Journal of Tumour Research & Reports

Primary Synovial Sarcoma of Kidney: Innovative Diagnostic and Therapeutic Techniques

Yumiko Araki^* Department of Medicine, Osaka University, Suita, Japan
^*Correspondence: Yumiko Araki, Department of Medicine, Osaka University, Suita, Japan, Email:

Received: 03-Jun-2024, Manuscript No. JTRR-24-25922; Editor assigned: 05-Jun-2024, Pre QC No. JTRR-24-25922 (PQ); Reviewed: 19-Jun-2024, QC No. JTRR-24-25922; Revised: 26-Jun-2024, Manuscript No. JTRR-24-25922 (R); Published: 03-Jul-2024, DOI: 10.35248/2684-1614.24.9.233

Description

Primary synovial sarcoma of the kidney is an exceedingly rare and aggressive malignancy, accounting for less than 1% of all primary renal tumors. Unlike more common kidney cancers such as renal cell carcinoma, synovial sarcoma originates from the mesenchymal tissue, displaying unique biological behaviors and requiring specialized treatment approaches. The rarity of this tumor has historically led to a lack of dedicated research and therapeutic advancements. However, recent innovative strategies in diagnosis, surgical intervention, targeted therapy, and immunotherapy provides potential approaches for improving patient outcomes.

Chemotherapy

Traditional chemotherapy has limited efficacy in treating synovial sarcoma. However, innovative approaches are improving outcomes.

Combination regimens: Combining multiple chemotherapeutic agents, such as doxorubicin and ifosfamide, has shown increased effectiveness. These regimens work synergistically to attack the cancer cells at different stages of the cell cycle.

High-dose chemotherapy: High-dose chemotherapy followed by stem cell transplantation is being investigated as a potential treatment for advanced or recurrent synovial sarcoma. This approach aims to deliver a more aggressive chemotherapy regimen while preserving the patient’s bone marrow function.

Targeted therapy

Targeted therapy provides a potential approach for treating primary synovial sarcoma of the kidney by focusing on specific molecular abnormalities within the tumor cells.

Tyrosine Kinase Inhibitors (TKIs): TKIs such as pazopanib and imatinib target specific enzymes involved in tumor growth and proliferation. These agents have shown activity in synovial sarcoma and are being integrated into treatment protocols.

Monoclonal antibodies: Monoclonal antibodies such as olaratumab, which targets the Platelet-Derived Growth Factor Receptor alpha (PDGFRα), are being explored. These agents block pathways essential for tumor growth and survival.

Immunotherapy

Immunotherapy is revolutionizing cancer treatment by understanding the body's immune system to target and destroy cancer cells.

Immune checkpoint inhibitors: Drugs such as pembrolizumab and nivolumab, which target PD-1/PD-L1 and CTLA-4 pathways, have shown potential in various sarcomas. These inhibitors enhance the immune system’s ability to recognize and attack cancer cells.

Adoptive Cell Transfer (ACT): ACT involves extracting a patient’s immune cells, genetically modifying them to enhance their cancer-fighting capabilities, and reinfusing them into the patient. This personalized approach is being tested in clinical trials for synovial sarcoma.

Diagnosis

There are different types of diagnostic techniques for primary synovial sarcoma.

Imaging: Advanced imaging modalities such as Magnetic Resonance Imaging (MRI) and Positron Emission Tomography (PET) scans provide detailed visualization of the tumor's characteristics and its relationship with surrounding tissues. These imaging techniques help in planning surgical interventions and assessing the extent of disease spread.

Histopathology and immunohistochemistry: Histopathological examination remains as standard for diagnosis. Immunohistochemical staining is essential for differentiating synovial sarcoma from other sarcomas and renal tumors. Markers such as TLE1, vimentin, and translocation t(X;18) involving the SYT gene are indicative of synovial sarcoma.

Molecular genetic testing: Molecular diagnostic techniques, including Fluorescence In-Situ Hybridization (FISH) and Polymerase Chain Reaction (PCR), detect specific chromosomal translocations characteristic of synovial sarcoma. Identifying these genetic markers confirms the diagnosis and can guide targeted therapy decisions.

Surgical treatment

Surgical resection remains as the fundamental for the treatment of primary synovial sarcoma of the kidney. The goal is complete tumor removal with negative margins to reduce the risk of recurrence.

Radical nephrectomy: This procedure involves the removal of the entire kidney along with the tumor. Given the aggressive nature of synovial sarcoma, achieving clear surgical margins is potential. Minimally invasive techniques, such as laparoscopic nephrectomy, are being explored to reduce postoperative morbidity while ensuring complete tumor resection.

Neoadjuvant and adjuvant therapy: In some cases, neoadjuvant chemotherapy (administered before surgery) can reduce tumor size, making surgical resection more feasible. Adjuvant therapy (post-surgery) aims to eliminate residual microscopic disease and reduce the risk of metastasis.

Clinical trials and future directions

Ongoing clinical trials are critical for developing and validating new treatments for primary synovial sarcoma of the kidney. Patients are encouraged to participate in trials to access innovative therapies and contribute to advancing the medical knowledge.

Genomic studies: Comprehensive genomic profiling of synovial sarcoma tumors is providing insights into novel therapeutic targets. Personalized medicine approaches based on the genetic makeup of the tumor are being developed.

Combination therapies: Combining different treatment methods, such as targeted therapy with immunotherapy, is being explored to enhance treatment efficacy and overcome resistance mechanisms.

Primary synovial sarcoma of the kidney remains a challenging malignancy due to its rarity and aggressive nature. However, innovative diagnostic techniques, advanced surgical interventions, and the integration of targeted therapy and immunotherapy are transforming the treatment landscape. Continued research and clinical trials are essential for developing more effective strategies and improving the prognosis for patients with this rare and aggressive cancer. The future facilitates for more personalized and effective treatment approaches, ultimately enhancing the survival and quality of life for patients with primary synovial sarcoma of the kidney.