mesna and Sarcoma--Synovial

This report describes the unusually high response rate of metastatic synovial sarcoma to high dose ifosfamide (14-18 g/m2) when that drug was used to treat 13 consecutive patients with recurrent metastatic synovial sarcoma before surgery (or thoracotomies) to provide optimal salvage therapy for these patients.. Thirteen patients with recurrent or pulmonary metastatic synovial sarcoma seen at the Cedars-Sinai Comprehensive Cancer Center (Los Angeles, CA) from April, 1989 through January, 1993 were treated with high dose ifosfamide (14-18 g/m2). Ifosfamide was infused at the dose of 2 g/m2 over a 4-hour bolus infusion, followed by 2-g/m2 24-hour continuous infusions of ifosfamide, for a total of 14 or 18 g/m2 (6-8 days). Mesna (Mesnex, Bristol-Myers Oncology, Princeton, NJ) was infused with the ifosfamide at equimolar doses. Supplemental sodium bicarbonate (180 mEq) was given daily to prevent severe acidosis. Nine of the thirteen patients were treated with prior chemotherapy for their primary tumors. Prior chemotherapy consisted of doxorubicin (Adriamycin, Adria Labs, Dublin, OH) in all patients and doxorubicin combined with cisplatin in eight of them.. All 13 patients had objective responses to high dose ifosfamide chemotherapy. There were nine partial responses and four complete responses. Five of the patients died of disease at 20-40 months (median, 27 months) from initial therapy. Eight patients have survived from 2 to 43 months (median, 20 months) from initial therapy, and three of these patients are disease free. Those patients surviving disease free had successful surgical removal of their residual metastatic disease after chemotherapy.. Metastatic synovial sarcoma appears to be particularly sensitive to high dose ifosfamide chemotherapy. This experience suggests that there is a role for high dose ifosfamide chemotherapy in preoperative and postoperative adjuvant chemotherapy for primary synovial sarcoma, which is usually always a high grade malignant lesion with a poor prognosis after surgery alone.

Topics: Adolescent; Adult; Female; Humans; Ifosfamide; Infusions, Parenteral; Lung Neoplasms; Male; Mesna; Neoplasm Recurrence, Local; Sarcoma, Synovial

The role of adjuvant chemotherapy (AC) in treatment of synovial sarcoma remains controversial. Aim of our study is to investigate the influence of AC on disease-specific survival and metastasis free survival, the difference in time to metastasis (TTM) was also analyzed.. Seventy-six cases of stage IIB/III synovial sarcoma from January 1993 to December 2008 were retrospectively analyzed. All the 76 patients were treated with surgical resection. AC regimen included first line MAID or AIM, second line Gemcitabine + Docetaxel with sufficient dose intensity. The clinical, pathologic, and treatment variables were analyzed for disease specific survival (DSS), metastasis free survival (MFS) and TTM.. Median follow up period was 68 months. 51 patients received AC (51/76, 67%), 25 received no adjuvant chemotherapy (NAC, 25/76, 33%). The 5-year DSS of the AC patients was 73%(58-87%) compared with 31%(19-52%) for the NAC patients (P = 0.001). AC was also independently associated with improved MFS (P = 0.008) and prolonged TTM (P = 0.001).. Patients with stage IIB/III synovial sarcoma might benefit in DSS, MFS, and a prolonged TTM from AC.

Topics: Adult; Analysis of Variance; Antineoplastic Combined Chemotherapy Protocols; Chemotherapy, Adjuvant; Dacarbazine; Deoxycytidine; Disease-Free Survival; Docetaxel; Doxorubicin; Drug Administration Schedule; Extremities; Female; Gemcitabine; Humans; Ifosfamide; Kaplan-Meier Estimate; Male; Mesna; Middle Aged; Neoplasm Grading; Neoplasm Recurrence, Local; Neoplasm Staging; Radiotherapy, Adjuvant; Remission Induction; Sarcoma, Synovial; Soft Tissue Neoplasms; Taxoids

Vulvar synovial cell sarcomas are rare, with only four previously published cases in the literature. Traditionally, the primary management for these tumors has been surgery alone.. We report a case of a large vulvar synovial cell sarcoma in a 50-year-old woman treated with comprehensive combined multimodality management, including preoperative intensity-modulated radiation therapy, radical hemivulvectomy, flap reconstruction, interstitial low-dose-rate brachytherapy boost, and adjuvant chemotherapy.. Based on this case and the limited data in the literature, multimodality treatment of advanced soft tissue sarcoma of the vulva may optimize local control and minimize toxicity while preserving sexual function.

Topics: Antineoplastic Combined Chemotherapy Protocols; Brachytherapy; Chemotherapy, Adjuvant; Combined Modality Therapy; Doxorubicin; Female; Humans; Ifosfamide; Mesna; Middle Aged; Plastic Surgery Procedures; Sarcoma, Synovial; Surgical Flaps; Vulvar Neoplasms

Retroperitoneal synovial sarcomas are very rare. The authors describe a 39-year-old male with a primary retroperitoneal synovial sarcoma showing a monophasic pattern. Immunohistochemically, the tumor cells were positive for cytokeratin AE1/AE3, epithelial membrane antigen, vimentin, S-100 protein, CD99 and calretinin. The differential diagnosis, clinical evolution and principles of treatment are shortly discussed.

Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Dacarbazine; Doxorubicin; Humans; Ifosfamide; Male; Mast Cells; Mesna; Mitosis; Retroperitoneal Neoplasms; Sarcoma, Synovial; Thoracic Neoplasms

Topics: Adult; Aneuploidy; Antineoplastic Combined Chemotherapy Protocols; Biomarkers, Tumor; Carboplatin; Doxorubicin; Etoposide; Fatal Outcome; Female; Humans; Ifosfamide; Maternal Age; Mesna; Neoplasm Recurrence, Local; Omentum; Peritoneal Neoplasms; Pregnancy; Pregnancy Complications, Neoplastic; Pregnancy, High-Risk; Sarcoma, Synovial