(P 03) DEMOGRAPHICS, PRACTICE PATTERNS, CHALLENGES AND OUTCOMES OF SYNOVIAL SARCOMA PATIENTS FROM A TERTIARY CARE CENTRE FROM A LARGE LOW-MIDDLE INCOME COUNTRY

Objective: Soft tissue sarcoma (STS) is a rare malignancy and synovial sarcoma (SS) is chemo sensitive subtype of STS. Data is sparse world over and especially from low-middle income country (LMIC)with predominant population of adolescent and young adults. The study aimed to explore demographics, varied practice patterns, unique challenges, survival statistics and prognostic markers from a tertiary care center in India.

Methods: The current study involved histologically diagnosed, consecutive, synovial sarcoma patients who were registered at our institute between 2010-2019 and received chemotherapy and with availability of adequate medical records. Demographics, practice patterns, were studied. For survival analysis time from date of registration till any event is calculated for event free survival(EFS) and till death or last follow-up for overall survival(OS) analysis. An event was defined as recurrence/ progression or death.

Results: There were 255 patients, however, 165(65%) who received at-least partial treatment at our centre and with sufficient medical records were analysed. The median age was 30 years, 99 (60%) were males At diagnosis 112 (68%) were localised while 53 (32%) had metastasis. Baseline median haemoglobin was 13.7 (IQR 12.4-15) gm/dl and albumin was 4.1 (IQR 3.5-4.7) gm/dl. The extremities were the predominant primary site (123, 75%) followed by pelvis (15, 9%).
Treatment Characteristics
A total of 119(72%) patients received chemotherapy (CT)including 71 with localised disease wherein 5 patients received neoadjuvant(NA)- chemotherapy (NACT), 7 received NACT-radiation(RT) and remaining received adjuvant CT. Most common CT was combination of ifosfamide and doxorubicin (88, 74%) and doxorubicin alone (31, 26%).
A total78 patients underwent surgery and 91(55%) received radiation.
At a median follow-up of 41 (95%CI 30 - 52) months, the median EFS of the entire cohort of patients was 18 (95% CI 17-21) months and the median OS was not reached (NR). The median EFS for patients with localised and metastatic disease was 25 months (95% CI 17-33) and 10 months (95% CI 6-14) respectively and the median OS was NR and 60 (95% CI 26-94) months respectively. (Figure1 to 6)
The significant grade III/IV toxicities were febrile neutropenia in 47 (40%) patients and thrombocytopenia in 45 (38%) with two chemotherapy toxicity related deaths in metastatic cohort.
On multivariate analysis significant factors for worse OS and EFS was metastasis (P< 0.0001, Hazard Ratio [HR] 3.8; 95% CI 1.87-7.84) and (P< 0.001, HR2.5 95% CI 1.7-3.6) respectively. Additionally, in metastatic cohort poorly differentiated histology was found as independent predictor for EFS (P 0.003, HR 2.3; 95% CI 1.3-4.3).
Unique challenges
A significant proportion of patients (35%) did not peruse treatment immediately after diagnosis due to varied reasons including diagnosis at an advanced stage with logistic constrains.

Conclusion: The contemporary data from India suggested predominance of young population, comparable survival and accepted tolerance of chemotherapy from the published literature for those who received treatment. Metastatic disease at presentation stands out as robust prognosticator and significant proportion of patients drop-out immediately after diagnosis which underscores the importance of awareness and education towards early diagnosis and collaborative efforts to ensure compliance and sustainable care for all.

Table abs 27june.docx

Graphs.pptx