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

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Item Type:Article
Title:Pre-operative radiotherapy is associated with superior local relapse-free survival in advanced synovial sarcoma
Creators Name:Scheer, M. and Hallmen, E. and Vokuhl, C. and Fuchs, J. and Tunn, P.U. and Münter, M. and Timmermann, B. and Bauer, S. and Henssen, A.G. and Kazanowska, B. and Niggli, F. and Ladenstein, R. and Ljungman, G. and Eggert, A. and Klingebiel, T. and Koscielniak, E.
Abstract: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.
Keywords:Soft Tissue Sarcoma, Synovial Sarcoma, Local Therapy, Chemotherapy, Maintenance Therapy, Radiotherapy, Scheduling of Radiotherapy, Pre-Operative Radiotherapy, Surgery
Source:Journal of Cancer Research and Clinical Oncology
Page Range:1717-1731
Date:May 2023
Official Publication:https://doi.org/10.1007/s00432-022-04051-9
PubMed:View item in PubMed

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