eMedicine Specialties > Orthopedic Surgery > Neoplasms

Synovial Cell Sarcoma: Follow-up

Author: Bernardo Vargas, MD, Consulting Staff, Department of Orthopedic Surgery, Hôpital Universitaire de Geneva, Switzerland
Coauthor(s): Mark Clayer, MD, MBBS, FRACS, FAOrthA, Head of Musculoskeletal Tumor Service, Department of Orthopaedics and Trauma, Queen Elizabeth Hospital; Senior Visiting Medical Specialist, Royal Adelaide Hospital and Women's and Children's Hospital, Australia
Contributor Information and Disclosures

Updated: Aug 7, 2008

Outcome and Prognosis

Synovial cell sarcoma has been reported to be a particularly metastasizing tumor.22 Many factors modify patient outcome,10,18,23,12 such as tumor size, anatomic localization, and histologic grade. Nevertheless, histologic criteria such as nuclear grade, measures of mitotic count, and amount of necrosis are subjective and sometimes difficult to compare. Synovial cell sarcoma has survival rates of 50-60% at 5 years and 40-50% at 10 years. However, advances in oncologic therapy, particularly the development of monoclonal antibodies, may improve survival rates (see Future and Controversies).

A slight improvement in survival rate has been reported with the use of chemotherapy as adjuvant therapy.7,2,3 Recurrence has been reported up to 69 months after treatment and suggests a worse prognosis with low survival rates. Distant metastases at presentation suggests a bad prognosis (2-year survival rate of 25%)

Prognostic factors that correlate with a better prognosis have been described24 and include the following:

  • Biphasic histologic pattern
  • Patients with SYT/SSX2 fusion genes
  • Location in the hand or foot
  • Size < 5 cm
  • Female sex
  • Age < 50 years
  • Negative resection margins

Future and Controversies

Some studies have shown promising results in the treatment of synovial cell sarcoma xenografts with a murine monoclonal antibody.16 This monoclonal antibody attacks a frizzled homologue called FZD10 (a cell-surface receptor), which is present in the synovial sarcoma cells and absent in the normal organs. Clinical applications of these monoclonal antibodies are not still available. An additional innovative technique could be a SYT-SSX – derived peptide vaccine.11

Another controversial aspect of treatment of synovial cell sarcoma is the efficacy of chemotherapy as adjuvant treatment after surgery. Chemotherapy has not proved to provide a significant benefit in survival rates in all series. A multicenter clinical trial for the treatment of patients with soft tissue sarcoma includes patients with soft tissue sarcoma stage IV and evaluates the clinical response of a treatment with topotecan and carboplatin. Information is available on the clinical trial web site. 

 


More on Synovial Cell Sarcoma

Overview: Synovial Cell Sarcoma
Workup: Synovial Cell Sarcoma
Treatment: Synovial Cell Sarcoma
Follow-up: Synovial Cell Sarcoma
Multimedia: Synovial Cell Sarcoma
References
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References

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Further Reading

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Keywords

synovial cell sarcoma, synovial sarcoma, synovial cell, connective tissue tumor, connective tissue neoplasm, synovioma, malignant neoplasm, malignant tumor, joint tumors

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Contributor Information and Disclosures

Author

Bernardo Vargas, MD, Consulting Staff, Department of Orthopedic Surgery, Hôpital Universitaire de Geneva, Switzerland
Disclosure: Nothing to disclose.

Coauthor(s)

Mark Clayer, MD, MBBS, FRACS, FAOrthA, Head of Musculoskeletal Tumor Service, Department of Orthopaedics and Trauma, Queen Elizabeth Hospital; Senior Visiting Medical Specialist, Royal Adelaide Hospital and Women's and Children's Hospital, Australia
Mark Clayer, MD, MBBS, FRACS, FAOrthA is a member of the following medical societies: Australian Medical Association and Australian Orthopaedic Association
Disclosure: Orthopedics hyperguide Honoraria Independent contractor; Stryker Grant/research funds Employment

Medical Editor

Howard A Chansky, MD, Associate Professor, Department of Orthopedics and Sports Medicine, University of Washington Medical Center
Howard A Chansky, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Sean P Scully, MD, PhD, Professor, Department of Orthopedics, University of Miami
Sean P Scully, MD, PhD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, International Society on Thrombosis and Haemostasis, and Society of Surgical Oncology
Disclosure: Nothing to disclose.

CME Editor

Dinesh Patel, MD, FACS, Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital
Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Physicians of Indian Origin, American College of International Physicians, and American College of Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Harris Gellman, MD, Consulting Surgeon, Broward Hand Center; Voluntary Clinical Professor of Orthopedic Surgery and Plastic Surgery, Departments of Orthopedic Surgery and Surgery, University of Miami School of Medicine
Harris Gellman, MD is a member of the following medical societies: American Academy of Medical Acupuncture, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Society for Surgery of the Hand, and Arkansas Medical Society
Disclosure: Nothing to disclose.

 
 
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