title: Synovial sarcoma: retrospective analysis of 250 patients treated at a single institution.
abstract: BACKGROUND
  The optimal treatment for synovial sarcoma remains controversial. Treatment, outcome, and prognostic factors in patients treated in a single institution were examined.
  
  
  METHODS
  Synovial sarcoma patients who underwent surgery at the Rizzoli Institute between 1976 and 2006 were identified and analyzed.
  
  
  RESULTS
  Characteristics of the 250 patients (128 female; 122 male) included: median age, 37 years (range, 7-83 years); 177 (71%) with tumors in the lower extremity, 40 (16%) with tumors in the upper extremity, and 33 with tumors in the trunk (13%); primary lesion size >5 cm in 121 patients (55%); and 204 (82%) patients with localized disease and 46 (18%) with metastatic disease at the time of presentation. All patients with localized disease underwent surgery. Twenty-four percent of patients underwent amputation. Adequate surgical margins were achieved in 88% patients. In patients with localized disease, radiotherapy was administered to 103 (50%) patients, and chemotherapy to 98 (48%). With a median follow-up of 5.5 years (range, 1-30 years), the 5-year overall survival rate was 10% for patients with metastatic disease and 76% for patients with localized disease (P = .0001). The 5-year event-free survival was 58% in patients with localized disease. Multivariate analysis indicated that size, age, histologic subtype, and the use of radiotherapy were independent factors for event-free survival.
  
  
  CONCLUSIONS
  In those patients with localized disease, a good rate of cure can be achieved. Age, size, histology, and use of radiotherapy influence prognosis, whereas to the authors' knowledge, the role of adjuvant chemotherapy remains unproven.
authors.affiliation: Department of Chemotherapy, Rizzoli Orthopedic Institute, Bologna, Italy. emanuela.palmerini@ior.it
authors.forename: Emanuela
authors.initials: E
authors.lastname: Palmerini
authors.forename: Eric L
authors.initials: EL
authors.lastname: Staals
authors.forename: Marco
authors.initials: M
authors.lastname: Alberghini
authors.forename: Licciana
authors.initials: L
authors.lastname: Zanella
authors.forename: Cristina
authors.initials: C
authors.lastname: Ferrari
authors.forename: Maria Serena
authors.initials: MS
authors.lastname: Benassi
authors.forename: Piero
authors.initials: P
authors.lastname: Picci
authors.forename: Mario
authors.initials: M
authors.lastname: Mercuri
authors.forename: Gaetano
authors.initials: G
authors.lastname: Bacci
authors.forename: Sefano
authors.initials: S
authors.lastname: Ferrari
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001132:Arm; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007866:Leg; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D011379:Prognosis; D012189:Retrospective Studies; D013584:Sarcoma, Synovial / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D015996:Survival Rate