Stereotactic radiotherapy with simultaneous integrated protection planning technique for synovial sarcoma with stomach abutment: A case report of a complete response

Here, we report the clinical case of a 44-year-old lady, affected by synovial sarcoma (SS) of the mediastinum which was treated in 2014, and relapsed in the upper abdomen in 2020. SS is a relatively radioresistant disease, radiotherapy (RT) is routinely reserved for the neoadjuvant/adjuvant or palliative context. In our scenario, stereotactic RT consisting in 45Gy in 6 fractions was proposed to manage the upper abdominal relapse. Exploiting simultaneous integrated protection, a deliberated reduction in the dose prescription in area of planning target volume overlapped with stomach was achieved, obtaining reasonable dosimetric goals. Acute toxicity in the patient was acceptable, and she did not experience late toxicity and was still free from disease, as noted in last follow-up, 15 months after treatment.