYA sarcoma patients attending adult hospitals were not on a standard protocol. Poorer survival for ET patients not on a standard protocol highlights the importance of ensuring all patients receive optimal care.


Ewing family tumors; adolescents and young adults; bone sarcoma; population-based; soft tissue sarcoma; survival; treatment


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