A Case Report of Radiotherapy in Synovial Sarcoma of the Larynx: An Organ Preservation Approach

Abstract

Aim: Synovial sarcoma is a malignant tumor of mesenchymal origin. It is more commonly associated with extremities in young adults. The head and neck region account for less than 10% of presentations. The larynx is an extremely rare site. We report a case of a 28-year-old male treated with laser excision followed by adjuvant radiotherapy. This study adds to the limited literature available for the management of synovial sarcoma and lay emphasis on the organ preservation treatment approach for early-stage disease. Case Presentation: A 28-year-old gentleman with no comorbidities reported to us in August, 2023 with complaints of dysphagia and progressive hoarseness of voice for 2 months. He underwent emergency tracheostomy for stridor. Direct laryngoscopy showed a large globular mass at right aryepiglottic fold, obstructing the view of rest of the larynx. Pyriform sinus was free. The biopsy from the lesion revealed supraglottic laryngeal sarcoma. He underwent laser excision of right   supraglottic lesion followed by adjuvant radiotherapy to a dose of 66 Gy in 33 fractions to post-operative bed. Discussion: There are no specific guidelines for the treatment of synovial sarcoma due to its rare nature. Surgical resection with negative margins remains the mainstay of treatment, which is sometimes not achievable in the head and neck region due to the complex anatomy and the presence of major neurovascular structures. Total laryngectomy is usually preferred in these cases to provide negative surgical margins. There is severe diminution of quality of life and functional outcomes of the patient. Adjuvant radiotherapy has been used to reduce the incidence of local recurrence. Conclusion: Due to paucity of literature, a multidisciplinary treatment approach is essential for the management of laryngeal synovial sarcoma and long-term follow-up is required to monitor for recurrence and improve disease-free survival. Early detection and treatment will result in laryngeal preservation thereby reducing surgical morbidity and maintaining patient’s speech and swallow functions.