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

Background and purpose We reviewed our experience of synovial sarcoma to identify factors predictive of local recurrence and overall survival, the impact of chemotherapy and outcomes after surgical excision alone. Materials and methods 81 patients were treated between 1997 and 2014 of mean age 39 ye...

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Bibliographic Details
Published in:Archives of orthopaedic and trauma surgery 2019-04, Vol.139 (4), p.443-449
Main Authors: Khan, Munir, Rankin, Kenneth S., Todd, Radha, Lethbridge, Emma, Gerrand, Craig
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Antineoplastic Agents - therapeutic use
Chemotherapy
Child
Humans
Medicine
Medicine & Public Health
Middle Aged
Neoplasm Recurrence, Local
Orthopaedic Surgery
Orthopedics
Radiation therapy
Retrospective Studies
Sarcoma
Sarcoma, Synovial - drug therapy
Sarcoma, Synovial - mortality
Sarcoma, Synovial - surgery
Surgery
Treatment Outcome
Tumors
United Kingdom
Young Adult
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Summary:Background and purpose We reviewed our experience of synovial sarcoma to identify factors predictive of local recurrence and overall survival, the impact of chemotherapy and outcomes after surgical excision alone. Materials and methods 81 patients were treated between 1997 and 2014 of mean age 39 years (8–78). Tumours were in the extremity in 55 (67%). 9 patients presented with metastases and 10 with unresectable disease. Mean follow-up was 3.7 years (SD 3.8). Treatment groups were palliative, surgery only, surgery and radiotherapy, or surgery with chemotherapy (with or without radiotherapy). Results Local recurrence-free survival (LRFS) was 73% at 5 years, and 68% at 10 and 15 years. In multivariate analysis, positive surgical margins were an independent predictor of LRFS. Overall survival (OS) was 50% at 5 years for all patients, and 62% at 5 years for those treated with curative intent. Larger tumour size and non-extremity locations were predictors of poorer OS. Patients who had chemotherapy did not have significantly better OS or LRS than others. Interpretation These results show that where feasible, curative resection should not be delayed for chemotherapy. Treatment with surgery only can be associated with good outcomes in selected patients with smaller extremity tumours; although our series is small.
ISSN:0936-8051
1434-3916
DOI:10.1007/s00402-018-3059-x