Pre-operative radiotherapy is associated with superior local relapse-free survival in advanced synovial sarcoma

  • 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.

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Author:Monika ScheerORCiD, Erika Hallmen, Christian Oliver VokuhlORCiDGND, Jörg FuchsGND, Per-Ulf TunnGND, Marc MünterGND, Beate TimmermannGND, Sebastian BauerORCiDGND, Anton George HenssenGND, Bernarda KazanowskaORCiD, Felix NiggliORCiDGND, Ruth LadensteinORCiD, Gustaf LjungmanORCiD, Angelika EggertORCiDGND, Thomas KlingebielORCiDGND, Ewa KoscielniakORCiD
Parent Title (English):Journal of cancer research and clinical oncology
Place of publication:Berlin ; Heidelberg
Document Type:Article
Date of Publication (online):2022/06/10
Date of first Publication:2022/06/10
Publishing Institution:Universitätsbibliothek Johann Christian Senckenberg
Creating Corporation:Cooperative Weichteilsarkom Studiengruppe [CWS]
Release Date:2023/02/06
Tag:Chemotherapy; Local therapy; Maintenance therapy; Pre-operative radiotherapy; Radiotherapy; Scheduling of radiotherapy; Soft tissue sarcoma; Surgery; Synovial sarcoma
Issue:online version before inclusion in an issue
Page Number:15
Open Access funding enabled and organized by Projekt DEAL. Deutsche Krebshilfe, Deutsche Kinderkrebsstiftung, BMBF, Förderkreis Krebskranke Kinder e.V. Stuttgart.
Early View: Online Version before inclusion in an issue
Dewey Decimal Classification:6 Technik, Medizin, angewandte Wissenschaften / 61 Medizin und Gesundheit / 610 Medizin und Gesundheit
Licence (German):License LogoCreative Commons - CC BY - Namensnennung 4.0 International