Background:
The optimal treatment strategy for synovial sarcoma (ss) is subject to debate, and different strategies have been used for pediatric and adult patients. the current retrospective analysis examined a large group of patients of all ages who were treated at a single institution over a 30-year period.
Methods:
The study included 271 patients who ranged in age from 5 years to 87 years; 255 had localized disease, which was macroscopically resected in 215 cases and deemed unresectable at diagnosis in 40 cases. chemotherapy was administered to 41% of patients, corresponding to 76% of patients age or 16 years and < 20% of older patients; 28% of patients with macroscopically resected disease received chemotherapy on an adjuvant basis.
Results:
The 5-year event-free survival rate for the study cohort as a whole was 37%, although this rate varied with age (66%, 40%, and 31% for patients age < or = 16 years, 17-30 years, and > 30 years, respectively). chemotherapy was used more commonly for children than for adults. among patients with surgically resected disease, the 5-year metastasis-free survival (mfs) rate was 60% for those who were treated with chemotherapy and 48% for those who were not; the benefit associated with chemotherapy use appeared to be greatest for patients age > or = 17 years who had tumors measuring > 5 cm (mfs, 47% [chemotherapy] vs. 27% [no chemotherapy]). in the subgroup of patients with measurable disease, the rate of tumor response to chemotherapy was approximately 48%.
Conclusions:
Although the authors await more convincing proof of the efficacy of adjuvant chemotherapy in the treatment of adult soft tissue sarcoma, they recommend that patients with high-risk ss (tumor size > 5 cm) be the first to be considered for this type of treatment.