M. D. Cserhati

Synovial sarcomas usually metastasize after >5 years: a multicenter retrospective analysis with minimum follow-up of 10 years for survivors

BACKGROUND Synovial sarcoma (SS) is a malignant soft tissue sarcoma with a poor prognosis because of late local recurrence and distant metastases. To our knowledge, no studies have minimum follow-up of 10 years that evaluate long-term outcomes for survivors. PATIENTS AND METHODS Data on 62 patients who had been treated for SS from 1968 to 1999 were studied retrospectively in a multicenter study. Mean follow-up of living patients was 17.2 years and of dead patients 7.7 years. RESULTS Mean age at diagnosis was 35.4 years (range 6-82 years). Overall survival was 38.7%. The 5-year survival was 74.2%; 10-year survival was 61.2%; and 15-year survival was 46.5%. Fifteen patients (24%) died of disease after 10 years of follow-up. Local recurrence occurred after a mean of 3.6 years (range 0.5-14.9 years) and metastases at a mean of 5.7 years (range 0.5-16.3 years). Only four patients were treated technically correctly with a planned biopsy followed by a wide resection or amputation. Factors associated with significantly worse prognosis included larger tumor size, metastases at the time of diagnosis, high-grade histology, trunk-related disease, and lack of wide resection as primary surgical treatment. CONCLUSIONS In SS, metastases develop late with high mortality. Patients with SS should be followed for >10 years.

The Effect of Chemotherapy on Human Bone Sarcomas: A Clinical and Experimental Study

Osteosarcomas are relatively rare tumors affecting younger people, mostly men. The prognosis in these cases is uniformly bad. An analysis of the course of the disease 10 years ago revealed that roughly 10 months after removal of the primary tumor, lung metastases develop (Sweetnam et al. 1971). Before 1970, a 5-year survival of 20% or less is reported following surgical treatment of the bone tumor. Chemotherapy was essentially unsuccesful until the early 1970s, when trials with doxorubicin and high-dose methotrexate were initiated. With these two drugs, considerable response rates (mostly partial remissions) were reported in metastatic disease.

Chemotherapy of soft tissue sarcomas with Cyclophosphamid or Ifosfamid, Adriamycin and DTIC (CAD or IAD) preoperatively and in patients with metastatic disease : a non randomized pilot study

Soft tissue sarcomas are rare tumors, in localized disease most authors report a five year survival between 40 and 60%. Patients with soft tissue sarcomas mostly present with their primary tumors; they can be rendered disease free clinically by wide resection. Since local recurrences and metastases, especially in grade II and III soft tissue sarcomas over 5 cm in size are a major therapeutic problem, combined modality treatment with radiotherapy and adjuvant chemotherapy is evaluated in prospective studies. Limb sparing procedures without jeopardizing the result may be used, if they are associated with radiotherapy and chemotherapy (Eilber 1980, Consensus Conference 1985, Eilber 1990). Several chemotherapeutic agents, most recently Ifosfamid was added to the list, are found to be effective; among the most promising regimes were Cyclophosphamid, Adriamycin, DTIC (CAD, Blum 1980) and in recent years Ifosfamid, Adriamycin, DTIC (IAD, Elias 1989).

Clinical Experience with Preoperative Chemotherapy for Osteosarcoma

Since 1978 preoperative chemotherapy has been administered to 15 consecutive patients with osteosarcomas in Zurich. Preoperative chemotherapy was acceptably well tolerated and did not impair surgical procedures. Our retrospective analysis confirmed that the extent of necrosis after preoperative chemotherapy is of biological importance for the further course of the disease. Patients with extensive necrosis had better relapse-free survival and longer overall survival than those with little necrosis.