TY  - JOUR
A1  - Scheer, Monika
A1  - Hallmen, Erika
A1  - Vokuhl, Christian Oliver
A1  - Fuchs, Jörg
A1  - Tunn, Per-Ulf
A1  - Münter, Marc
A1  - Timmermann, Beate
A1  - Bauer, Sebastian
A1  - Henssen, Anton George
A1  - Kazanowska, Bernarda
A1  - Niggli, Felix
A1  - Ladenstein, Ruth
A1  - Ljungman, Gustaf
A1  - Eggert, Angelika
A1  - Klingebiel, Thomas
A1  - Koscielniak, Ewa
T1  - Pre-operative radiotherapy is associated with superior local relapse-free survival in advanced synovial sarcoma
T2  - Journal of cancer research and clinical oncology
N2  - Purpose: Optimization of local therapies in synovial sarcoma (SS) considered unresectable at diagnosis is needed. We evaluated the effects of neoadjuvant versus adjuvant radiation versus surgery only on long-term outcomes.
Methods: Patients with macroscopic SS tumors before chemotherapy (IRS-group-III) in the trials CWS-81, CWS-86, CWS-91, CWS-96, CWS-2002-P and SoTiSaR-registry were analyzed. Local therapies were scheduled after 3 neoadjuvant chemotherapy cycles.
Results: Median age of 145 patients was 14.5 years. 106 survivors had median follow-up of 7.0 years. Tumor site was 96 extremities, 19 head–neck, 16 shoulder/hip, 14 trunk. Tumors were < 3 cm in 16, 3–5 cm in 28, 5–10 cm in 55, > 10 cm in 34 patients. In a secondary resection during chemotherapy, R0-status was accomplished in 82, R1 in 30, R2 in 21 (12 missing). Radiotherapy was administered to 115 (R0 61, R1 29, R2 20, missing 5), thereof 57 before and 52 after tumor resection. 23 were treated with surgery only. For all patients, 5 year event-free (EFS) and overall survival (OS) was 68.9% ± 7.6 (95%CI) and 79.1% ± 6.9. To establish independent significance, tumor site, size, surgical results and sequencing of local therapies were analyzed in a Cox regression analysis. Variables associated with EFS and OS are site, size and sequencing of local therapies. Variables associated with local recurrence are site, surgical results and sequencing of local therapies. The only variable associated with suffering metastatic recurrence is tumor size.
Conclusion: Differences in sequencing of local therapy procedures are independently associated with outcomes. Best local control is achieved when tumors are irradiated pre-operatively and undergo R0 or R1 resection thereafter.
KW  - Soft tissue sarcoma
KW  - Synovial sarcoma
KW  - Local therapy
KW  - Chemotherapy
KW  - Maintenance therapy
KW  - Radiotherapy
KW  - Scheduling of radiotherapy
KW  - Pre-operative radiotherapy
KW  - Surgery
Y1  - 2022
UR  - http://publikationen.ub.uni-frankfurt.de/frontdoor/index/index/docId/69455
UR  - https://nbn-resolving.org/urn:nbn:de:hebis:30:3-694550
SN  - 1432-1335
N1  - Open Access funding enabled and organized by Projekt DEAL. Deutsche Krebshilfe, Deutsche Kinderkrebsstiftung, BMBF, Förderkreis Krebskranke Kinder e.V. Stuttgart.
N1  - Early View: Online Version before inclusion in an issue
VL  - 2022
IS  - online version before inclusion in an issue
PB  - Springer
CY  - Berlin ; Heidelberg
ER  -