Association of Histologic Subtype With Radiation Response and Survival Outcomes in Synovial Sarcoma
Purpose: Synovial sarcoma (SS) is a rare, aggressive soft tissue malignancy that is divided into biphasic and monophasic histologic subtypes. In addition to surgical resection, radiation therapy (RT) improves local control in patients at higher risk of recurrence. This study aimed to investigate the...
Saved in:
| Main Authors: | , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2025-03-01
|
| Series: | Advances in Radiation Oncology |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2452109425000065 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850205440480116736 |
|---|---|
| author | Jennifer K. Matsui, MD, PhD Scott Jackson, MS Judy Fang, MS David G. Mohler, MD Robert J. Steffner, MD Raffi S. Avedian, MD Gregory W. Charville, MD, PhD Matt van de Rijn, MD Lynn Million, MD Alexander L. Chin, MD, MBA Susan M. Hiniker, MD Anusha Kalbasi, MD Everett J. Moding, MD, PhD |
| author_facet | Jennifer K. Matsui, MD, PhD Scott Jackson, MS Judy Fang, MS David G. Mohler, MD Robert J. Steffner, MD Raffi S. Avedian, MD Gregory W. Charville, MD, PhD Matt van de Rijn, MD Lynn Million, MD Alexander L. Chin, MD, MBA Susan M. Hiniker, MD Anusha Kalbasi, MD Everett J. Moding, MD, PhD |
| author_sort | Jennifer K. Matsui, MD, PhD |
| collection | DOAJ |
| description | Purpose: Synovial sarcoma (SS) is a rare, aggressive soft tissue malignancy that is divided into biphasic and monophasic histologic subtypes. In addition to surgical resection, radiation therapy (RT) improves local control in patients at higher risk of recurrence. This study aimed to investigate the impact of histologic subtype on radiation response and survival outcomes in patients treated with RT as part of definitive management. Methods and Materials: We retrospectively identified patients with SS treated with RT and surgical resection from 1997 to 2020 at Stanford Medical Center. We assessed the association between histologic subtypes (biphasic vs monophasic) and response to preoperative RT based on imaging and pathology. Volumetric response was calculated using the pre-RT and post-RT/preoperative postcontrast T1-weighted magnetic resonance imaging images. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method. Univariable and multivariable analyses were conducted using Cox regression models. Variables for univariable and multivariable analyses included age, histologic subtypes, tumor location, tumor size, margin status, chemotherapy, and performance status. Results: In our study, 50 patients met the inclusion criteria. The median age was 34.8 years at diagnosis, and 36% (n = 18) received concurrent chemotherapy. Biphasic (n = 18, 36%) and monophasic (n = 32, 64%) tumors exhibited significant differences in negative margin status (94% vs 66%, P = .036). Of the 22 patients who underwent preoperative RT, 15 patients had pre-RT and post-RT imaging to assess volumetric changes. Biphasic tumors demonstrated less necrosis at the time of surgical resection but a significantly greater volumetric decrease with preoperative RT (42% vs 5%, P = .004). PFS and OS were superior in biphasic tumors (P = .003 and P = .009, respectively). Multivariable analyses identified histologic subtypes (monophasic vs biphasic) as a significant factor impacting PFS (HR, 5.65; 95% CI, 1.78-17.91; P = .003). Conclusions: Biphasic tumors exhibit an improved volumetric response to preoperative RT and improved outcomes. These findings underscore the importance of considering histology when tailoring treatment for patients with SS. |
| format | Article |
| id | doaj-art-0b286eb61ca44a50b6b89a779b47ad01 |
| institution | OA Journals |
| issn | 2452-1094 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Advances in Radiation Oncology |
| spelling | doaj-art-0b286eb61ca44a50b6b89a779b47ad012025-08-20T02:11:05ZengElsevierAdvances in Radiation Oncology2452-10942025-03-0110310171810.1016/j.adro.2025.101718Association of Histologic Subtype With Radiation Response and Survival Outcomes in Synovial SarcomaJennifer K. Matsui, MD, PhD0Scott Jackson, MS1Judy Fang, MS2David G. Mohler, MD3Robert J. Steffner, MD4Raffi S. Avedian, MD5Gregory W. Charville, MD, PhD6Matt van de Rijn, MD7Lynn Million, MD8Alexander L. Chin, MD, MBA9Susan M. Hiniker, MD10Anusha Kalbasi, MD11Everett J. Moding, MD, PhD12The Ohio State University College of Medicine, Columbus, Ohio; Department of Radiation Oncology, Stanford University, Stanford, CaliforniaDepartment of Radiation Oncology, Stanford University, Stanford, CaliforniaDepartment of Radiation Oncology, Stanford University, Stanford, CaliforniaDepartment of Orthopedic Surgery, Stanford University, Stanford, CaliforniaDepartment of Orthopedic Surgery, Stanford University, Stanford, CaliforniaDepartment of Orthopedic Surgery, Stanford University, Stanford, CaliforniaDepartment of Pathology, Stanford University, Stanford, CaliforniaDepartment of Pathology, Stanford University, Stanford, CaliforniaDepartment of Radiation Oncology, Stanford University, Stanford, CaliforniaDepartment of Radiation Oncology, Stanford University, Stanford, CaliforniaDepartment of Radiation Oncology, Stanford University, Stanford, CaliforniaDepartment of Radiation Oncology, Stanford University, Stanford, CaliforniaDepartment of Radiation Oncology, Stanford University, Stanford, California; Corresponding author: Everett J. Moding, MD, PhDPurpose: Synovial sarcoma (SS) is a rare, aggressive soft tissue malignancy that is divided into biphasic and monophasic histologic subtypes. In addition to surgical resection, radiation therapy (RT) improves local control in patients at higher risk of recurrence. This study aimed to investigate the impact of histologic subtype on radiation response and survival outcomes in patients treated with RT as part of definitive management. Methods and Materials: We retrospectively identified patients with SS treated with RT and surgical resection from 1997 to 2020 at Stanford Medical Center. We assessed the association between histologic subtypes (biphasic vs monophasic) and response to preoperative RT based on imaging and pathology. Volumetric response was calculated using the pre-RT and post-RT/preoperative postcontrast T1-weighted magnetic resonance imaging images. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method. Univariable and multivariable analyses were conducted using Cox regression models. Variables for univariable and multivariable analyses included age, histologic subtypes, tumor location, tumor size, margin status, chemotherapy, and performance status. Results: In our study, 50 patients met the inclusion criteria. The median age was 34.8 years at diagnosis, and 36% (n = 18) received concurrent chemotherapy. Biphasic (n = 18, 36%) and monophasic (n = 32, 64%) tumors exhibited significant differences in negative margin status (94% vs 66%, P = .036). Of the 22 patients who underwent preoperative RT, 15 patients had pre-RT and post-RT imaging to assess volumetric changes. Biphasic tumors demonstrated less necrosis at the time of surgical resection but a significantly greater volumetric decrease with preoperative RT (42% vs 5%, P = .004). PFS and OS were superior in biphasic tumors (P = .003 and P = .009, respectively). Multivariable analyses identified histologic subtypes (monophasic vs biphasic) as a significant factor impacting PFS (HR, 5.65; 95% CI, 1.78-17.91; P = .003). Conclusions: Biphasic tumors exhibit an improved volumetric response to preoperative RT and improved outcomes. These findings underscore the importance of considering histology when tailoring treatment for patients with SS.http://www.sciencedirect.com/science/article/pii/S2452109425000065 |
| spellingShingle | Jennifer K. Matsui, MD, PhD Scott Jackson, MS Judy Fang, MS David G. Mohler, MD Robert J. Steffner, MD Raffi S. Avedian, MD Gregory W. Charville, MD, PhD Matt van de Rijn, MD Lynn Million, MD Alexander L. Chin, MD, MBA Susan M. Hiniker, MD Anusha Kalbasi, MD Everett J. Moding, MD, PhD Association of Histologic Subtype With Radiation Response and Survival Outcomes in Synovial Sarcoma Advances in Radiation Oncology |
| title | Association of Histologic Subtype With Radiation Response and Survival Outcomes in Synovial Sarcoma |
| title_full | Association of Histologic Subtype With Radiation Response and Survival Outcomes in Synovial Sarcoma |
| title_fullStr | Association of Histologic Subtype With Radiation Response and Survival Outcomes in Synovial Sarcoma |
| title_full_unstemmed | Association of Histologic Subtype With Radiation Response and Survival Outcomes in Synovial Sarcoma |
| title_short | Association of Histologic Subtype With Radiation Response and Survival Outcomes in Synovial Sarcoma |
| title_sort | association of histologic subtype with radiation response and survival outcomes in synovial sarcoma |
| url | http://www.sciencedirect.com/science/article/pii/S2452109425000065 |
| work_keys_str_mv | AT jenniferkmatsuimdphd associationofhistologicsubtypewithradiationresponseandsurvivaloutcomesinsynovialsarcoma AT scottjacksonms associationofhistologicsubtypewithradiationresponseandsurvivaloutcomesinsynovialsarcoma AT judyfangms associationofhistologicsubtypewithradiationresponseandsurvivaloutcomesinsynovialsarcoma AT davidgmohlermd associationofhistologicsubtypewithradiationresponseandsurvivaloutcomesinsynovialsarcoma AT robertjsteffnermd associationofhistologicsubtypewithradiationresponseandsurvivaloutcomesinsynovialsarcoma AT raffisavedianmd associationofhistologicsubtypewithradiationresponseandsurvivaloutcomesinsynovialsarcoma AT gregorywcharvillemdphd associationofhistologicsubtypewithradiationresponseandsurvivaloutcomesinsynovialsarcoma AT mattvanderijnmd associationofhistologicsubtypewithradiationresponseandsurvivaloutcomesinsynovialsarcoma AT lynnmillionmd associationofhistologicsubtypewithradiationresponseandsurvivaloutcomesinsynovialsarcoma AT alexanderlchinmdmba associationofhistologicsubtypewithradiationresponseandsurvivaloutcomesinsynovialsarcoma AT susanmhinikermd associationofhistologicsubtypewithradiationresponseandsurvivaloutcomesinsynovialsarcoma AT anushakalbasimd associationofhistologicsubtypewithradiationresponseandsurvivaloutcomesinsynovialsarcoma AT everettjmodingmdphd associationofhistologicsubtypewithradiationresponseandsurvivaloutcomesinsynovialsarcoma |