How would you approach therapy in a young adult with synovial sarcoma of the head and neck who is not amenable to surgery due to location on the face?

I do not think primary synovial sarcoma is curable without surgery. I have never seen a durable response in a tumor treated with radiation alone. Synovial sarcoma responds to ifosfamide based chemotherapy generally, but in my experience, the response rates for primary tumors are lower than response rates of metastases.

For the curative treatment of sarcoma on the face, I would want radiation because margins are small and local recurrence is common. I defer to the surgeon as regard, preop, or postop. Where I am, orthopedic surgery likes preop, and ENT likes postop. There is nothing on the face that is unresectable and if surgery is not an option, that is almost certainly because the patient refuses. If it is because the surgeon refuses then y...

Unlikely to cure without surgery. GTR and postop RT. If not suitable for GTR, RT and prayer.