Limb Salvage in Recurrent Synovial Sarcoma of the Right Ankle and Lower Leg

Abstract

Synovial sarcoma of the extremities represents 7% of all soft-tissue sarcomas. This article presents the case of a patient who was treated for a synovial sarcoma of the lateral aspect of the distal lower leg extending to the ankle and involving the fibular bone. The patient underwent a wide excision of the tumor, including the fibular bone, followed by radiation and chemotherapy, rather than undergo an amputation of the right leg. Consideration is also given to the traumatic etiology of the tumor.

Soft Tissue Sarcomas of the Foot and Ankle: Impact of Unplanned Excision, Limb Salvage, and Multimodality Therapy

“…Neoadjuvant and adjuvant therapies represent a critical component of the local control and systemic treatment of patients with STS. 9,17,30,31 Particularly for high grade lesions, limb salvage without chemotherapy or radiation may result in a high rate of local recurrence and relapse. 31,32 Modern radiation therapy can assist in the control of residual microscopic STS.…”

“…Achieving local tumor control while avoiding amputation and preserving satisfactory function therefore remain the principal challenges in the surgical management of patients with foot and ankle sarcomas. 31…”

“…Previous studies on this topic have generally reported small numbers of patients, making meaningful analysis of oncologic and functional outcomes difficult (Table 1). 3,25–27,31–33 Questions remain unanswered regarding the feasibility of limb salvage following initial unplanned excision, whether multimodal adjuvant therapy permits limb-sparing surgery without compromise of functional or oncologic outcomes, and whether transtibial amputation offers a better oncologic outcome in these patients. The purpose of this study was to evaluate the efficacy of limb salvage in the treatment of STS of the foot and ankle over a 22-year period, with particular attention to the aforementioned lingering clinical questions.…”

Long-Term Outcome of Soft Tissue Sarcomas of the Foot Treated with Limb Salvage Surgery and Radiotherapy.

“…6,7,9,15,20,[23][24][25][26] Synovial sarcoma has poor prognosis due to the patterns of recurrence such as local invasion potential along the fascia, regional lymph node metastases and the distant metastases. 22 In this study, even though there is a distinct difference of local control, disease-free and overall survival rates between patients with synovial histopathology and the patients with other histopathology, this difference was not statistically significant. Our patients with local recurrences were controlled with salvage treatments.…”

“…13,14,21 Good local control with sparing of limb function using the combined therapeutic approach in the sarcoma of foot has been demonstrated. 3,8,10,22 In the literature, local recurrence rate was 10-14% for STS of the foot. 7,11,13 Temple et al and Kozawa et al reported worse outcomes in patients undergoing amputations compared to patients having limb sparing surgery.…”