Correspondence
Genetic Abnormalities in Synovial Sarcoma
N Engl J Med 1998; 338:1699June 4, 1998
- Article
To the Editor:
In their study of SYT–SSX gene fusion in synovial sarcoma, Kawai et al. (Jan. 15 issue)1 found a significant relation between the SYT–SSX2 subtype and metastasis-free survival. Adjuvant ifosfamide-based chemotherapy did not appear to be a prognostic factor. The authors conclude “that the survival advantage of the SYT–SSX2 group was not related to treatment with this agent.”
Randomized trials have suggested that adjuvant chemotherapy may prolong survival free of distant metastases, but in meta-analyses, only doxorubicin-based adjuvant chemotherapy significantly improves recurrence-free survival in soft-tissue sarcomas.2 There are few data about the results with ifosfamide used as a single agent in soft-tissue sarcomas.3,4 Ifosfamide seems to improve the response rate in synovial sarcoma, but only in association with doxorubicin.5 A more complete description of the chemotherapy regimens used, including the doses and schedules of ifosfamide and the number of patients treated with doxorubicin, would have made it easier to understand what effect the chemotherapy had on metastasis-free survival.
5 ReferencesPhilippe Debourdeau, M.D.
Joseph Gligorov, M.D.
Corinne Couteau, M.D.
Hôpital Percy, 92141 Clamart CEDEX, France1
Kawai A ,Woodruff J ,Healey JH ,Brennan MF ,Antonescu CR ,Ladanyi M . SYT-SSX gene fusion as a determinant of morphology and prognosis in synovial sarcoma. N Engl J Med 1998;338:153-160
Full Text | Web of Science | Medline2
Sarcoma Meta-analysis Collaboration
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Rosen G ,Forscher C ,Lowenbraun S , et al. Synovial sarcoma: uniform response of metastases to high dose ifosfamide. Cancer 1994;73:2506-2511
CrossRef | Web of Science | Medline4
Connelly EF ,Budd GT . Ifosfamide in the treatment of soft tissue sarcomas. Semin Oncol 1996;23:Suppl 6:16-21
Web of Science | Medline5
Edmonson JH ,Ryan LM ,Blum RH , et al. Randomized comparison of doxorubicin alone versus ifosfamide plus doxorubicin or mitomycin, doxorubicin, and cisplatin against advanced soft tissue sarcomas. J Clin Oncol 1993;11:1269-1275
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Author/Editor Response
The authors reply:
To the Editor: Debourdeau et al. point out that meta-analysis has suggested a small (4 to 10 percent) benefit from adjuvant doxorubicin-based chemotherapy in soft-tissue sarcomas.1 Our study was not designed to examine the benefit of adjuvant chemotherapy in synovial sarcoma. Ifosfamide was always used as part of a multiagent regimen in our patients, usually in combination with doxorubicin, but not all patients received chemotherapy. The number of patients in our study is small because of the rarity of the tumor and does not allow meaningful examination of the absolute benefit of chemotherapy. Analysis of chemotherapy-related variables in subgroups would have been inappropriate, given the small number of patients with each fusion transcript who received chemotherapy.
Only 7 percent of soft-tissue sarcomas are synovial sarcomas. More common sarcomas, such as liposarcomas and malignant fibrous histiocytomas, dominate in most reports of treatment. This concern is especially pertinent since synovial sarcoma is one of the few solid tumors that has a unique chromosomal abnormality, and it differs from other soft-tissue sarcomas in terms of age at onset and its anatomical distribution. For these reasons, we believe that it is inappropriate to extrapolate the results of treatment of heterogeneous types of sarcomas to any one histologic subtype.
1 ReferencesJohn H. Healey, M.D.
Marc Ladanyi, M.D.
Murray F. Brennan, M.D.
Memorial Sloan-Kettering Cancer Center, New York, NY 100211
Tierney JF ,Mosseri V ,Stewart LA ,Souhami RL ,Parmar MK . Adjuvant chemotherapy for soft-tissue sarcoma: review and meta-analysis of the published results of randomised clinical trials. Br J Cancer 1995;72:469-475
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