ROLE OF IRRADIATION IN MANAGEMENT OF SYNOVIAL SARCOMA - ST-JUDE-CHILDRENS-RESEARCH-HOSPITAL EXPERIENCE

The role of irradiation in the management of synovial sarcoma (SS) in pediatric patients is evaluated. The review covers all children seen a t St. jude Children's Research Hospital between May 1969 and December 1992 with the diagnosis of soft tissue sarcoma, of the 37 patients wit h the subtype SS, 16 received irradiation for the management of primar y site disease. There were four IRS Group I, six Group II, four Group III, and two Group IV patients receiving irradiation. Tumor grade incl uded seven Grade II and nine Grade III lesions. TMN staging identified eight T1 and eight T2 lesions. Follow-up has ranged from 14 to 117 mo nths (med = 33 months). All IRS Group I patients had documented local control. Five of six IRS Group II and 4/4 Group lit patients have had documented local control at last followup. IRS Group IV patients had e ither local control tumor stabilization (n = 1) or evidence of tumor r egression (n = 1) at autopsy. Complications following irradiation incl ude wound dehiscence (n = 1), surgery to revise a painful scar (n = 1) extremity length discrepancy (n = 2), and femoral head avascular necr osis (n = 1). At last follow-up, 10 of 14 patients receiving curative intent irradiation remain alive. This review indicates questionable be nefit to the addition of irradiation for patients with adequate surgic al resection and having ''good'' tumor characteristics (Grade I, II; I RS Group I, TMN T-1A, T-1B). For lesions that have had incomplete rese ction or partial response to chemotherapy, there is evidence that irra diation may provide durable local control. The role of irradiation in those patients with IRS Group IV disease is at present confined to pal liative roles until the time when more effective chemotherapy will man date the decision to treat primary disease for curative measures. (C) 1996 Wiley-Liss, Inc.