Page 69 - TD-2-2

Tumor Discovery

CASE REPORT
Stereotactic radiotherapy with simultaneous

integrated protection planning technique for
synovial sarcoma with stomach abutment: A

case report of a complete response

Marco Lorenzo Bonù, Eneida Mataj*, Jacopo Balduzzi, Maria Teresa Cefaratti,
Gloria Pedersoli, Gianluca Cossali, Luca Triggiani, Davide Tomasini,
Michela Buglione, and Stefano Maria Magrini
Department of Radiation Oncology, Istituto del Radio O. Alberti, University of Brescia and Spedali
Civili Hospital, Brescia, Italy

Abstract
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
*Corresponding author: from disease, as noted in last follow-up, 15 months after treatment.
Eneida Mataj
(e.mataj@unibs.it)
Citation: Bonù ML, Mataj E, Keywords: Synovial sarcoma; Radiotherapy; Stereotactic body radiotherapy; Stereotactic
Balduzzi J, et al., 2023, Stereotactic radiotherapy (RT); Simultaneous integrated protection
radiotherapy with simultaneous
integrated protection planning
technique for synovial sarcoma with
stomach abutment: A case report
of a complete response. Tumor 1. Introduction
Discov, 2(2): 356.
https://doi.org/10.36922/td.356 Synovial sarcoma (SS) is a malignant mesenchymal neoplasm with partial epithelial
[1]
Received: February 7, 2023 differentiation that occurs predominantly in older children and young adults .
Accepted: April 26, 2023 The designation SS has become historically established but is known to be incorrect
Published Online: May 10, 2023
as this tumor does not originate from intra-articular synovium, but from primitive
Copyright: © 2023 Author(s). mesenchymal cells [2,3] . SS has been classically described as occurring in the soft tissues
This is an Open Access article of the extremities (80%), especially near large joints but can develop in almost any
[4]
distributed under the terms of the
Creative Commons Attribution anatomic site (20%) [5-10] . The most common non-extremity sites of primary disease
License, permitting distribution, and include the trunk (8%) followed by retroperitoneum/abdomen (7%).
reproduction in any medium, which
provided that the original work is SS is generally considered a high-grade malignant sarcoma, with 5- and 10-year
properly cited. survival rates between 24% – 68% and 11% – 56%, respectively . The natural history
[11]
Publisher’s Note: AccScience of primary SS is best predicted by a combination of patient, tumor, and treatment
Publishing remains neutral with factors. The most important prognostic factors identified are age, primary tumor size,
regard to jurisdictional claims in
published maps and institutional stage, grade, margin of resection, mitotic activity, bone or neurovascular invasion,
affiliations. histologic subtype, p53 overexpression, Ki67 proliferative index, and SYT-SSX fusion

Volume 2 Issue 2 (2023) 1 https://doi.org/10.36922/td.356