Collaborating to address rare childhood cancer

Sarcomas are rare types of cancer that form in the connective tissue of the human body. Osteosarcoma is well known as the type of cancer diagnosed in Terry Fox, but there are many types of sarcoma and they are most common in children and young adults.

“While rare, sarcomas are associated with worse outcomes when compared to other types of childhood cancer. It can be a devastating diagnosis for a family to receive,” says Dr. Andreana Bütter, Associate Scientist at Lawson Health Research Institute and Paediatric Surgeon at London Health Sciences Centre (LHSC).

Treatment for sarcoma normally involves a combination of surgery with chemotherapy and radiation therapy. Unfortunately, treatment is not always successful. Many children’s hospitals see only a few sarcoma patients each year which makes studying these cancers difficult.

The Pediatric Surgical Oncology Research Collaborative (PSORC) was formed to tackle this problem. PSORC is a group of Canadian and American paediatric surgeons from more than 30 hospitals. They share data on rare childhood cancer to accelerate research.

Understanding outcomes for children with chest wall sarcomas

Dr. Bütter and her team are involved in a number of PSORC studies.

In one project, led by Dr. Timothy Lautz at Ann & Robert H. Lurie Children’s Hospital in Chicago, researchers are assessing patient outcomes after treatment for sarcoma located in the chest wall. Sarcomas that can occur in the chest wall include osteosarcoma, Ewing sarcoma, chondrosarcoma, synovial sarcoma, rhabdomyosarcoma and variety of other soft-tissue sarcomas.

“Even when effective, treatments like surgery, chemotherapy and radiation can have complications that affect children for years to come,” explains Jacob Davidson, Research Coordinator at Lawson. “There have been few studies to look at patient outcomes and quality of life following treatment for chest wall sarcomas.”

In this multi-centre study, researchers will collect anonymous health care data from childhood sarcoma patients treated between 2008 and 2017, including those treated at Children’s Hospital at London Health Sciences Centre (LHSC). The team will study patient demographics and outcomes, including survival and any complications from treatment. Patients will also be asked to complete a questionnaire to assess their long-term quality of life after sarcoma surgery.

“Our goal is to understand which treatments work best for which patients,” says Dr. Bütter. “By understanding quality of life following treatment, we hope to counsel future patients about life after treatment and ensure they are receiving the right forms of support.”

Preventing the spread of osteosarcoma

A concern for any cancer patient is whether or not the cancer will return.

“When it comes to osteosarcoma, the lung is a common place for the cancer to spread, either when it’s first discovered or if the cancer returns,” explains Jacob.

As a precaution, many patients undergo surgery to remove a part of their lung. The surgery is called pulmonary metastasectomy.

“Unfortunately, even with aggressive chemotherapy and lung surgery, long term survival remains only 20 to 30 per cent,” adds Dr. Bütter. “We need to better understand the most effective treatments for this disease.”

In another study, led by Dr. John Doski at Children’s Hospital of San Antonio and Dr. Lautz at Lurie Children’s, researchers are analyzing outcomes in children previously treated for osteosarcoma, including those treated at Children’s Hospital at LHSC. They are comparing two different surgical methods used to remove part of the lung to determine which is associated with better outcomes.

“It’s our goal to understand which treatments work best for which patients,” says Dr. Bütter. “Both of these studies would be impossible for a single hospital to complete because sarcomas are so rare. By collaborating with hospitals across North America, we hope to standardize treatments and improve patient outcomes.”