Salvage Treatment Experience in Advanced Synovial Sarcoma: a Multicenter Retrospective Analysis of the Anatolian Society of Medical Oncology

  • Yetisyigit, Tarkan (Medical Oncology Department, Namık Kemal University Hospital) ;
  • Arpaci, Erkan (Medical Oncology Department, Dr. Abdurrahman Yurtaslan Education and Research Hospital) ;
  • Seber, Erdogan Selcuk (Medical Oncology Department, Marmara University) ;
  • Kucukoner, Mehmet (Medical Oncology Department, Dicle University) ;
  • Kos, Fatma Tugba (Medical Oncology Department, Ankara Numune Education and Research Hospital) ;
  • Sonmez, Ozlem Uysal (Medical Oncology Department, Dr. Abdurrahman Yurtaslan Education and Research Hospital) ;
  • Alici, Suleyman (Medical Oncology Department, Goztepe Medical Park Hospital) ;
  • Akman, Tulay (Medical Oncology Department, Kartal Education and Research Hospital) ;
  • Aktas, Bilge (Medical Oncology Department, Marmara University) ;
  • Yildiz, Ramazan (Medical Oncology Department, Dokuz Eylul University) ;
  • Gunaydin, Yusuf (Medical Oncology Department, Dokuz Eylul University) ;
  • Inanc, Mevlude ;
  • Demirci, Umut (Medical Oncology Department, Dokuz Eylul University) ;
  • Alkis, Necati (Medical Oncology Department, Dr. Abdurrahman Yurtaslan Education and Research Hospital) ;
  • Gumus, Mahmut (Kartal Education and Research Hospital)
  • Published : 2013.09.30


Background: We aimed to evaluate prognostic factors and response rates to various treatment approaches to patients with synovial sarcoma in an advanced setting. Materials and Methods: We retrospectively reviewed the medical records of 55 patients (18 pts; 32.7% women) diagnosed with synovial sarcomas. Twenty had metastatic disease at the time of diagnosis while the remainder of the study group consisted of patients who developed metastatic or inoperable locally advanced disease during follow up. Results: The median follow up time was 15 months (range: 1-53). Regarding outcomes for the 55 patients, 3 and 5 year overall survival rates were 26% and 14%, respectively. In univariate analyses among demographic factors female gender was associated with a better outcome (p=0.030). Patients with early progressing disease (<2 years) had a worse prognosis when compared to patient group with late relapse, but this difference did not reach statistical significance (p=0.056). According to multivariate Cox regression analysis patients who had undergone metastasectomy had a significant survival advantage (p=0.044). The overall response rate to different salvage chemotherapy regimens given as second line treatment was around 42.9-53.9% for all regimes. There were no statistically significant differences between chemotherapy regimens given in either second or third line settings in terms of overall survival. Conclusions: We observed no major differences in terms of response rate and survival between different salvage chemotherapy regimens. Although metastatic disease still carries a poor prognosis, metastasectomy was found to be associated with improved survival.


Synovial sarcoma;advanced disease;salvage chemotherapy;prognostic factors;metastasectomy


  1. Bramwell VH, Anderson D, Charette ML (2003). Doxorubicinbased chemotherapy for the palliative treatment of adult patients with locally advanced or metastatic soft tissue sarcoma. Cochrane Database Syst Rev, 3, 3293.
  2. Canter RJ, Qin LX, Maki RG, et al (2008). A synovial sarcomaspecific preoperative nomogram supports a survival benefit to ifosfamide-based chemotherapy and improves risk stratification for patients. Clin Cancer Res, 14, 8191-7.
  3. Elias AD (1994). Salvage therapy for soft tissue sarcomas. Semin Oncol, 4, 76-81.
  4. Ferrari A, De Salvo GL, Dall'Igna P, et al (2012). Salvage rates and prognostic factors after relapse in children and adolescents with initially localised synovial sarcoma. Eur J Cancer, 48, 3448-55.
  5. Hensley ML, Maki R, Venkatraman E, et al (2002). Gemcitabine and docetaxel in patients with unresectable leiomyosarcoma: results of a phase II trial. J Clin Oncol, 20, 2824-31.
  6. Karavasilis V, Seddon BM, Ashley S, et al (2008). Significant clinical benefit of first-line palliative chemotherapy in advanced soft-tissue sarcoma: retrospective analysis and identification of prognostic factors in 488 patients. Cancer, 112, 1585-91.
  7. Kaya AO, Buyukberber S, Ozkan M, et al (2012). Efficacy and toxicity of gemcitabine plus docetaxel combination as a second line therapy for patients with advanced stage soft tissue sarcoma. Asian Pac J Cancer Prev, 13, 463-7.
  8. Lee EM, Rha SY, Lee J, Park KH, Ahn JH (2012). Phase II study of weekly docetaxel and fixed dose rate gemcitabine in patients with previously treated advanced soft tissue and bone sarcoma. Cancer Chemother Pharmacol, 69, 635-42.
  9. Palmerini E, Staals EL, Alberghini M, et al (2009). Synovial sarcoma: retrospective analysis of 250 patients treated at a single institution. Cancer, 115, 2988-98.
  10. Potter DA, Glenn J, Kinsella T, et al (1985). Patterns of recurrence in patients with high-grade soft-tissue sarcomas. J Clin Oncol, 3, 353-66.
  11. Shi W, Indelicato DJ, Morris CG, et al (2013). Long-term treatment outcomes for patients with synovial sarcoma: a 40-year experience at the University of Florida. Am J Clin Oncol, 36, 83-8.
  12. Sleijfer S, Ouali M, van Glabbeke M, et al (2010). Prognostic and predictive factors for outcome to first-line ifosfamidecontaining chemotherapy for adult patients with advanced soft tissue sarcomas: an exploratory, retrospective analysis on large series from the European Organization for Research and Treatment of Cancer-Soft Tissue and Bone Sarcoma Group (EORTC-STBSG). Eur J Cancer, 46, 72-83.
  13. Spurrell EL, Fisher C, Thomas JM, Judson IR (2005). Prognostic factors in advanced synovial sarcoma: an analysis of 104 patients treated at the Royal Marsden Hospital. Ann Oncol, 16, 437-44.
  14. Trassard M, Le Doussal V, Hacene K, et al (2001). Prognostic factors in localized primary synovial sarcoma: a multicenter study of 128 adult patients. J Clin Oncol, 19, 525-34.
  15. van Geel AN, Pastorino U, Jauch KW, et al (1996). Surgical treatment of lung metastases: the European organization for research and treatment of cancer-soft tissue and bone sarcoma group study of 255 patients. Cancer, 77, 675-82.<675::AID-CNCR13>3.0.CO;2-Y
  16. Van Glabbeke M, van Oosterom AT, Oosterhuis JW, et al (1999). Prognostic factors for the outcome of chemotherapy in advanced soft tissue sarcoma: an analysis of 2,185 patients treated with anthracycline-containing first-line regimens--a European organization for research and treatment of cancer soft tissue and bone sarcoma group study. J Clin Oncol, 17, 150-7.

Cited by

  1. Computed Tomography Manifestations of Histologic Subtypes of Retroperitoneal Liposarcoma vol.15, pp.15, 2014,
  2. Synovial sarcoma diagnosis and management in the era of targeted therapies vol.27, pp.4, 2015,