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Sarcoma sinovial de extremidades com doença localizada ao diagnóstico: tratamento e padrões de recidiva em 57 casos Localized extremity sinovial sarcoma: treatment and patterns of recurrence in 57 cases

By Danton S. Corrêa, Isabela W. da Cunha, André L. Carvalho, Fernando A Soares, Roberto Fauzoni and Ademar Lopes

Abstract

OBJETIVOS: Os sarcomas sinoviais são tumores raros e agressivos que acometem adultos jovens, com sobrevida doençaespecífica em cinco anos de 57 a 63%. O presente estudo analisa a experiência institucional com este tumor, dando ênfase à associação entre variáveis clínicas, padrões de recorrência e sobrevida. MÉTODO: Entre 1970 e 2001 foram identificados 57 pacientes com sarcomas sinoviais. Fatores demográficos, clínicos e anatomopatológicos foram pesquisados. Associações entre variáveis clínicas e a sobrevida livre de recidiva local, livre de metástases e doença-específica em cinco anos foram calculadas. RESULTADOS: A idade mediana dos pacientes foi 26 anos, 56% eram masculinos, 79% eram brancos. Localizavam-se em membro inferior em 74%, proximalmente em 53%. O sintoma mais comum foi a presença de tumor em 42%. Na admissão 18% eram intactos, 42% manipulados e 40% recidivados. A maioria era maior que 5 cm., e três pacientes apresentavam metástase linfonodal. A cirurgia mais freqüente foi ressecção ampla, 30% necessitou amputação. Margens amplas foram obtidas em 65%, 51% eram tumores bifásicos. Neoadjuvância foi utilizada em 46% e adjuvância em 58% dos casos. As sobrevidas livre de recidiva local , metástases e doença específica em cinco anos foram 60&plusmn;8%, 47&plusmn;7% e 58&plusmn;7%. A localização proximal do tumor associou-se com preservação de membro (p=-0,001), margens inadequadas (p=0,006) e subtipo bifásico (p=0,047). CONCLUSÕES: Os dados confirmam a hipótese de tratar-se de tumor agressivo, com altos índices de recidiva local e à distância. Os resultados do tratamento são comparáveis a outros centros especializados. Tratamento fora destes centros deve ser desencorajado.<br>BACKGROUND: Synovial sarcoma is a rare and aggressive tumor more frequently affecting young adults and has a 5 year disease specific survival of 57-63%. The present study describes the institutional experience with the treatment of this tumor, emphasizing associations between clinical variables, patterns of recurrence and survival. METHODS: Between 1970 and 2001, 57 patients were identified with synovial sarcomas. Demographic, clinical and histological factors were analyzed. Associations between clinical variables and 5 year local recurrence free, metastasis free and disease specific survival were calculated. RESULTS: Median patient age was 26 years, 56% were male and 79% caucasians. Tumors were located in the lower limb in 74%, proximally in 53%.The most common symptom was the presence of tumor in 42%. At admission, 18% were intact, 42% manipulated and 40% recurrent. Most of them were larger than 5 cm, 3 patients had lymph node metastasis. The most common procedure was extensive resection, 30% were amputated. Wide margins were obtained in 65%, 51% were biphasic tumors. Neoadjuvant therapy was performed in 46%, 56% had adjuvant therapy. The 5 year local recurrence free, metastasis free and disease specific survival were 60&plusmn;8%, 47&plusmn;7% e 58&plusmn;7%. Proximal location was associated with limb sparing procedures (p=0.001), close margins (p=0.006) and biphasic tumors (p=0.047). CONCLUSION: Data support the hypothesis that this is an aggressive tumor, with high rates of local and remote recurrences. The survival obtained was comparable to other reference centers. Treatment outside these centers should be discouraged

Topics: Sarcoma sinovial, Tratamento, Recidiva, Synovial sarcoma, Therapy, Recurrence, LCC:Surgery, LCC:RD1-811, LCC:Medicine, LCC:R, DOAJ:Surgery, DOAJ:Medicine (General), DOAJ:Health Sciences
Publisher: Colégio Brasileiro de Cirurgiões
Year: 2005
DOI identifier: 10.1590/S0100-69912005000600004
OAI identifier: oai:doaj.org/article:b52749ead4b140f9bd029c68b3e17630
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