Annals of Oncology Advance Access originally published online on December 16, 2008
Annals of Oncology 2009 20(3):425-430; doi:10.1093/annonc/mdn678
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sarcomas |
Neo/adjuvant chemotherapy does not improve outcome in resected primary synovial sarcoma: a study of the French Sarcoma Group
,*
1 Department of Medical Oncology, Institut Bergonié, Bordeaux
2 Department of Medical Oncology, Centre Oscar Lambret, Lille
3 Equipe d'Accueil 2694: Santé Publique, Epidémiologie et modélisation des maladies chroniques, University of Lille II, Lille
4 Department of Pathology, Centre Oscar Lambret, Lille
5 Department of Medicine, Institut Gustave Roussy, Villejuif
6 Department of Medical Oncology, Institut Curie, Paris
7 Department of Medical Oncology, Centre René Huguenin, Saint-Cloud
8 Department of Medical Oncology, Centre René Gauducheau, Nantes
9 Department of Medical Oncology, Institut Claudius Regaud, Toulouse
10 Department of Medical Oncology, Centre Georges-François Leclerc, Dijon, France
11 Department of Medical Oncology, University Hospital Centre Vaudois, Lausanne, Switzerland
12 Department of Radiotherapy, Centre Paul Papin, Angers
13 Department of Medical Oncology, Centre Antoine-Lacassagne, Nice
14 Department of Pathology, Institut Bergonié, Bordeaux
15 Departement of Medical Oncology, Hôpital Edouard Herriot, Lyon
16 Unité INSERM 590, Centre Léon Bérard, Lyon, France
* Correspondence to: Dr A. Italiano, Department of Medical Oncology, Institut Bergonié, 229 cours de l'Argonne, 33076 Bordeaux Cedex, France. Tel: +33-05-56-33-33-33; Fax: +33-05-56-33-33-30; E-mail: italiano{at}bergonie.org
Background: There are only scarce data about the benefit of adjunctive chemotherapy in patients with localized synovial sarcoma (SS).
Patients and methods: Data from 237 SS patients recorded in the database of the French Sarcoma Group were retrospectively analyzed. The respective impact of radiotherapy, neo-adjuvant chemotherapy and adjuvant chemotherapy on overall survival (OS), local recurrence-free survival (LRFS) and distant recurrence-free survival (DRFS) were assessed after adjustment to prognostic factors.
Results: The median follow-up was 58 months (range 1–321). Adjuvant, neo-adjuvant chemotherapy and postoperative radiotherapy were administered in 112, 45 and 181 cases, respectively. In all, 59% of patients treated with chemotherapy received an ifosfamide-containing regimen. The 5-year OS, LRFS and DRFS rates were 64.0%, 70% and 57%, respectively. On multivariate analysis, age >35 years old, grade 3 and not-R0 margins were highly significant independent predictors of worse OS. After adjustment to prognostic factors, radiotherapy significantly improved LRFS but not DRFS or OS. Neither neo-adjuvant nor adjuvant chemotherapy had significant impact on OS, LRFS or DRFS.
Conclusion: As for other high-grade soft-tissue sarcomas, well-planned wide surgical excision with adjuvant radiotherapy remains the cornerstone of treatment for SS. Neo-adjuvant or adjuvant chemotherapy should not be delivered outside a clinical trial setting.
Key words: adjuvant chemotherapy, neo-adjuvant chemotherapy, radiotherapysynovial sarcoma
These authors contributed equally to the work and must be considered as two first coauthors. Received for publication July 29, 2008. Revision received September 13, 2008. Accepted for publication September 17, 2008.