The Long-Term Outcomes of Intensive Combined Therapy of Adult Patients with Localised Synovial Sarcoma.

Katarzyna Kozak,Sławomir Falkowski,Anna M Czarnecka,Tadeusz Morysiński,Iwona Ługowska,Hanna Koseła-Paterczyk,Tomasz Świtaj,Ewa Bartnik,Michał Wągrodzki,Piotr Rutkowski,Paweł Teterycz

doi:10.3390/jcm9103129

Abstract

Introduction: Synovial sarcoma (SaSy) is a high-grade, malignant soft tissue sarcoma (STS) accounting for 5–9% of STS. The aim of this study was to analyse outcomes of patients with localised SaSy treated in a single institution with a uniform neo- and adjuvant-combined therapy protocol. Methods: 171 patients with stage II/III SaSy were treated between 1997 and 2014. Chemotherapy consisted of 4 cycles of ifosfamide 12 g/m2 and two cycles of a doxorubicin-based regimen 75 mg/m2. With the exception of patients who underwent amputation, all patients received neoadjuvant radiotherapy. Results: Median age was 33 years (range 17–69). Tumours larger than 5 cm in size were found in 70% of patients. The 5-year overall survival (OS), local relapse-free survival (LRFS) and metastasis-free survival (MFS) rates were 75%, 80% and 60%, respectively. In multivariate Cox’s regression, age > 35 years, male sex, larger tumour size and histology other than monophasic were associated with worse OS. Conclusions: In adult patients with localised SaSy, long-term survival can be achieved in a significant proportion of cases with intensive combined therapy. The multivariate analysis identified age, sex, disease stage and histology subtype as independent prognostic factors of OS.

Highlights

Synovial sarcoma (SaSy) is a high-grade, malignant soft tissue sarcoma (STS) accounting for 5–9% of STS
In the group of patients with SaSy localised in the extremities, limb-sparing surgery was performed in 136 patients (89%)
Vining et al, in an analysis of the data derived from the American National Cancer Database (NCDB), observed that adjuvant chemotherapy was associated with better overall survival (OS) in patients with stage III disease (7th American Joint Committee on Cancer (AJCC))

Summary

Introduction

Synovial sarcoma (SaSy) is a high-grade, malignant soft tissue sarcoma (STS) accounting for 5–9% of STS. In multivariate Cox’s regression, age > 35 years, male sex, larger tumour size and histology other than monophasic were associated with worse OS. Synovial sarcoma (SaSy) is a high-grade malignant mesenchymal tumour which accounts for 5–9% of all soft tissue sarcomas (STS) [1,2,3,4]. The following are mentioned among factors negatively affecting the prognosis: large primary tumour size, grade 3 tumour, monophasic subtype, male sex, older age at onset, non-extremity location, SS18–SSX1 fusion and resection R1 [2,5,6,11,13,14,15,16]. Wide surgical resection combined with perioperative radiation therapy (RT) is the cornerstone in the treatment of patients with localised SaSy. The role of adjuvant chemotherapy in adult patients with SaSy is not well established. Disease recurrence occurs most commonly within 2 years after primary tumour resection, late relapses after 10 years have been noted [21]

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