Overview

Synovial sarcoma is a rare and aggressive type of soft tissue cancer that most commonly arises near the joints in the arms or legs. It can metastasize (spread) to distant organs, particularly the lungs and lymph nodes. In Korea, early detection and advanced oncology services have significantly improved outcomes for patients with metastatic synovial sarcoma, with access to cutting-edge therapies, surgical techniques, and multidisciplinary care.

What is Synovial Sarcoma Metastasis?

Synovial sarcoma metastasis refers to the spread of the primary synovial sarcoma tumor to other parts of the body. While the cancer typically originates in the soft tissues near joints, it can extend to:

• Lungs (most common site)
• Lymph nodes
• Bone
• Liver
• Brain (rarely)

Metastasis can occur early or years after the primary tumor is removed, and is associated with a more serious prognosis.

Symptoms

Symptoms depend on the location of the metastasis, but may include:

• Chronic cough or chest pain (if metastasized to lungs)
• Shortness of breath
• Swollen lymph nodes
• Bone pain or fractures
• Unexplained weight loss
• Fatigue
• Neurological symptoms (if brain involvement)
• Abdominal pain or swelling (if liver is involved)

Patients with a history of synovial sarcoma should be regularly monitored for these signs.

Causes

The exact cause of synovial sarcoma and its metastasis is unknown, but it is associated with:

• A specific genetic translocation between chromosomes X and 18 (SYT-SSX fusion gene)
• The aggressive and infiltrative nature of the tumor
• Delayed diagnosis or incomplete tumor resection
• Micrometastases that spread before primary treatment

Risk Factors

• Large tumor size at diagnosis
• Tumor location deep within muscle or near vital structures
• High-grade tumors
• Incomplete surgical margins
• Delay in treatment or recurrence
• Younger patients (commonly affects adolescents and young adults)
• Poor response to chemotherapy

Complications

Metastatic synovial sarcoma can lead to:

• Respiratory failure (from lung metastasis)
• Spinal cord compression (from bone involvement)
• Multiple organ failure
• Severe pain and reduced mobility
• Treatment resistance
• Emotional distress and reduced quality of life

Prognosis depends on the extent of metastasis and the patient’s overall health and response to therapy.

Prevention

While synovial sarcoma itself cannot be prevented, early and aggressive treatment can reduce the risk of metastasis. Preventive strategies include:

• Early diagnosis and staging
• Complete surgical removal of the tumor
• Regular imaging follow-ups (CT, MRI, PET scans)
• Adjuvant chemotherapy and radiation
• Monitoring for recurrence

Genetic testing may help guide prognosis and treatment planning.

Treatment Options in Korea

Korea offers state-of-the-art care for metastatic synovial sarcoma through national cancer centers and university hospitals specializing in sarcoma oncology.

1. Diagnosis

• CT and PET-CT scans to detect metastasis
• MRI for local recurrence
• Biopsy of metastatic sites
• Molecular testing for SYT-SSX gene fusion
• Bone scan (for suspected skeletal spread)

2. Surgical Treatment

• Metastasectomy: Surgical removal of lung, lymph node, or liver metastases
• Limb-sparing surgery if recurrence occurs near original site
• Advanced robotic and minimally invasive surgery options are available in top Korean hospitals

3. Chemotherapy

• Standard regimens include:
  • Ifosfamide + Doxorubicin
  • Gemcitabine + Docetaxel
• Targeted agents may be used in clinical trials
• Neoadjuvant (before surgery) and adjuvant (after surgery) protocols available

4. Radiation Therapy

• Used to control unresectable metastases or after surgery
• Advanced options include:
  • IMRT (Intensity-Modulated Radiation Therapy)
  • Proton Beam Therapy (available in selected centers like National Cancer Center Korea)

5. Targeted and Immunotherapy

• Clinical trials in Korea are exploring drugs like:
  • Pazopanib (tyrosine kinase inhibitor)
  • Tazemetostat
  • Immune checkpoint inhibitors (PD-1/PD-L1 inhibitors)

6. Palliative and Supportive Care

• Pain management
• Pulmonary care for lung metastasis
• Psychosocial support and counseling
• Nutritional therapy
• Rehabilitation