title: Neo/adjuvant chemotherapy does not improve outcome in resected primary synovial sarcoma: a study of the French Sarcoma Group.
abstract: BACKGROUND
  There are only scarce data about the benefit of adjunctive chemotherapy in patients with localized synovial sarcoma (SS).
  
  
  METHODS
  Data from 237 SS patients recorded in the database of the French Sarcoma Group were retrospectively analyzed. The respective impact of radiotherapy, neo-adjuvant chemotherapy and adjuvant chemotherapy on overall survival (OS), local recurrence-free survival (LRFS) and distant recurrence-free survival (DRFS) were assessed after adjustment to prognostic factors.
  
  
  RESULTS
  The median follow-up was 58 months (range 1-321). Adjuvant, neo-adjuvant chemotherapy and postoperative radiotherapy were administered in 112, 45 and 181 cases, respectively. In all, 59% of patients treated with chemotherapy received an ifosfamide-containing regimen. The 5-year OS, LRFS and DRFS rates were 64.0%, 70% and 57%, respectively. On multivariate analysis, age >35 years old, grade 3 and not-R0 margins were highly significant independent predictors of worse OS. After adjustment to prognostic factors, radiotherapy significantly improved LRFS but not DRFS or OS. Neither neo-adjuvant nor adjuvant chemotherapy had significant impact on OS, LRFS or DRFS.
  
  
  CONCLUSIONS
  As for other high-grade soft-tissue sarcomas, well-planned wide surgical excision with adjuvant radiotherapy remains the cornerstone of treatment for SS. Neo-adjuvant or adjuvant chemotherapy should not be delivered outside a clinical trial setting.
authors.affiliation: Department of Medical Oncology, Institut Bergonié, Bordeaux, France. italiano@bergonie.org
authors.forename: A
authors.initials: A
authors.lastname: Italiano
authors.forename: N
authors.initials: N
authors.lastname: Penel
authors.forename: Y-M
authors.initials: YM
authors.lastname: Robin
authors.forename: B
authors.initials: B
authors.lastname: Bui
authors.forename: A
authors.initials: A
authors.lastname: Le Cesne
authors.forename: S
authors.initials: S
authors.lastname: Piperno-Neumann
authors.forename: M
authors.initials: M
authors.lastname: Tubiana-Hulin
authors.forename: E
authors.initials: E
authors.lastname: Bompas
authors.forename: C
authors.initials: C
authors.lastname: Chevreau
authors.forename: N
authors.initials: N
authors.lastname: Isambert
authors.forename: S
authors.initials: S
authors.lastname: Leyvraz
authors.forename: P P
authors.initials: PP
authors.lastname: du Chatelard
authors.forename: A
authors.initials: A
authors.lastname: Thyss
authors.forename: J-M
authors.initials: JM
authors.lastname: Coindre
authors.forename: J-Y
authors.initials: JY
authors.lastname: Blay
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D005260:Female; D005602:France; D006801:Humans; D008297:Male; D008875:Middle Aged; D013584:Sarcoma, Synovial / Q000188:drug therapy* / Q000601:surgery; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents