SYNOVIAL SARCOMA OF THE FOOT

Introduction: Soft tissue tumours are common in the foot however few are malignant. Synovial Sarcoma of the foot is the most common soft tissue sarcoma to present in the foot (~50%). Despite this diagnosis is often delayed and treatment may be difficult. The aim of this paper is to review the presenting features, management and outcome of synovial sarcoma of the foot and to try and identify areas for improvement. Method: The clinical presentation, radiological features and treatment of 33 patients with histologically proven synovial sarcoma of the foot were reviewed along with outcomes in terms of local control, metastases and survival. Results: 33 patients with synovial sarcoma were treated at out unit over a 25 year period, 22 in the last 10 years. The average duration of symptoms was 125 weeks. The age range at presentation was between 11 to 80 years (mean 44). The mean size of the tumour at diagnosis was 5cm in diameter (range 1–10cm). 75% of the tumours were deep at the time of diagnosis. Treatment was by amputation in 21 patients and limb salvage in 11 with 1 patient receiving palliative chemotherapy. Only one patient had local recurrence and presented with lung metastases. Four patients had metastases at diagnosis and nine developed them subsequently. Overall survival at 10 years was 53%. Discussion: These results have shown that late diagnosis is common for synovial sarcoma of the foot and that by the time of diagnosis 75 % have invaded extra-compartmentally leading to a high risk for amputation. 20 patients had an inadvertent excision of the tumour before referral to our unit. Local control was best achieved with amputation. Overall survival was surprisingly poor despite successful local control. Conclusion: Earlier aggressive investigation of patients with foot swelling or pain may influence their long term prognosis.