Pubfacts. com – synovial sarcoma relapses in children and adolescents_ prognostic factors, treatment, and outcome

Twenty-five to 32% of patients with synovial sarcoma (SS) relapse after appropriate treatment, and experience a poor outcome. Sarcoma oncology Patients who can be salvaged by second-line therapy need to be more clearly identified.

Data of patients treated in SFCE (Société Française des Cancers de l’Enfant) centers with an initial diagnosis of localized SS before the age of 18 years and treated from 1/1988 to 12/2008, and who experienced at least one relapse, were retrieved. Undifferentiated sarcoma survival rate After descriptive analysis, statistical analysis was performed to determine prognostic factors.


Thirty-seven patients were identified. Sarcoma chemotherapy regimen First relapse occurred after a median interval of 24 months and was localized in 73.0% of cases and metastatic in 24.3% of cases. Sarcoma statistics Treatment of relapse consisted of new surgery in 75.7% of cases, second-line chemotherapy in 73.0% of cases and radiotherapy in 48.6% of cases. Sarcoma survival rate Response rate to ifosfamide-based regimens was 36.4%. Ewing sarcoma cancer ribbon color Overall, 70.3% patients achieved a second complete remission. Granulocytic sarcoma Median 5-year-event-free survival was 32.8% and 5-year overall survival was 42.1%. Sarcoma lung metastases prognosis Factors significantly correlated with better survival were primary tumor involving the limbs, age less than 12 years at diagnosis, absence of chemotherapy or radiotherapy as initial treatment and local relapse.

Despite its poor overall outcome, relapse of synovial sarcoma sometimes remains curable. Cancer sarcoma de kaposi Aggressive surgery, when possible, in combination with chemotherapy and radiotherapy is the recommended treatment. Ewing sarcoma translocation Ifosfamide-based regimens may remain effective in patients with relapsed SS. Types of sarcoma cancer in dogs However, alternative therapies should be proposed in patients with poor prognostic factors.

Twenty-five to 32% of patients with synovial sarcoma (SS) relapse after appropriate treatment, and experience a poor outcome. Cure sarcoma Patients who can be salvaged by second-line therapy need to be more clearly identified.

Data of patients treated in SFCE (Société Française des Cancers de l’Enfant) centers with an initial diagnosis of localized SS before the age of 18 years and treated from 1/1988 to 12/2008, and who experienced at least one relapse, were retrieved. Sarcoma institute After descriptive analysis, statistical analysis was performed to determine prognostic factors.

Thirty-seven patients were identified. Granulocytic sarcoma prognosis First relapse occurred after a median interval of 24 months and was localized in 73.0% of cases and metastatic in 24.3% of cases. Pnet sarcoma Treatment of relapse consisted of new surgery in 75.7% of cases, second-line chemotherapy in 73.0% of cases and radiotherapy in 48.6% of cases. Synovial sarcoma foot Response rate to ifosfamide-based regimens was 36.4%. Synovial cell sarcoma cancer Overall, 70.3% patients achieved a second complete remission. Ewing sarcoma radiology Median 5-year-event-free survival was 32.8% and 5-year overall survival was 42.1%. Sarcoma breast cancer symptoms Factors significantly correlated with better survival were primary tumor involving the limbs, age less than 12 years at diagnosis, absence of chemotherapy or radiotherapy as initial treatment and local relapse.

Despite its poor overall outcome, relapse of synovial sarcoma sometimes remains curable. Sarcoma skin cancer pictures Aggressive surgery, when possible, in combination with chemotherapy and radiotherapy is the recommended treatment. Synovial sarcoma images Ifosfamide-based regimens may remain effective in patients with relapsed SS. Osteosarcoma symptoms However, alternative therapies should be proposed in patients with poor prognostic factors.

Treatment of aggressive lymphoma in relapse is difficult. Endometrial sarcoma staging Patients who initially present with these diseases often know they have a malignancy considered curable in many cases, and diagnosis of relapse can be devastating. Sarcoma tumor For this reason, it is useful to know the individual patient’s risk of relapse prior to starting initial therapy, since it may be appropriate to treat patients with poor prognoses with intensive programs or investigational studies. Sarcoma tumor in lung In the private practice setting, most patients with these diseases receive CHOP or similar cyclophosphamide and doxorubicin-containing regimens at the time of initial diagnosis. Signs and symptoms of sarcoma However, there are certain disease-related features which determine whether these patients have a high or low risk of relapse, and investigators are now using combinations of these features to determine which patients may be safely treated with CHOP and which may benefit from more intensive chemotherapy management. Pleomorphic fibroblastic sarcoma For example, the International Prognostic Factor Index system, now in common usage, delineates four different groups of patients with differing complete remission, freedom from progression, and overall survival rates. Epithelioid sarcoma like hemangioendothelioma The Tumor Score System, developed at MDACC, delineates only two groups with very different survival rates, and may be a better scoring system for patients with diffuse large cell lymphomas, primarily because of its inclusion of the serum beta(2)-microglobulin level prior to treatment, an important predictor of relapse. Uterine sarcoma In addition to pretreatment features, certain treatment-related factors are also important in determining the risk of relapse, including the dose of chemotherapy administered and the rapidity of response. Sarcoma cancer centers Results of a gallium scan with SPECT imaging may be an important method of confirming complete response, and should be incorporated into treatment programs, whether the treatment is standard CHOP or an investigational program. Ewing sarcoma stage 4 survival rate For the patient with relapse or progressive disease following induction with CHOP or a similar regimen, the type of response to initial therapy plays an important role in determining potential response to salvage therapy, including high-dose therapy followed by stem cell rescue. What is a sarcoma tumor Patients for whom initial treatment fails to achieve any response have a very poor chance of responding to any currently used standard-dose program for relapse. Can sarcoma be cured Those with partial responses have a better chance of responding to relapse therapy, but a high risk of disease progression or early relapse, and those with a prior complete response to initial therapy have a good chance of responding to relapse therapy, especially those in whom the complete response lasted more than a year. Sarcoma lump on leg For these reasons, stem cell transplant (SCT) protocols routinely require complete response with initial therapy as a requirement for entry, although “good partial remission” may be acceptable at certain centers. Connective tissue sarcoma Other limitations for SCT protocols include age greater than 60 or 65 years, significant chronic obstructive pulmonary, renal, or cardiac disease, a poor performance status, and central nervous system or marrow involvement. Angiosarcoma liver For these reasons, there is a continued need for newer treatment programs which offer the potential for higher response rates and better survival rates, not only for those for whom SCT is not an option, but also for those who must have an adequate response to “standard dose therapy” prior to selecting SCT as a treatment option. Angiosarcoma of the breast Three broad groups of relapse therapy for aggressive lymphoma have been described, based upon the drugs contained within these regimens. Sarcoma breast cancer treatment These include platinum-based, mitoxantrone-based, and ifosfamide-based chemotherapy regimens. Ewing sarcoma definition Results with these programs vary widely and are likely different because of tumor-related features prior to relapse therapy, including size of mass, beta(2)-microglobulin level, LDH level, and type of response to initial therapy. Sarcoma treatment guidelines Other features, such as dose of therapy, specific drugs utilized, and number of prior treatments also play important roles in determining results with relapse therapy. Myxoid sarcoma symptoms In a study of DHAP followed by transplant or more DHAP, DHAP induced a response in 56% of patients, and at 5 years, significantly more of the responders to DHAP who were subsequently treated with high-dose therapy and bone marrow transplant were free of disease compared to those who continued to receive DHAP after response to this regimen. Sarcoma signs Therefore, high-dose therapy is clearly better for DHAP responders than is continued DHAP. Sarcoma surgeon However, results for the overall population are still not good when non-responders are included in the analysis, and DHAP, a first-generation platinum regimen, may not be the optimal regimen to use prior to high-dose therapy followed by peripheral stem cell rescue. Stromal sarcoma in dogs At MDACC, we have extensively investigated various combinations containing ifosfamide and etoposide. Retroperitoneal sarcoma symptoms The most recently reported regimen, MINE-ESHAP, contains mesna, ifosfamide, mitoxantrone, and etoposide, followed after adequate response with etoposide, methylprednisolone, high-dose cytarabine, and continuous infusion as cis-platinum, a second-generation platinum regimen. Pediatric sarcoma prognosis This strategy resulted in a complete response in 47% of the patients treated, with a 44% complete response in patients with intermediate-grade lymphoma, 56% in those with low-grade lymphoma and 36% in those with transformed lymphoma. Osteogenic sarcoma definition Results varied according to type of response achieved with initial therapy, and serum LDH and beta(2)-microglobulin levels prior to treatment with MINE-ESHAP. Ewing sarcoma medscape Using more intensive doses of ifosfamide and etoposide, we have described therapy for 36 patients with relapsed aggressive lymphomas, prior to pheresis and SCT. Ewing sarcoma chemotherapy regimen Results of this study are encouraging: 42% entered complete response with ifosfamide-etoposide and the overall survival was 52%, with a progression-free survival of 32%. Sarcoma types of cancer Therapy with a similar regimen, combining ifosfamide, carboplatin, and etoposide in standard doses (ICE) has also been described. Sarcoma bone cancer statistics This regimen has been extensively studied in patients with relapsed aggressive lymphomas and Hodgkin’s disease, followed by SCT. Sarcoma tumor size In patients with relapsed lymphomas, ICE has achieved a 66% complete response rate, with 89% undergoing transplant. Ewing sarcoma recurrence Overall survival in these studies is affected by the quality of the response to ICE. Histiocytic sarcoma cytology The same program was used to treat 65 patients with Hodgkin’s disease. Basal cell carcinoma symptoms The response rate to ICE was 88%, and the 5-year event-free survival for those transplanted was 68%. Spindle cell sarcoma stages These factors predicted outcome: B symptoms, extranodal disease, and complete response less than 1 year. Kaposi sarcoma meaning Finally, we have recently studied paclitaxel in combination with topotecan for relapsed and refractory aggressive lymphomas. Angiosarcoma in dogs These and newer combinations should be further developed to treat patients in relapse of aggressive lymphomas.

The aim of this analysis was to identify if the modified indications of radiotherapy (RT) or radical surgery compromised survival in pediatric synovial sarcoma (SS).

Children with non-metastatic SS, prospectively enrolled in three trials, were analyzed. Types of sarcoma After primary surgery or biopsy, they received chemotherapy. Sarcoma cancer color RT was planned after chemotherapy in patients who had not achieved a complete response (CR). Pleomorphic sarcoma lung The considered outcome was 5-year overall survival (OS) and event-free survival (EFS).

Eighty-eight patients were identified. Stromal sarcoma Primary tumors were mainly located in limbs (66%). Kaposi sarcoma mouth The first-line therapy for 65 patients was primary resection. Sarcoma awareness images Of the 49 patients who had gross tumor resection, 43 received adjuvant chemotherapy, and 8 had RT. Mfh sarcoma All of the 39 patients with macroscopic residual disease received chemotherapy, then only surgery (n = 12) ± RT (n = 22). Sarcoma staging ajcc The 5-year EFS and OS rates were 68% and 85%, respectively. Osteosarcoma treatment The TNM stage was a prognostic factor for relapse, whereas primary site of the tumor and TNM stage were prognostic factors for death.

Only 32% of survivors received RT. Basal cell carcinoma cancer OS was similar to published data. Endometrial sarcoma treatment Omission of RT may be considered in younger children, to limit the potential sequelae in patients with tumors less than 5 cm in size initially submitted to marginal resection. Ewing sarcoma lung cancer This strategy may also be considered in initially unresected cases, when the tumor is resected at delayed surgery with microscopically free margins, and in patients in complete remission after primary chemotherapy.