The natural history of metastatic synovial sarcoma: experience of the Southwest Oncology group.

Of 35 treated cases of metastatic synovial sarcoma, there was a slight male predominance (60%). The median age was 33 years, with 88% of the patients being white. The lower extremity was the most common primary site, occurring in 66% of the cases. The most common metastatic involvement was pulmonary (33 patients), with only three patients having lymph node involvement. The low incidence of lymph node involvement and the poor prognosis when positive lymph nodes are found suggest that prophylactic lymph node resection is unwarranted. The median time from evidence of metastases to death was ten months. The complete and partial response rate to chemotherapy in this series was 50%; however, duration of the response was rather short with recurrence of metastatic disease a median of seven months after response was first noted. The size of the primary lesion was greater than 5 cm in all but one of the cases. The local recurrence rate was 70% in those cases undergoing local resection and 30% in those cases in which local resection plus irradiation to the primary lesion was undertaken. No case in which radical resection of the primary tumor was undertaken had a local recurrence.