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Clinical outcomes for patients with synovial sarcoma of the hand.

Outani H, Hamada K, Oshima K, Joyama S, Naka N, Araki N, Ueda T, Yoshikawa H - Springerplus (2014)

Bottom Line: No patients developed lymph node metastasis.The estimated 5-year overall survival was 80%.Regional lymph node dissection does not seem to be essential for synovial sarcoma of the hand.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita, Osaka 565-0871 Japan.

ABSTRACT

Purpose: Soft tissue sarcoma of the hand is rare, and one of the most common histological diagnosis is synovial sarcoma. We report the clinical outcomes of patients with synovial sarcoma of the hand and discuss treatment strategies.

Methods: We reviewed five patients with synovial sarcoma of the hand treated at our institutions from 1983 to 2013. The mean patient age at the time of diagnosis was 36.6 years (range, 20-62 years). Two patients underwent marginal excision after neoadjuvant chemotherapy, followed by radiation therapy, one underwent wide local excision and two received chemotherapy and radiation therapy.

Results: The average duration of follow-up for all patients was 88.2 months (range, 14-218 months). Two patients continuously remained disease free, two experienced local recurrence requiring additional surgery and then showed no evidence of disease, and one who had distant metastasis at diagnosis died of the disease. No patients developed lymph node metastasis. The estimated 5-year overall survival was 80%.

Conclusions: Our case series suggests that patients with localised synovial sarcoma of the hand may have favourable outcomes. Wide excision or marginal excision, followed by radiation therapy combined with chemotherapy, represent acceptable treatment strategies for synovial sarcoma of the hand. Regional lymph node dissection does not seem to be essential for synovial sarcoma of the hand.

No MeSH data available.


Related in: MedlinePlus

Representative case: case 3. (a) A 62-year-old male patient with synovial sarcoma in the dorsoradial aspect of the hand. (b) Magnetic resonance imaging (MRI) of the tumour showed isointensity on a T1 image, (c) inhomogeneous high on a T2 image and (d) enhancement with the use of gadolinium. The mass spanned the first, second and third compartments of the extensor tendon sheath but with no evidence of bone involvement.
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Fig1: Representative case: case 3. (a) A 62-year-old male patient with synovial sarcoma in the dorsoradial aspect of the hand. (b) Magnetic resonance imaging (MRI) of the tumour showed isointensity on a T1 image, (c) inhomogeneous high on a T2 image and (d) enhancement with the use of gadolinium. The mass spanned the first, second and third compartments of the extensor tendon sheath but with no evidence of bone involvement.

Mentions: Two patients underwent biopsy at our institutions (Cases 3 and 4). Of these two patients, one was treated with marginal excision after neoadjuvant chemotherapy, followed by radiation therapy (Figure 1), and the other patient who had distant metastasis at diagnosis refused surgery and received chemotherapy and radiation therapy. Three patients underwent inappropriate surgical excisions without wide safety margins in another hospital and required further treatment (Cases 1, 2 and 5). Of these three patients, one developed multiple local recurrences and underwent marginal excision to avoid hand amputation and preserve hand function after neoadjuvant chemotherapy followed by radiation therapy, one underwent wide excision with free tendon graft reconstruction, and the third refused surgery and received chemotherapy and radiation therapy. From 1983 to 1996, the chemotherapy regimen was dacarbazine, vincristine, nimustine, and interferon β (dacarbazine, 140 mg/m2/day over 1–5 days; vincristine, 1.5 mg/m2 only on the first day; nimustine, 80 mg/m2 only on the first day and interferon β, 6 × 106 U/day for 1–5 days). After 1997, the regimen was a combination of doxorubicin and ifosfamide (doxorubicin, 30 mg/m2/day for 1–2 days and ifosfamide, 2.5 g/m2/day for 1–4 days) or high-dose ifosfamide (3 g/m2/day for 1–5 days).Figure 1


Clinical outcomes for patients with synovial sarcoma of the hand.

Outani H, Hamada K, Oshima K, Joyama S, Naka N, Araki N, Ueda T, Yoshikawa H - Springerplus (2014)

Representative case: case 3. (a) A 62-year-old male patient with synovial sarcoma in the dorsoradial aspect of the hand. (b) Magnetic resonance imaging (MRI) of the tumour showed isointensity on a T1 image, (c) inhomogeneous high on a T2 image and (d) enhancement with the use of gadolinium. The mass spanned the first, second and third compartments of the extensor tendon sheath but with no evidence of bone involvement.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4230306&req=5

Fig1: Representative case: case 3. (a) A 62-year-old male patient with synovial sarcoma in the dorsoradial aspect of the hand. (b) Magnetic resonance imaging (MRI) of the tumour showed isointensity on a T1 image, (c) inhomogeneous high on a T2 image and (d) enhancement with the use of gadolinium. The mass spanned the first, second and third compartments of the extensor tendon sheath but with no evidence of bone involvement.
Mentions: Two patients underwent biopsy at our institutions (Cases 3 and 4). Of these two patients, one was treated with marginal excision after neoadjuvant chemotherapy, followed by radiation therapy (Figure 1), and the other patient who had distant metastasis at diagnosis refused surgery and received chemotherapy and radiation therapy. Three patients underwent inappropriate surgical excisions without wide safety margins in another hospital and required further treatment (Cases 1, 2 and 5). Of these three patients, one developed multiple local recurrences and underwent marginal excision to avoid hand amputation and preserve hand function after neoadjuvant chemotherapy followed by radiation therapy, one underwent wide excision with free tendon graft reconstruction, and the third refused surgery and received chemotherapy and radiation therapy. From 1983 to 1996, the chemotherapy regimen was dacarbazine, vincristine, nimustine, and interferon β (dacarbazine, 140 mg/m2/day over 1–5 days; vincristine, 1.5 mg/m2 only on the first day; nimustine, 80 mg/m2 only on the first day and interferon β, 6 × 106 U/day for 1–5 days). After 1997, the regimen was a combination of doxorubicin and ifosfamide (doxorubicin, 30 mg/m2/day for 1–2 days and ifosfamide, 2.5 g/m2/day for 1–4 days) or high-dose ifosfamide (3 g/m2/day for 1–5 days).Figure 1

Bottom Line: No patients developed lymph node metastasis.The estimated 5-year overall survival was 80%.Regional lymph node dissection does not seem to be essential for synovial sarcoma of the hand.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita, Osaka 565-0871 Japan.

ABSTRACT

Purpose: Soft tissue sarcoma of the hand is rare, and one of the most common histological diagnosis is synovial sarcoma. We report the clinical outcomes of patients with synovial sarcoma of the hand and discuss treatment strategies.

Methods: We reviewed five patients with synovial sarcoma of the hand treated at our institutions from 1983 to 2013. The mean patient age at the time of diagnosis was 36.6 years (range, 20-62 years). Two patients underwent marginal excision after neoadjuvant chemotherapy, followed by radiation therapy, one underwent wide local excision and two received chemotherapy and radiation therapy.

Results: The average duration of follow-up for all patients was 88.2 months (range, 14-218 months). Two patients continuously remained disease free, two experienced local recurrence requiring additional surgery and then showed no evidence of disease, and one who had distant metastasis at diagnosis died of the disease. No patients developed lymph node metastasis. The estimated 5-year overall survival was 80%.

Conclusions: Our case series suggests that patients with localised synovial sarcoma of the hand may have favourable outcomes. Wide excision or marginal excision, followed by radiation therapy combined with chemotherapy, represent acceptable treatment strategies for synovial sarcoma of the hand. Regional lymph node dissection does not seem to be essential for synovial sarcoma of the hand.

No MeSH data available.


Related in: MedlinePlus