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Synovial Sarcoma — SCE Medical Oncology MCQ

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ModerateSarcomaSynovial SarcomaSCE Medical Oncology

A 48-year-old man with synovial sarcoma (confirmed by SS18-SSX fusion) of the thigh has completed neoadjuvant radiotherapy and wide excision. The tumour was 10 cm, high-grade, deep, with close margins. The role of adjuvant chemotherapy in soft tissue sarcoma is debated. What do the data suggest?

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Correct answer: D — Adjuvant doxorubicin-ifosfamide chemotherapy may provide a modest OS benefit in high-risk STS, though the evidence remains controversial

The role of adjuvant chemotherapy in STS remains one of the most debated topics in sarcoma oncology. The ISG-STS 1001 trial (histotype-tailored neoadjuvant chemotherapy) and meta-analyses suggest a modest DFS and possibly OS benefit with anthracycline-ifosfamide regimens for high-risk localised STS (large, deep, high-grade). Benefit may be greater for chemosensitive histotypes (synovial sarcoma, UPS). The STRASS2 trial is evaluating neoadjuvant chemotherapy. Patient selection is critical.

Reference: ESMO 2024 Soft Tissue Sarcoma Guidelines; Pervaiz et al Cancer 2008 meta-analysis; ISG-STS 1001