Synovial Sarcoma of the Extremities: A Literature Review
, Roxana Folescu 3,†, Daniela Gurgus 3,†, Andrei Gheorghe Marius Motoc 4,†, Jenel Marian Patrascu 1, Sorin Bogdan Motoi 5,*, Oana Belei 6 and Ana Maria Ungureanu 5Round 1
Reviewer 1 Report
Faur et al., submitted a short review entitled “Synovial sarcoma of the extremities: a literature review”.
The authors attempted to present the global view of Synovial sarcoma (SS), particularly in diagnosis and treatment.
The introduction is perfectly coup with the SS. Furthermore, the authors have described the important diagnostic methods for SS. Finally, the different treatment options are well captured.
However, few suggestions, which is proposed here, would improve the quality of the manuscript.
Line 84: "pacient" ----- "patient"
Line 97: Do authors mean "presence of overgrowing tumoral mass " instead of "presence of o growing tumoral mass"
Figures: indicate the figures with arrow marks (like figures 2 & 3) to understand well. For e.g., in figure 1, where is the exact location of erosions or osteolysis.
It would be great if the authors provide the major therapeutics options in a table with examples.
Author Response
Grammar corrections were made
Line 84: "pacient" was replaced with patient
Line 97. "presence of o growing" was replaced with "presence of an overgrowing tumoral mass"
Figure 1. Arrow was added in order to indicate better the localization of calcifications in the tumoral mass.
A table with diagnostic and therapeutic options was added
Reviewer 2 Report
The author review the SS and the manuscript is well written. However, I have some concerns.
- What is the review type, narrative or systematic?
- What is the novelty of the current study?
Author Response
This study is a literature (narrative review). It's aim is to structure the existent relevant data in the diagnosis and treatment of synovial sarcomas, also taking into consideration some research directions that may prove to be beneficial in this area of interest.
Reviewer 3 Report
The review described the current topics of synovial sarcoma at extremities.
1.Introduction: The authors defined adolescents and young adults as 15-39 years (or 29 years). That may be AYA generation.
2. Diagnosis: Imaging: The patient's characteristics (age, sex, diagnosis) should be included as figure legends (Fig.1-7). Are all figures synovial sarcoma?
3. Diagnosis: Line 160-165 (Page.6). These sentences are not consistent with Figure 8 and 9.
4. Treatment: Radiotherapy. Which dose of adjuvant radiotherapy is recommended?
5. Treatment: Chemotherapy. One systematic review proposed systemic chemotherapy is not recommended in patients with synovial sarcoma < 5cm (Nakamura T et al. Jpn J Clin Oncol 2021; 51(6): 927-931).
6. The authors should add the review of the chemotherapy at an advanced stage.
7. The authors should add immunotherapy for synovial sarcoma. (e.g. D'Angelo SP et al. Cancer Discov 2018;8:944-957.)
Author Response
1. The term AYA generation was added in the introduction paragraph - line 42
2. More explicit legends for figures 1-7 were added indicating the age and gender of patient.
3. Lines 160-165 are describing the core needle biopsy technique. However, for better understanding we changed the legend for figure 8 and the reference in the main text for both figures (8,9).
4. A statement with the median accepted dose in RT for SS was added together with the relevant reference - line 222.
5-6. The controversial role of chemotherapy is highlighted in the corresponding paragraph, indicating the fact that, based on the existing literature the is no specific indication excepting high-risk, large, deep tumors that have approximately 50% risk of developing metastatic lesions. A statement was added indicating the fact that there is no indication of chemo in young patients with small SS, where appropriate oncologic surgical margin can be obtained according to the metanalysis of Nakamura. Study of Nakamura was added in the reference list - 233-236.
7. A paragraph regarding the antitumoral effect of immunotherapy in the treatment of SS was added - line 269-275
We would like to thank you for all your comments - you really helped us make our review better.
Round 2
Reviewer 2 Report
The authors show the comments to the concerns, so I recommend accepting.
Author Response
Thank you for reviewing this paper
Reviewer 3 Report
The manuscript is improved and will be published.
Before publication, figure legends should be improved (e.g. Figure.2 Synovial sarcoma (26 years, female) at right thigh. Axial T2 FSE (Fast Spin Echo) + FATSAT (Fat Saturation) MR image showing the increased diameter of the right thigh, because of a soft tissue mass, inhomogeneous, with a mixture of solid and cystic areas (block arrow).
I can't understand the legends of Figure.8.
Author Response
Legends for figures 2 and 8 were modified, trying to be more accurate.
