Back to Search Start Over

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

Authors :
Scheer, Monika
Hallmen, Erika
Vokuhl, Christian
Fuchs, Joerg
Tunn, Per-Ulf
Muenter, Marc
Timmermann, Beate
Bauer, Sebastian
Henssen, Anton George
Kazanowska, Bernarda
Niggli, Felix
Ladenstein, Ruth
Ljungman, Gustaf
Eggert, Angelika
Klingebiel, Thomas
Koscielniak, Ewa
Scheer, Monika
Hallmen, Erika
Vokuhl, Christian
Fuchs, Joerg
Tunn, Per-Ulf
Muenter, Marc
Timmermann, Beate
Bauer, Sebastian
Henssen, Anton George
Kazanowska, Bernarda
Niggli, Felix
Ladenstein, Ruth
Ljungman, Gustaf
Eggert, Angelika
Klingebiel, Thomas
Koscielniak, Ewa
Publication Year :
2023

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.

Details

Database :
OAIster
Notes :
application/pdf, English
Publication Type :
Electronic Resource
Accession number :
edsoai.on1387019190
Document Type :
Electronic Resource
Full Text :
https://doi.org/10.1007.s00432-022-04051-9