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. 2023 May;149(5):1717-1731.
doi: 10.1007/s00432-022-04051-9. Epub 2022 Jun 10.

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

Monika Scheer  1 , Erika Hallmen  2 , Christian Vokuhl  3 , Jörg Fuchs  4 , Per-Ulf Tunn  5 , Marc Münter  6 , Beate Timmermann  7 , Sebastian Bauer  8 , Anton George Henssen  9 , Bernarda Kazanowska  10 , Felix Niggli  11 , Ruth Ladenstein  12 , Gustaf Ljungman  13 , Angelika Eggert  9 , Thomas Klingebiel  14 , Ewa Koscielniak  2   15 ; Cooperative Weichteilsarkom Studiengruppe [CWS]
Affiliations

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

Monika Scheer et al. J Cancer Res Clin Oncol. 2023 May.

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: Chemotherapy; Local therapy; Maintenance therapy; Pre-operative radiotherapy; Radiotherapy; Scheduling of radiotherapy; Soft tissue sarcoma; Surgery; Synovial sarcoma.

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Conflict of interest statement

We declare no conflict of interest.

Figures

Fig. 1
Fig. 1
Overall and event-free survival of 145 patients with initially unresectable synovial sarcoma (IRS III)
Fig. 2
Fig. 2
Local relapse-free and metastatic relapse-free survival probabilities according to scheduling of radiotherapy
Fig. 3
Fig. 3
Sequencing of local therapies, disease characteristics and outcome of treated patients
See this image and copyright information in PMC

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