title: Chemotherapy is associated with improved survival in adult patients with primary extremity synovial sarcoma.
abstract: OBJECTIVE
  To determine if ifosfamide-based chemotherapy (IF) offers a survival benefit to adult patients with primary extremity synovial sarcoma.
  
  
  METHODS
  Prospectively collected patient data from 2 institutions was used to identify all adult patients (>or=16 years) with >or=5 cm, deep, primary, extremity, synovial sarcoma that underwent surgical treatment of cure from 1990 to 2002. A total of 101 patients were identified and the median follow-up for survivors was 58 months. Clinical, pathologic, and treatment variables were analyzed for disease-specific survival (DSS), distant recurrence-free survival (DRFS), and local recurrence-free survival (LRFS).
  
  
  RESULTS
  Sixty-eight (67%) patients were treated with IF and 33 (33%) patients received no chemotherapy (NoC) for the primary tumor. The characteristics of the IF-treated patients [median tumor size = 7.2 cm; monophasic n = 46 (68%)] were similar to NoC patients [median tumor size = 7 cm; monophasic n = 23 (70%)]. The 4-year DSS of the IF-treated patients was 88% compared with 67% for the NoC patients (P = 0.01). Smaller size (HR = 0.3 per 5-cm decrease, P < 0.0001) and treatment with IF (HR = 0.3 compared with NoC, P = 0.007) were independently associated with an improved DSS. Treatment with IF was independently associated with an improved DRFS (HR = 0.4, P = 0.03) but not associated with an improved LRFS (P = 0.39).
  
  
  CONCLUSIONS
  Ifosfamide-based chemotherapy was associated with an improved DSS in adult patients with high-risk, primary, extremity, synovial sarcoma and should be considered in the treatment of such patients.
authors.affiliation: Division of Surgical Oncology, University of California Los Angeles, Los Angeles, CA, USA.
authors.forename: Fritz C
authors.initials: FC
authors.lastname: Eilber
authors.forename: Murray F
authors.initials: MF
authors.lastname: Brennan
authors.forename: Frederick R
authors.initials: FR
authors.lastname: Eilber
authors.forename: Jeffery J
authors.initials: JJ
authors.lastname: Eckardt
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Grobmyer
authors.forename: Elyn
authors.initials: E
authors.lastname: Riedel
authors.forename: Charles
authors.initials: C
authors.lastname: Forscher
authors.forename: Robert G
authors.initials: RG
authors.lastname: Maki
authors.forename: Samuel
authors.initials: S
authors.lastname: Singer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000903:Antibiotics, Antineoplastic / Q000627:therapeutic use; D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use; D001132:Arm; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007069:Ifosfamide / Q000627:therapeutic use*; D007866:Leg; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality; D011446:Prospective Studies; D013584:Sarcoma, Synovial / Q000188:drug therapy* / Q000401:mortality*; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome
chemical_list: D000903:Antibiotics, Antineoplastic; D018906:Antineoplastic Agents, Alkylating; D004317:Doxorubicin; D007069:Ifosfamide