Surgical excision and not chemotherapy is the most powerful modality in treating synovial sarcoma: the UK’s North East experience

Khan, Mumtaz Ahmad; Rankin, Kenneth; Todd, R; Lethbridge, Emma; Gerrand, Craig

doi:10.1007/s00402-018-3059-x

Cited by 10 publications

(13 citation statements)

References 21 publications

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“…With surgical resection of the tumor, adjuvant radiotherapy and chemotherapy are alternatively recommended as a local and systemic therapy for synovial sarcoma patients, which is primarily applied with patients at high risk of incomplete removal of the tumor (1,27,28). Age, tumor location, the presence of distal metastasis, and histological response are important preoperative prognostic variables in high-grade synovial sarcoma patients undergoing adjuvant treatment (29).…”

Section: Discussionmentioning

confidence: 99%

Multimodal Risk-Adapted Treatment in Surgical Patients With Synovial Sarcoma: A Preoperative Nomogram-Guided Adjuvant Treatment Strategy

Zeng

Yao

et al. 2020

Front. Surg.

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Background: Synovial sarcoma is characterized by heterogeneous clinical manifestations, making it difficult to evaluate individual patients' prognoses and design personal treatment schemes. We established an effective preoperative nomogram to predict cancer-specific survival (CSS) and present a risk-adapted adjuvant treatment strategy in surgical patients with synovial sarcoma.Methods: This retrospective study included patients from the Surveillance, Epidemiology, and End Results (SEER) database who were diagnosed with synovial sarcoma between 1996 and 2015. The patients were randomly divided into training and validation groups. The predictors were selected using univariate and multivariate Cox hazards models. The nomogram performance was verified for its discriminatory ability and calibration. We further stratified the patients into different risk groups according to the nomogram scores and compared the efficacy of chemotherapy, radiotherapy, and combination of radiotherapy and chemotherapy.Results: There were 915 patients enrolled in our study, with 874 patients either alive or dead due to synovial sarcoma. We established a nomogram to predict 5-year CSS based on independent factors, including sex, age, grade, tumor size, location, and extent (all p < 0.05). Our model showed a consistently good discriminatory ability and calibration for predicting 5-year CSS in both the training (c-index = 0.78, 95% CI 0.75–0.81) and validation (c-index = 0.73, 95% CI 0.68–0.78). Based on their nomogram scores, we divided patients into 5 groups. Compared to patients without adjuvant treatment, nomogram I patients with adjuvant treatment had no improvements in 5-year CSS (100.0% vs. 100.0%), nomogram II patients had higher 5-year CSS with radiotherapy or chemotherapy (92.9% vs. 72.2%, p = 0.015), nomogram III patients had higher 5-year CSS with combination of chemotherapy and radiotherapy (70.1% vs. 47.2%, p = 0.004), nomogram IV patients had higher 5-year CSS with radiotherapy (41.3% vs. 15.6%, p = 0.015), and nomogram V patients had no improvements in 5-year CSS rates with adjuvant treatment (28.9% vs. 16.9%, p = 0.18).Conclusion: The nomogram showed a satisfactory discriminatory ability and calibration for predicting 5-year CSS in synovial sarcoma patients. Based on this nomogram, we stratified synovial sarcoma patients according to risk levels, which enabled us to provide a useful grouping scheme that can inform multimodal risk-adapted treatment in synovial sarcoma.

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Section: Discussionmentioning

confidence: 99%

Multimodal Risk-Adapted Treatment in Surgical Patients With Synovial Sarcoma: A Preoperative Nomogram-Guided Adjuvant Treatment Strategy

Zeng

Yao

et al. 2020

Front. Surg.

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“…Local relapse is a common finding in the evolution of SS but it is difficult to predict. Reexcision remains the best option, without clear data on the role of systematic chemotherapy and RT after local relapse [42]. Local recurrence-free survival was reported to be similar in patients who received surgery only, compared to those who received surgery with RT or surgery with chemotherapy ( n = 49).…”

Section: Discussionmentioning

confidence: 99%

Management of Synovial Sarcoma in a Tertiary Referral Center: A Retrospective Analysis of 134 Patients

et al. 2021

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Background: Synovial sarcomas (SS) are malignant mesenchymal neoplasms that account for about 10% of all sarcomas. Complete surgical excision is the mainstay of primary treatment for localized disease, but SS have a high tendency for local relapse and metastases. Metastatic disease is commonly treated with systemic chemotherapy. Methods: We designed a retrospective analysis to describe the clinical presentation, course of treatment, outcome, and prognosis of patients with SS. Univariate and multivariate analyses were performed for potential prognostic factors. Results: We identified 134 patients treated between 1987 and 2018, with a cutoff date of December 2018. Demographics, disease characteristics, treatment, and survival rates were collected and analyzed. The median overall survival (mOS) from the date of diagnosis was 96.7 months. The median progression-free survival was 6.37 months. Disease-free survival was 26 months. Age over 65 years was found to be a prognostic factor with statistically significant value in the univariate analysis regarding mOS (p = 0.015) and mOS after local relapse (p = 0.0228). Conclusions: Even though our study is limited by the retrospective nature of the analysis, it adds an important amount of clinical data regarding the treatment and outcome of SS.

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“…Diagnosis of synovial sarcomas can be difficult due to the large variety of possible tumour sites, including extremities, head and neck, thorax, axilla and even abdomen 2 4 8 9. The clinical history is often that of a slow-growing mass which may be present for years, associated with pain or tenderness, but can also present with motor and sensory deficits or painless swelling 1 2.…”

Section: Discussionmentioning

confidence: 99%

“…The primary treatment for synovial sarcomas is complete surgical resection combined with radiation therapy 4 7 14 15. A recent study combining two prospective trials has reported that for small, localised disease, a surgery-only approach can be a safe and viable treatment option 16.…”

Section: Discussionmentioning

confidence: 99%

“…Synovial sarcomas are rare and account for less than 10% of all soft-tissue sarcomas 1–3. Its name is a misnomer, as synovial sarcomas do not originate from synovial tissue; rather, they typically arise from the deep mesenchymal tissues of the extremities as well as the head and neck 2 4. Primarily, adolescents and young adults are affected 5 6.…”

Section: Introductionmentioning

confidence: 99%

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Synovial sarcoma mimicking a traumatic pseudoaneurysm in the upper extremity

2019

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Synovial sarcomas are a rare but aggressive malignancy that primarily affects young patients. Diagnosis is often difficult and delayed due to its insidious onset, heterogenous presentation and mimicry of other pathologies. We present the case of a patient with a history of a slow-growing left arm mass that arose after a traumatic fracture of the humerus. Multimodal imaging was undertaken and reported the mass as being consistent with a vascular malformation of the brachial artery. The patient underwent surgical repair of the artery and intraoperative biopsies confirmed a diagnosis of synovial sarcoma. This case highlights the importance of maintaining suspicion for soft-tissue sarcomas in young patients presenting with a mass, and demonstrates the way in which these tumours may mimic other pathologies both clinically and radiologically. Early referral to a specialist sarcoma centre is key for further investigative workup.

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Surgical excision and not chemotherapy is the most powerful modality in treating synovial sarcoma: the UK’s North East experience

Cited by 10 publications

References 21 publications

Multimodal Risk-Adapted Treatment in Surgical Patients With Synovial Sarcoma: A Preoperative Nomogram-Guided Adjuvant Treatment Strategy

Multimodal Risk-Adapted Treatment in Surgical Patients With Synovial Sarcoma: A Preoperative Nomogram-Guided Adjuvant Treatment Strategy

Management of Synovial Sarcoma in a Tertiary Referral Center: A Retrospective Analysis of 134 Patients

Synovial sarcoma mimicking a traumatic pseudoaneurysm in the upper extremity

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