1
|
Sharma J, Deo SVS, Kumar S, Barwad AW, Rastogi S, Sharma DN, Singh G, Bhoriwal S, Mishra A, K R, Saikia J, Mandal A, Bansal B, Gaur M. Clinicopathological Profile and Survival Outcomes in Patients with Localised Extremity Synovial Sarcomas. Clin Oncol (R Coll Radiol) 2024; 36:e97-e104. [PMID: 38326122 DOI: 10.1016/j.clon.2024.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 12/11/2023] [Accepted: 01/26/2024] [Indexed: 02/09/2024]
Abstract
AIMS Synovial sarcoma is a rare but aggressive variant of soft-tissue sarcoma. Literature is sparse and reported mostly from the West. We analysed the clinical profiles and prognostic factors of extremity synovial sarcoma patients in order to study their clinical journey. MATERIALS AND METHODS This was a retrospective analysis. All patients with extremity synovial sarcoma treated between 1992 and 2020 were included. Patients with metastases at presentation were excluded. A descriptive analysis of demographic and clinicopathological features of patients undergoing limb salvage surgery (LSS) or amputation was carried out. Overall survival and disease-free survival were calculated for the entire cohort as well as for the LSS and amputation groups. Factors prognostic for survival were identified. RESULTS In total, 157 patients had localised extremity synovial sarcoma. Predominantly, young adults (median 31 years) and males (61%) were affected. Over 70% of patients presented after recurrence or unplanned surgeries. Sixty-seven per cent of tumours were >5 cm, 69% were deep and 23% involved bone. The limb salvage rate was 64%. In the LSS group, adjuvant radiotherapy and chemotherapy were given to 72% and 68% of patients, respectively. In the amputation group, 72% of patients received adjuvant chemotherapy. In a median follow-up of 59 months, 39.4% of patients had recurrences, the majority (61.2%) were systemic. Five-year overall survival and disease-free survival were 53.4% and 49.8%, respectively. Overall survival was 63.9% and 29.7% in the LSS and amputation groups, respectively. On multivariate analysis, tumour size, depth, omission of radiotherapy and bone invasion were found to be the adverse prognostic factors. CONCLUSION This is one of the largest studies on extremity synovial sarcoma. Mostly males and young adults were affected. The limb salvage rate was 64%, despite most being referred after unplanned surgery. Almost 70% of patients received radiotherapy and chemotherapy. Overall survival was inferior in the amputation group. Tumour size >5 cm, depth and bone invasion were negative, whereas adjuvant radiotherapy was a positive prognostic factor for survival. Chemotherapy had no impact on survival.
Collapse
Affiliation(s)
- J Sharma
- Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India.
| | - S V S Deo
- Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - S Kumar
- Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - A W Barwad
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - S Rastogi
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - D N Sharma
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - G Singh
- Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - S Bhoriwal
- Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - A Mishra
- Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - R K
- Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - J Saikia
- Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - A Mandal
- Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - B Bansal
- Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - M Gaur
- Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
2
|
Endara SA, De la Torre JS, Terán FJ, Alarcón JP, Tovar CE. Multidisciplinary management of recurrent synovial sarcoma of the chest wall. NORTH AMERICAN SPINE SOCIETY JOURNAL 2023; 15:100243. [PMID: 37575880 PMCID: PMC10415753 DOI: 10.1016/j.xnsj.2023.100243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/14/2023] [Accepted: 07/05/2023] [Indexed: 08/15/2023]
Abstract
Background Synovial sarcoma (SS) is part of soft tissue sarcomas (STS). An incidence between 5% to 10% is estimated. The origin is mesenchymal mainly affecting the extremities. Being even rarer at the chest level and vertebral body, representing around 1%. Histologically, it consists of 3 variants: monophasic, biphasic, and poorly differentiated. Surgical resection is a priority when it comes to multidisciplinary management. The prognosis of patients with SS over the years has improved markedly. Purpose Understand and evaluate the multidisciplinary management of SS considering that the SS has a lowe prevalence and highly malignancy. Study Design We present a case of a 31-year-old male who has a history of monophasic synovial sarcoma diagnosed in 2019 and underwent surgery. Patient came back after two years without symptoms and posterior to a control MRI we observed a local recurrence of SS. Methods The literature was reviewed with a focus on best clinical and surgical strategy for recurrence of SS. Results The patient recovered well with return to his normal daily activities. The review of the literature shows us the importance of the multidisciplinary management for the optimal clinical and surgical approach of SS recurrence. Conclusions SS represents a unique variant of STS, with malignant and metastatic potential. Being a rare pathology, an adequate multidisciplinary management is essential when providing optimal care for the patient.
Collapse
Affiliation(s)
- Santiago A. Endara
- Cardiovascular and Thoracic surgeon, Hospital Metropolitano, Quito, Ecuador
| | | | - Fernando J. Terán
- Orthopedic surgery senior resident, Universidad Internacional del Ecuador, Quito, Ecuador
| | - Juan Pablo Alarcón
- General Surgery resident, Universidad Internacional del Ecuador, Quito, Ecuador
| | - Carla E. Tovar
- Oncologist surgeon, Hospital Metropolitano. Quito, Ecuador
| |
Collapse
|