Surgery alone is sufficient therapy for children and adolescents with low-risk synovial sarcoma: A joint analysis from the European paediatric soft tissue sarcoma Study Group and the Children's Oncology Group

Surgery alone is sufficient therapy for children and adolescents with low-risk synovial sarcoma: A joint analysis from the European paediatric soft tissue sarcoma Study Group and the Children's Oncology Group
Approaches to synovial sarcomas (SS) have involved multimodal therapy using chemotherapy, surgery and radiation therapy. Retrospective analysis has suggested that low-risk SS may be treated with surgery alone. European and North American clinical trials in Non-rhabdomyosarcoma soft tissue sarcoma used a risk-based approach to therapy. This analysis reports on the pooled the data from the European (EpSSG NRSTS 2005) and North American (COG ARST0332) sarcoma trials.
Subset analysis of prospective study: 60 patients with synovial sarcoma under age 21 enrolled on European paediatric Soft tissue sarcoma Study Group (N=24) and Children Oncology Group (COG) trials (N=36), who had received surgery alone with complete resection. Median tumor size was 3 cm.
3-year EFS was 90% (82%, 98%), OS 100%. 8 local tumor recurrences; all were salvaged with combinations of surgery, chemotherapy and/or radiation therapy. Small tumor size of 3cm was predictive of EFS but clinical trial approach, age, gender, grade and site did not predict EFS.
Difference in patients eligible for surgery-only approach for SS patients in different trials. Limited number patients with large tumors.
This study showed that small synovial sarcomas ≤ 5cm that are completely resected with negative margins can be treated with surgery alone.