Adjuvant chemotherapy in resectable synovial sarcoma

Vining, Charles C.; Sinnamon, Andrew J.; Ecker, Brett L.; Kelz, Rachel R.; Fraker, Dougas L.; Roses, Robert E.; Karakousis, Giorgos C.

doi:10.1002/jso.24688

Cited by 32 publications

(32 citation statements)

References 27 publications

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“…The role of adjuvant therapy in SS is highly debated. Two large registry‐based studies showed a clinical benefit of adjuvant chemotherapy in patients with stage III SS . Contrarily, a pooled analysis of two European Organisation for Research and Treatment of Cancer (EORTC) phase III clinical trials found no correlation between adjuvant chemotherapy and better overall survival (OS) in SS patients .…”

Section: Discussionmentioning

confidence: 99%

Localized synovial sarcoma: A single institutional study of 191 patients with a minimum follow‐up of 5 years for survivors

Outani

Nakamura

Murata

et al. 2019

Journal of Surgical Oncology

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Purpose Factors affecting long‐term outcomes of synovial sarcoma (SS) remain unknown. Here, we aimed to investigate the long‐term oncological outcomes and prognostic factors in a large group of patients with surgically‐treated localized SS. Patients and Methods Between 1980 and 2011, 191 patients (94 males and 97 females) were treated at a single hospital with a minimum follow‐up of 5 years for survivors. The median age was 35 years (range, 3‐80 years), and the median follow‐up period was 83 months (range, 3‐235 months). Results Disease‐specific survival was 76.4% and 60.4% at 5 and 10 years, respectively. Local recurrence occurred in 23 patients at a median of 33 months (range, 6‐158 months), and metastasis occurred in 73 patients at a median of 20 months (range, 2‐166 months). In multivariate analysis, grade 3 tumors sized ≥5 cm were significantly associated with worse survival. Ten patients (5.2%) developed metastasis more than 5 years after surgery. Conclusion Tumor size and grade govern prognosis in surgically‐treated localized SS in long‐term settings. If adequately treated patients have not developed metastases for 5 years after surgery, the risk of subsequently developing metastases was lower than previously reported.

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Section: Discussionmentioning

confidence: 99%

Localized synovial sarcoma: A single institutional study of 191 patients with a minimum follow‐up of 5 years for survivors

Outani

Nakamura

Murata

et al. 2019

Journal of Surgical Oncology

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“…As far as resectable, non-metastatic synovial sarcomas in the extremities are concerned, it has been reported that neoadjuvant chemotherapy (mesna/adriamycin/ifosfamide/dacarbazine) decreases distant metastasis and improves survival time, 13 while adjuvant chemotherapy has been reported to lead to a slight but definite risk reduction in local recurrence, distant recurrence, and overall recurrence. 14 From another study, 15 it seems that locally aggressive tumors benefit more from chemotherapy than those which are not. However, despite these positive reports, the long-term benefit of chemotherapy on survival is still controversial.…”

Section: Discussionmentioning

confidence: 99%

Synovial sarcoma of the maxillary sinus: an extremely rare case with excellent response to chemotherapy

Saito¹,

Ozawa²,

Ikari³

et al. 2018

OTT

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This paper presents an extremely rare case of synovial sarcoma arising from the maxillary sinus, which resulted in a clinically complete response to chemotherapy. Synovial sarcoma is a rare soft tissue malignant tumor, most commonly affecting the extremities. While ~10% occur in the head and neck region, synovial sarcoma of the sinonasal tract is extremely rare, with only 11 cases having been reported previously. As with other sarcomas, the standard treatment is complete resection while allowing for a safe margin, but this is often difficult in the head and neck area due to the complicated anatomy there. This makes the treatment of head and neck sarcoma challenging and leads to the need for a multimodal approach in advanced cases. However, the exact efficacy of chemotherapy is not well understood. In this report, we present a case of unresectable maxillary sinus synovial sarcoma that was successfully treated by chemotherapy followed by radiation therapy. A 53-year-old Japanese man was referred to our hospital with a history of left nose obstruction over the previous couple of years. Computed tomography/magnetic resonance imaging revealed a tumor arising from the maxillary sinus that extended to adjacent tissues. A biopsy was performed, and the tumor was diagnosed as synovial sarcoma. Since the tumor was unresectable, neoadjuvant chemotherapy was administered. The response was excellent, and the tumor became undetectable under endoscopy and radiological imaging. This provided us with a clinical evaluation of “complete response”. The treatment was concluded with definitive radiotherapy and two more cycles of adjuvant chemotherapy. The patient remains free of disease 12 months after treatment. Synovial sarcoma of the head and neck is a rare entity; complete resection is the treatment of choice but (neo)adjuvant chemotherapy can be considered in unresectable cases, as we show here in the present case.

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“…On the contrary, Chen et al (16) reported that adjuvant chemotherapy improved disease-specific survival and prolonged the time to metastasis in stage IIB/III SS patients. Recently, Vining et al (17) reported improved outcomes with adjuvant chemotherapy in stage III SS patients from an analysis of the National Cancer Database and recommended less restricted use of adjuvant chemotherapy for stage III SS. These differences might come from varying use of chemotherapy regimens among patients and different proportions of N/AC administration.…”

Section: Discussionmentioning

confidence: 99%

Favorable outcomes of localized synovial sarcoma patients with a high utilization rate of neoadjuvant and/or adjuvant chemotherapy

et al. 2019

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Synovial sarcoma (SS) is considered to be a chemosensitive, soft tissue sarcoma. Therefore, neoadjuvant and/or adjuvant chemotherapy (N/AC) is used for the treatment of high-risk SS patients. However, the role of N/AC remains controversial. The present study aimed to review the clinical outcomes of surgically treated localized SS and investigate the effects of N/AC with long-term observation. The clinical outcomes of 54 patients with surgically treated localized SS were retrospectively analyzed. The median patient age was 42 years (range, 8-81 years), and the median follow-up period was 94 months for survivors (range, 7-220 months). A total of 38 patients (70%) received chemotherapy. Of these, 32 (59%) patients received neoadjuvant chemotherapy, 33 (61%) received adjuvant chemotherapy, and 27 (50%) received neoadjuvant and adjuvant chemotherapy. Fourteen patients (26%) received adjuvant radiotherapy. Three patients (6%) had local recurrence and 13 patients (24%) developed distant metastasis. The overall survival (OS) rates at 5 and 10 years were 87 and 84%, respectively. N/AC did not improve survival. In conclusion, we found satisfactory long-term OS among patients with a high utilization rate of N/AC. Further study should be necessary to evaluate which population of SS would benefit from N/AC.

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Adjuvant chemotherapy in resectable synovial sarcoma

Abstract: In this national cohort, AC was associated with prolonged OS for SS for stage III patients but not in lower stages. Less restricted use of this therapy may be warranted in this population.

Cited by 32 publications

References 27 publications

Localized synovial sarcoma: A single institutional study of 191 patients with a minimum follow‐up of 5 years for survivors

Localized synovial sarcoma: A single institutional study of 191 patients with a minimum follow‐up of 5 years for survivors

Synovial sarcoma of the maxillary sinus: an extremely rare case with excellent response to chemotherapy

Favorable outcomes of localized synovial sarcoma patients with a high utilization rate of neoadjuvant and/or adjuvant chemotherapy

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