Pulmonary metastasectomy in pediatric/adolescent patients with synovial sarcoma: An institutional review

Purpose: Synovial sarcoma (SS) often metastasizes to the lung; however, the indications for and outcomes of pulmonary metastasectomy have not been evaluated in pediatric/adolescent patients. Methods: The records of pediatric patients (age < 22 years) with pathologically confirmed SS and pulmonary metastasis treated between June 1971 and May 2011 at our institution were retrospectively reviewed for the number and type of surgical metastasectomies, tumor characteristics, and survival outcomes. Results: Forty-one patients (mean age: 15.9 years) were identified and 31 (76%) underwent at least one metastasectomy. Seventy-two resections (range, 1-8/patient) were performed. Two- and 5-year survival rates after metastasis diagnosis were 65% and 24% for patients who underwent metastasectomy. Patients who did not undergo a metastasectomy survived no more than 2 years from the diagnosis of pulmonary disease (P < 0.001). Longer time to progression after primary tumor resection (> 1 year) and complete resection of pulmonary disease correlated with greater OS (P = 0.02 and P < 0.001, respectively). Palliative debulking did not improve OS. Survival was unaffected by tumor histological subtype, bilateral pulmonary disease, number of surgical resections, or number and size of resected metastatic lesions. Conclusion: Pulmonary metastasectomy may be associated with improved survival in pediatric/adolescent patients with SS and pulmonary metastases if complete resection is achieved. (c) 2013 Elsevier Inc. All rights reserved.