New clinical application of high-intensity focused ultrasound: local control of synovial sarcoma
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CASE REPORT
WORLD JOURNAL OF SURGICAL ONCOLOGY
Open Access
New clinical application of high-intensity focused ultrasound: local control of synovial sarcoma Xiaoye Hu1†, Hongke Cai1†, Meiqi Zhou1, Haifei He1, Wei Tian1, Yue Hu1, Lirong Chen2 and Yongchuan Deng1*
Abstract High-intensity focused ultrasound (HIFU) is playing an increasingly important role in cancer therapy. Primary synovial sarcomas of the chest wall are extremely rare. We report the first case of noninvasive HIFU therapy for the control of synovial sarcoma. A 51-year-old man was diagnosed with spindle cell sarcoma on the left chest wall through lumpectomy. After four cycles of chemotherapy, local recurrence of the sarcoma was detected. Subsequent extended resection confirmed synovial sarcoma. After five cycles of a new chemotherapy option, the sarcoma relapsed again. Then the patient received five courses of HIFU; this completely ablated the sarcoma without complications. No chemotherapy, radiotherapy, or biological therapy has been applied since. Now the patient is stable and has a high quality of life. Keywords: Cancer therapy, High-intensity focused ultrasound, Noninvasive surgery, Synovial sarcoma
Background Synovial sarcoma is a type of rare sarcoma in the soft tissue near the large joints of the arm or leg. Primary synovial sarcoma of the chest wall is extremely rare. The cytological features of the monophasic spindle cell and biphasic subtypes of synovial sarcoma, samples of which were obtained through fine needle aspiration, have been reported in several case studies [1]. Surgery is the mainstream therapy for synovial sarcoma. However, the post-surgery recurrence rate is still as high as 60% [2]. Moreover, synovial sarcoma is not sensitive to chemotherapy or radiotherapy [3]. So far, no report of high-intensity focused ultrasound (HIFU) therapy for synovial sarcoma has been found in the English literature. This report presents a case of synovial sarcoma of the left chest wall. Two surgical procedures and postoperative chemotherapy failed to control the tumor but HIFU therapy achieved good clinical efficacy. Case presentation A solid texture mass, 2 cm in diameter, was found on the left chest wall of a 51-year-old man accompanied with local swelling and tenderness 1 year ago. Lumpectomy * Correspondence: [email protected] † Equal contributors 1 Department of Surgical Oncology, Second Affiliated Hospital, Zhejiang University College of Medicine, No. 88 Jiefang Road, Hangzhou, PR China Full list of author information is available at the end of the article
was performed in a local hospital. Postoperative pathological analysis confirmed the mass to be a spindle cell sarcoma. The patient was treated with a chemotherapy regimen of MTX 14.5 d1 + MTX 14.5 d8 + DDP 180 mg d15 + ADM 110 mg d17. After four cycles of chemotherapy, a similar mass with a more solid texture and some tenderness was found in the surgical site. Therefore, the patient was admitted to our hospital for a second surgery, expanded resection. Postoperative immunohistochemist
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