title: Pulmonary metastasectomy in pediatric/adolescent patients with synovial sarcoma: an institutional review.
abstract: OBJECTIVE
  Synovial sarcoma (SS) often metastasizes to the lung; however, the indications for and outcomes of pulmonary metastasectomy have not been evaluated in pediatric/adolescent patients.
  
  
  METHODS
  The records of pediatric patients (age <22years) with pathologically confirmed SS and pulmonary metastasis treated between June 1971 and May 2011 at our institution were retrospectively reviewed for the number and type of surgical metastasectomies, tumor characteristics, and survival outcomes.
  
  
  RESULTS
  Forty-one patients (mean age: 15.9years) were identified and 31 (76%) underwent at least one metastasectomy. Seventy-two resections (range, 1-8/patient) were performed. Two- and 5-year survival rates after metastasis diagnosis were 65% and 24% for patients who underwent metastasectomy. Patients who did not undergo a metastasectomy survived no more than 2years from the diagnosis of pulmonary disease (P<0.001). Longer time to progression after primary tumor resection (>1year) and complete resection of pulmonary disease correlated with greater OS (P=0.02 and P<0.001, respectively). Palliative debulking did not improve OS. Survival was unaffected by tumor histological subtype, bilateral pulmonary disease, number of surgical resections, or number and size of resected metastatic lesions.
  
  
  CONCLUSIONS
  Pulmonary metastasectomy may be associated with improved survival in pediatric/adolescent patients with SS and pulmonary metastases if complete resection is achieved.
authors.affiliation: Pediatric Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Stanelle
authors.forename: Emily R
authors.initials: ER
authors.lastname: Christison-Lagay
authors.forename: Suzanne L
authors.initials: SL
authors.lastname: Wolden
authors.forename: Paul A
authors.initials: PA
authors.lastname: Meyers
authors.forename: Michael P
authors.initials: MP
authors.lastname: La Quaglia
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008175:Lung Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D059146:Metastasectomy / Q000379:methods*; D012086:Reoperation; D012189:Retrospective Studies; D013584:Sarcoma, Synovial / Q000473:pathology*; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult