AccScience Publishing / TD / Volume 2 / Issue 2 / DOI: 10.36922/td.356
Cite this article
Journal Browser
Volume | Year
News and Announcements
View All

Stereotactic radiotherapy with simultaneous integrated protection planning technique for synovial sarcoma with stomach abutment: A case report of a complete response

Marco Lorenzo Bonù1 Eneida Mataj1* Jacopo Balduzzi1 Maria Teresa Cefaratti1 Gloria Pedersoli1 Gianluca Cossali1 Luca Triggiani1 Davide Tomasini1 Michela Buglione1 Stefano Maria Magrini1
Show Less
1 Department of Radiation Oncology, Istituto del Radio O. Alberti, University of Brescia and Spedali Civili Hospital, Brescia, Italy
Tumor Discovery 2023, 2(2), 356
Submitted: 7 February 2023 | Accepted: 26 April 2023 | Published: 10 May 2023
© 2023 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( )

Here, we report the clinical case of a 44-year-old lady, affected by synovial sarcoma (SS) of the mediastinum which was treated in 2014, and relapsed in the upper abdomen in 2020. SS is a relatively radioresistant disease, radiotherapy (RT) is routinely reserved for the neoadjuvant/adjuvant or palliative context. In our scenario, stereotactic RT consisting in 45Gy in 6 fractions was proposed to manage the upper abdominal relapse. Exploiting simultaneous integrated protection, a deliberated reduction in the dose prescription in area of planning target volume overlapped with stomach was achieved, obtaining reasonable dosimetric goals. Acute toxicity in the patient was acceptable, and she did not experience late toxicity and was still free from disease, as noted in last follow-up, 15 months after treatment.

Synovial sarcoma
Stereotactic body radiotherapy
Stereotactic radiotherapy (RT)
Simultaneous integrated protection
  1. Khin T, Cyril F, 2014, Synovial sarcoma: defining features and diagnostic evolution. Ann Diagn Pathol, 18: 369–380.


  1. Fisher C, 1998, Synovial sarcoma. Ann Diagn Pathol, 2: 401–421.


  1. Jo VY, Fletcher CD, 2014, WHO Classification of soft tissue tumours: An update based on the 2013 (4th) edition. Pathology, 46: 95–104.


  1. Orbach D, Mc Dowell H, Rey A, et al., 2011, Sparing strategy does not compromise prognosis in pediatric localized synovial sarcoma: experience of the International Society of Pediatric Oncology, Malignant Mesenchymal Tumors (SIOP- MMT) Working Group. Pediatr Blood Cancer, 57: 1130–1136.


  1. Miyashita T, Imamura T, Ishikawa Y, et al., 1994, Primary retroperitoneal synovial sarcoma. Intern Med, 33(11): 692–696.


  1. Oppedal BR, Royne T, Titterud I, 1985, Synovial sarcomas of the neck. A report of two cases. J Laryngol Otol, 99: 101–104.


  1. Holtz F, Magielski JE, 1985, Synovial sarcomas of the tongue base. Arch Otolaryngol, 111: 271–272.


  1. Pruszczynski M, Manni JJ, Smedts F, 1989, Endolaryngeal synovial sarcoma: Case report with immunohistochemical studies. Head Neck, 11: 76–80.


  1. Hayashi U, Sasao T, Fujita T, et al., 1986, Synovial sarcoma of the abdominal wall. Gan No Rinsho, 32: 95–100. (in Japanese).


  1. Bloch MJ, Iozzo RV, Edmunds LH, et al., 1987, Polypoid synovial sarcoma of the esophagus. Gastroenterology, 92: 229–233.


  1. Bergh P, Meis-Kindblom JM, Gherlinzoni F, et al., 1999, Synovial sarcoma: Identification of low and high risk groups. Cancer, 85: 2596–2607.


  1. Singer S, Baldini EH, Demetri GD, et al., 1996, Synovial sarcoma: Prognostic significance of tumor size, margin of resection, and mitotic activity for survival. J Clin Oncol, 14: 1201–1208.


  1. Ferrari A, Gronchi A, Casanova M, et al., 2004, Synovial sarcoma: A retrospective analysis of 271 patients of all ages treated at a single institution. Cancer, 101(3): 627–634.


  1. Guillou L, Benhattar J, Bonichon F, et al., 2004, Histologic grade, but not SYT-SSX fusion type, is an important prognostic factor in patients with synovial sarcoma: A multicenter, retrospective analysis. J Clin Oncol, 22: 4040–4050.


  1. Lewis JJ, Antonescu CR, Leung DH, et al., 2000, Synovial sarcoma: A multivariate analysis of prognostic factors in 112 patients with primary localized tumors of the extremity. J Clin Oncol, 18: 2087–2094.


  1. Gingrich AA, Marrufo AS, Liu Y, et al., 2020, Radiotherapy is associated with improved survival in patients with synovial sarcoma undergoing surgery: A national cancer database analysis. J Surg Res, 255: 378–387.


  1. Naing KW, Monjazeb AM, Li CS, et al., 2014, Perioperative radiotherapy is associated with improved survival among patients with synovial sarcoma: A SEER analysis. J Surg Oncol, 111: 158–164.


  1. Song S, Park J, Kim HJ, et al., 2017, Effects of adjuvant radiotherapy in patients with synovial sarcoma. Am J Clin Oncol, 40: 306–311.


  1. Gundle KR, Gupta S, Kafchinski L, et al., 2017, An analysis of tumor- and surgery-related factors that contribute to inadvertent positive margins following soft tissue sarcoma resection. Ann Surg Oncol, 24: 2137–2144.


  1. O’Donnell PW, Griffin AM, Eward WC, et al., 2014, The effect of the setting of a positive surgical margin in soft tissue sarcoma. Cancer (Basel), 120: 2866–2875.


  1. Soyfer V, Corn BW, Kollender Y, et al., 2010, Radiation therapy for palliation of sarcoma metastases: A unique and uniform hypofractionation experience. Sarcoma, 2010: 927972.


  1. Pisters PW, 2005, Preoperative multimodality treatment of localized soft tissue sarcoma: Addition through subtraction? Ann Surg Oncol, 12: 583–586.


  1. Codenotti S, Marampon F, Triggiani L, et al., 2021, Caveolin-1 promotes radioresistance in rhabdomyosarcoma through increased oxidative stress protection and DNA repair. Cancer Lett, 505: 1–12.


  1. Fappiano DB, Farooqi A, Somaiah N, et al., 2022, Hypofractionated radiation therapy for unresectable or metastatic sarcoma lesions. Adv Radiat Oncol, 7: 100913.


  1. Brunner T, Nestle U, Adebahr S, et al., Simultaneous integrated protection: A new concept for high-precision radiation therapy. Strahlenther Onkol, 192(12): 886–894.


  1. Tao R, Krishnan S, Bhosale PR, et al., 2016, Ablative radiotherapy doses lead to a substantial prolongation of survival in patients with inoperable intrahepatic cholangiocarcinoma: A retrospective dose response analysis. J Clin Oncol, 34(3): 219–226. Erratum in: J Clin Oncol, 37(11): 942.


  1. Tsurugai Y, Takeda A, Eriguchi T, et al., 2021, Hypofractionated radiotherapy for hepatocellular carcinomas adjacent to the gastrointestinal tract. Hepatol Res, 51(3): 294–302.


  1. Gkika E, Adebahr S, Kirste S, et al., 2017, Stereotactic body radiotherapy (SBRT) in recurrent or oligometastatic pancreatic cancer: A toxicity review of simultaneous integrated protection (SIP) versus conventional SBRT. Strahlenther Onkol, 193(6): 433–443.


  1. Reyngold M, Parikh P, Crane CH, 2019, Ablative radiation therapy for locally advanced pancreatic cancer: Techniques and results. Radiat Oncol, 14(1): 95.


  1. Mazzola R, Ruggieri R, Figlia V, et al., Stereotactic body radiotherapy of central lung malignancies using a simultaneous integrated protection approach: A prospective observational study. Strahlenther Onkol, 195(8): 719–724.


  1. Feng XY, Li J, Li AM, et al., 2022, Stereotactic body radiotherapy for recurrent and oligomeastatic soft tissue sarcoma. World J Surg Oncol, 20(1): 322.
Conflict of interest
The authors declare no conflicts of interest.
Back to top
Tumor Discovery, Electronic ISSN: 2810-9775 Published by AccScience Publishing