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Braggio DA, Costas C de Faria F, Koller D, Jin F, Zewdu A, Lopez G, Batte K, Casadei L, Welliver M, Horrigan SK, Han R, Larson JL, Strohecker AM, Pollock RE. Preclinical efficacy of the Wnt/β-catenin pathway inhibitor BC2059 for the treatment of desmoid tumors. PLoS One 2022; 17:e0276047. [PMID: 36240209 PMCID: PMC9565452 DOI: 10.1371/journal.pone.0276047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 09/28/2022] [Indexed: 11/18/2022] Open
Abstract
Mutation in the CTNNB1 gene, leading to a deregulation of the WTN/β-catenin pathway, is a common feature of desmoid tumors (DTs). Many β-catenin inhibitors have recently been tested in clinical studies; however, BC2059 (also referred as Tegavivint), a selective inhibitor of nuclear β-catenin that works through binding TBL-1, is the only one being evaluated in a clinical study, specifically for treatment of desmoid tumor patients. Preclinical studies on BC2059 have shown activity in multiple myeloma, acute myeloid leukemia and osteosarcoma. Our preclinical studies provide data on the efficacy of BC2059 in desmoid cell lines, which could help provide insight regarding antitumor activity of this therapy in desmoid tumor patients. In vitro activity of BC2059 was evaluated using desmoid tumor cell lines. Ex vivo activity of BC2059 was assessed using an explant tissue culture model. Pharmacological inhibition of the nuclear β-catenin activity using BC2059 markedly inhibited cell viability, migration and invasion of mutated DT cells, but with lower effect on wild-type DTs. The decrease in cell viability of mutated DT cells caused by BC2059 was due to apoptosis. Treatment with BC2059 led to a reduction of β-catenin-associated TBL1 in all mutated DT cells, resulting in a reduction of nuclear β-catenin. mRNA and protein levels of AXIN2, a β-catenin target gene, were also found to be downregulated after BC2059 treatment. Taken together, our results demonstrate that nuclear β-catenin inhibition using BC2059 may be a novel therapeutic strategy for desmoid tumor treatment, especially in patients with CTNNB1 mutation.
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Affiliation(s)
- Danielle Almeida Braggio
- Program in Translational Therapeutics, The James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States of America
- Department of Surgery, The Ohio State University, Columbus, OH, United States of America
| | - Fernanda Costas C de Faria
- Program in Translational Therapeutics, The James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States of America
- Department of Surgery, The Ohio State University, Columbus, OH, United States of America
| | - David Koller
- Program in Translational Therapeutics, The James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States of America
- Department of Surgery, The Ohio State University, Columbus, OH, United States of America
| | - Feng Jin
- Department of Radiation Oncology, The Ohio State University, Columbus, OH, United States of America
| | - Abeba Zewdu
- Program in Translational Therapeutics, The James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States of America
- Department of Surgery, The Ohio State University, Columbus, OH, United States of America
| | - Gonzalo Lopez
- Program in Translational Therapeutics, The James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States of America
- Department of Surgery, The Ohio State University, Columbus, OH, United States of America
| | - Kara Batte
- Program in Translational Therapeutics, The James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States of America
- Department of Surgery, The Ohio State University, Columbus, OH, United States of America
| | - Lucia Casadei
- Program in Translational Therapeutics, The James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States of America
- Department of Surgery, The Ohio State University, Columbus, OH, United States of America
| | - Meng Welliver
- Department of Radiation Oncology, The Ohio State University, Columbus, OH, United States of America
| | | | - Ruolan Han
- Iterion Therapeutics, INC., Houston, TX, United States of America
| | - Jeffrey L Larson
- Iterion Therapeutics, INC., Houston, TX, United States of America
| | - Anne M Strohecker
- Department of Surgery, The Ohio State University, Columbus, OH, United States of America
- Program in Molecular Biology and Cancer Genetics, The James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States of America
- Department of Cancer Biology and Genetics, College of Medicine, The Ohio State University, Columbus, OH, United States of America
| | - Raphael E Pollock
- Program in Translational Therapeutics, The James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States of America
- Department of Surgery, The Ohio State University, Columbus, OH, United States of America
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Yvette LWS, Tak FS, Lok MK. Management of extra-abdominal fibromatosis in a musculoskeletal tumour centre in Hong Kong. JOURNAL OF ORTHOPAEDICS, TRAUMA AND REHABILITATION 2021. [DOI: 10.1177/2210491721989082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: Fibromatosis is a benign disease yet prone to recurrence. The best treatment option remains controversial. The purpose of this study was to analyse the management approach in our musculoskeletal tumour centre. Materials and Methods: Thirty-four patients with extra-abdominal fibromatosis referred to our centre between 2000 to 2018 were included. Patients’ demographics, tumour location and size, year of diagnosis, treatment modalities, surgical margins, recurrence, and subsequent management were analysed. Results: Patients mostly presented in the second and third decade, with female predominance. Twenty-seven patients underwent excision. Other management options included ‘watchful waiting’, pharmacological treatment and radiotherapy. Recurrence rate was 51.9%. There was no statistically significant relationship between marginal status and recurrence. Conclusion: We report our experiences on management of fibromatosis, with strategy shifted from early excision to a conservative approach over the years. Surgical excision is still indicated in some situations. Tumour recurrence is not rare but second excision is not always necessary.
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Affiliation(s)
- Lam Wei Sze Yvette
- Department of Orthopaedics and Traumatology, Queen Elizabeth Hospital, Hong Kong
| | - Fong Sin Tak
- Department of Orthopaedics and Traumatology, Queen Elizabeth Hospital, Hong Kong
| | - Mak Ka Lok
- Department of Orthopaedics and Traumatology, Queen Elizabeth Hospital, Hong Kong
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Kohsaka S, Hirata M, Ikegami M, Ueno T, Kojima S, Sakai T, Ito K, Naka N, Ogura K, Kawai A, Iwata S, Okuma T, Yonemoto T, Kobayashi H, Suehara Y, Hiraga H, Kawamoto T, Motoi T, Oda Y, Matsubara D, Matsuda K, Nishida Y, Mano H. Comprehensive molecular and clinicopathological profiling of desmoid tumours. Eur J Cancer 2021; 145:109-120. [PMID: 33444924 DOI: 10.1016/j.ejca.2020.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 12/02/2020] [Indexed: 10/22/2022]
Abstract
Previous studies have not clearly identified a prognostic factor for desmoid tumours (DT). Whole-exome sequencing (WES) and/or RNA sequencing (RNA-seq) were performed in 64 cases of DT to investigate the molecular profiles in combination with the clinicopathological characteristics. CTNNB1 mutations with specific hotspots were identified in 56 cases (87.5%). A copy number loss in chromosome 6 (chr6) was identified in 14 cases (21.9%). Clustering based on the mRNA expression profiles was predictive of the patients' prognoses. The risk score generated by the expression of a three-gene set (IFI6, LGMN, and CKLF) was a strong prognostic marker for recurrence-free survival (RFS) in our cohort. In risk groups stratified by the expression of IFI6, the hazard ratio for recurrence-free survival in the high-risk group relative to the low-risk group was 12.12 (95% confidence interval: 1.56-94.2; p = 8.0 × 106). In conclusion, CTNNB1 mutations and a chr6 copy number loss are likely the causative mutations underlying the tumorigenesis of DT while the gene expression profiles may help to differentiate patients who would be good candidates for wait-and-see management and those who might benefit from additional systemic or radiation therapies.
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Affiliation(s)
- Shinji Kohsaka
- Division of Cellular Signaling, National Cancer Center Research Institute, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
| | - Makoto Hirata
- Laboratory of Genome Technology, Human Genome Center, Institute of Medical Science, The University of Tokyo, Tokyo, 108-8639, Japan
| | - Masachika Ikegami
- Division of Cellular Signaling, National Cancer Center Research Institute, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Toshihide Ueno
- Division of Cellular Signaling, National Cancer Center Research Institute, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Shinya Kojima
- Division of Cellular Signaling, National Cancer Center Research Institute, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Tomohisa Sakai
- Department of Orthopaedic Surgery, Nagoya University Hospital, Nagoya, 466-8550, Japan
| | - Kan Ito
- Department of Orthopaedic Surgery, Nagoya University Hospital, Nagoya, 466-8550, Japan
| | - Norifumi Naka
- Musculoskeletal Oncology Service, Osaka International Cancer Institute, Osaka, 541-8567, Japan
| | - Koichi Ogura
- Department of Musculoskeletal Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Akira Kawai
- Department of Musculoskeletal Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Shintaro Iwata
- Department of Musculoskeletal Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan; Division of Orthopaedic Surgery, Chiba Cancer Center, Chiba, 260-8717, Japan
| | - Tomotake Okuma
- Department of Muscloskeletal Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, 113-0021, Japan
| | - Tsukasa Yonemoto
- Division of Orthopaedic Surgery, Chiba Cancer Center, Chiba, 260-8717, Japan
| | - Hiroshi Kobayashi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, 113-0033, Japan
| | - Yoshiyuki Suehara
- Department of Orthopedic Surgery, Juntendo University, Graduate School of Medicine, Tokyo, 113-8431, Japan
| | - Hiroaki Hiraga
- Department of Orthopaedic Surgery, Hokkaido Cancer Center, Sapporo, 003-0804, Japan
| | - Teruya Kawamoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, 650-0017, Japan
| | - Toru Motoi
- Department of Pathology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, 113-0021, Japan
| | - Yoshinao Oda
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Daisuke Matsubara
- Division of Integrative Pathology, Jichi Medical University, Shimotsuke, 329-0498, Japan
| | - Koichi Matsuda
- Laboratory of Genome Technology, Human Genome Center, Institute of Medical Science, The University of Tokyo, Tokyo, 108-8639, Japan
| | - Yoshihiro Nishida
- Department of Orthopaedic Surgery, Nagoya University Hospital, Nagoya, 466-8550, Japan.
| | - Hiroyuki Mano
- Division of Cellular Signaling, National Cancer Center Research Institute, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
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Clinical features and treatment outcome of desmoid-type fibromatosis: based on a bone and soft tissue tumor registry in Japan. Int J Clin Oncol 2019; 24:1498-1505. [PMID: 31332613 DOI: 10.1007/s10147-019-01512-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 07/05/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Treatment modality of desmoid-type fibromatosis (DF) has changed from surgery with a wide surgical margin to conservative treatment. In this study, tumor characteristics of DF, transition of the treatment modality, and clinical outcome of surgical treatment were analyzed based on data obtained from the bone and soft tissue tumor registry established in Japan. METHODS Data were collected as registration data and follow-up data. Five hundred and thirty registered cases of DF were identified, including 223 cases with follow-up data with or without surgical treatment. RESULTS The number of registered patients increased gradually. The frequency of surgical treatment was gradually reduced year by year. The 3-year local recurrence free survival (LRFS) was 77.7%, with tumor location and size tending to correlate with LRFS. Interestingly, there was no significant difference in LRFS between wide and marginal margin (P = 0.34). CONCLUSIONS The treatment modality has shifted from surgical to conservative treatment, with risk factors for surgical treatment similar to those noted in previous studies. The National registry system is crucial for a rare disease such as DF, and in the future, a population based registry system should be established to better comprehend the actual status of DF.
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Braggio D, Koller D, Jin F, Siva N, Zewdu A, Lopez G, Batte K, Casadei L, Welliver M, Strohecker AM, Lev D, Pollock RE. Autophagy inhibition overcomes sorafenib resistance in S45F-mutated desmoid tumors. Cancer 2019; 125:2693-2703. [PMID: 30980399 DOI: 10.1002/cncr.32120] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 02/06/2019] [Accepted: 02/14/2019] [Indexed: 11/06/2022]
Abstract
BACKGROUND Desmoid tumors (DTs) are rare and understudied fibroblastic lesions that are frequently recurrent and locally invasive. DT patients often experience chronic pain, organ dysfunction, decrease in quality of life, and even death. METHODS Sorafenib has emerged as a promising therapeutic strategy, which has led to the first randomized phase 3 clinical trial devoted to DTs. Concurrently, we conducted a comprehensive analysis of sorafenib efficacy in a large panel of desmoid cell strains to probe for response mechanism. RESULTS We found distinctive groups of higher- and lower-responder cells. Clustering the lower-responder group, we observed that CTNNB1 mutation was determinant of outcome. Our results revealed that a lower dose of sorafenib was able to inhibit cell viability, migration, and invasion of wild-type and T41A-mutated DTs. Apoptosis induction was observed in those cells after treatment with sorafenib. On the other hand, the lower dose of sorafenib was not able to inhibit cell viability, migration, or invasion or to induce apoptosis in the S45F-mutated DTs. The investigation of autophagy showed the dependency of S45F-mutated DTs on this pathway as a part of cell survival mechanism. Significantly, when autophagy was inhibited genetically or pharmacologically in the S45F mutant cell strains, sensitivity to sorafenib was restored. CONCLUSIONS Our findings suggest that the response to sorafenib differs when comparing S45F-mutated DTs and T41A-mutated or wild-type DTs. Furthermore, the combination of hydroxychloroquine and sorafenib enhances the antiproliferative and proapoptotic effects in S45F-mutated DT cells, suggesting that profiling β-catenin status could guide clinical management of desmoid patients who are considering sorafenib treatment.
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Affiliation(s)
- Danielle Braggio
- Program in Translational Therapeutics, The James Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio.,Department of Surgery, The Ohio State University, Columbus, Ohio
| | - David Koller
- Program in Translational Therapeutics, The James Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio.,Department of Surgery, The Ohio State University, Columbus, Ohio
| | - Feng Jin
- Department of Radiation Oncology, The Ohio State University, Columbus, Ohio
| | - Nanda Siva
- Department of Chemical and Biomedical Engineering, West Virginia University Statler College of Engineering and Mineral Resources, Morgantown, West Virginia
| | - Abeba Zewdu
- Program in Translational Therapeutics, The James Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio.,Department of Surgery, The Ohio State University, Columbus, Ohio
| | - Gonzalo Lopez
- Program in Translational Therapeutics, The James Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio.,Department of Surgery, The Ohio State University, Columbus, Ohio
| | - Kara Batte
- Program in Translational Therapeutics, The James Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio.,Department of Surgery, The Ohio State University, Columbus, Ohio
| | - Lucia Casadei
- Program in Translational Therapeutics, The James Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio.,Department of Surgery, The Ohio State University, Columbus, Ohio
| | - Meng Welliver
- Department of Radiation Oncology, The Ohio State University, Columbus, Ohio
| | - Anne M Strohecker
- Department of Surgery, The Ohio State University, Columbus, Ohio.,Program in Molecular Biology and Cancer Genetics, The James Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio.,Department of Cancer Biology and Genetics, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Dina Lev
- Department of General Surgery B, Sheba Medical Center, Tel Aviv, Israel.,Tel Aviv University, Tel Aviv, Israel
| | - Raphael E Pollock
- Program in Translational Therapeutics, The James Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio.,Department of Surgery, The Ohio State University, Columbus, Ohio
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6
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Cho JY, Gupta S, Cho HS, Park MS, Mok SJ, Han I, Kim HS. Role of Nonsteroidal Anti-inflammatory Drug in Treatment of Extra-abdominal Desmoid Tumors. Clin Orthop Surg 2018; 10:225-233. [PMID: 29854347 PMCID: PMC5964272 DOI: 10.4055/cios.2018.10.2.225] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 01/19/2018] [Indexed: 11/22/2022] Open
Abstract
Background We retrospectively reviewed the outcomes of patients who had been treated with meloxicam for the extra-abdominal desmoid tumors and evaluated the correlation between clinical outcome and clinic pathological variables. Methods Twenty patients treated with meloxicam were followed up every 3 to 6 months. Meloxicam administration was planned at 15 mg/day orally for 6 months. Results Of the 20 patients evaluated, according to Response Evaluation Criteria in Solid Tumors criteria, there were five patients with partial response (25.0%), eight with stable disease (40.0%), and seven with tumor progression (35.0%). The cumulative probability of dropping out from our nonsurgical strategy using meloxicam was 35.0% at 1 year and 35.0% at 5 years. Conclusions The present study suggests that conservative treatment would be a primary treatment option for this perplexing disease even though we were not able to determine that the use of a cyclooxygenase-2 inhibitor would have an additional influence on the natural course of a desmoid tumor.
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Affiliation(s)
- Ja Young Cho
- Department of Surgery, Lin Women's Hospital, Seoul, Korea
| | - Sanjay Gupta
- Division of Orthopaedic Surgery, Glasgow Royal Infirmary, Glasgow, UK
| | - Hwan Seong Cho
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea.,Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Min Suk Park
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Su Jung Mok
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Ilkyu Han
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea.,Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Han-Soo Kim
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea.,Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
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7
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Tonelli F, Ficari F, Valanzano R, Brandi ML. Treatment of Desmoids and Mesenteric Fibromatosis in Familial Adenomatous Polyposis with Raloxifene. TUMORI JOURNAL 2018; 89:391-6. [PMID: 14606641 DOI: 10.1177/030089160308900408] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Among the great variety of extracolonic manifestations of familial adenomatous polyposis, the most serious are desmoids and fibromatosis of the abdominal cavity. These may be a danger to the patient and a concern to the clinician. Pharmacological management of this relentless problem is favored by surgical intervention. At present, however, beneficial actions of medical therapy are not separable from undesirable side effects. Methods We studied the effects of 120 mg daily of raloxifene, a non-steroidal benzothiophene, on progressive desmoid tumors and mesenteric fibromatosis by evaluation of lesion size and symptoms in 13 patients with familial adenomatous polyposis, selected on the basis of intra-abdominal localization of the lesion, on refractoriness to other medical treatments, and on estrogen receptor-α expression. Results The patients had a significant response to raloxifene therapy, with complete remission in 8 cases and partial response in 5 cases, evaluated by regression of symptoms and tumor size. Serum biochemical parameters did not show any significant changes. Side effects were never observed. Conclusions Although the number of patients included in the study is limited and in spite of some limitations, the available results support that, in the evaluation of response, daily therapy with raloxifene decreases desmoid tumor and mesenteric fibromatosis size and symptoms and does not cause side effects. These findings offer a novel option in the pharmacological treatment of desmoids, leading to medical therapy of these neoplastic lesions in familial adenomatous polyposis patients.
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Affiliation(s)
- Francesco Tonelli
- Department of Clinical Physiopathology, University of Florence, Italy
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8
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Rosenberg L, Yoon CH, Sharma G, Bertagnolli MM, Cho NL. Sorafenib inhibits proliferation and invasion in desmoid-derived cells by targeting Ras/MEK/ERK and PI3K/Akt/mTOR pathways. Carcinogenesis 2018. [DOI: 10.1093/carcin/bgy038] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
- Laura Rosenberg
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Charles H Yoon
- Department of Surgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - Gaurav Sharma
- Department of Surgery, Brigham and Women’s Hospital, Boston, MA, USA
| | | | - Nancy L Cho
- Department of Surgery, Brigham and Women’s Hospital, Boston, MA, USA
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9
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Walter T, Zhenzhen Wang C, Guillaud O, Cotte E, Pasquer A, Vinet O, Poncet G, Ponchon T, Saurin JC. Management of desmoid tumours: A large national database of familial adenomatous patients shows a link to colectomy modalities and low efficacy of medical treatments. United European Gastroenterol J 2017; 5:735-741. [PMID: 28815038 PMCID: PMC5548349 DOI: 10.1177/2050640616678150] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 10/12/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Desmoid tumours represent a major complication of familial adenomatous polyposis. Our aims were to study the factors associated with the development of desmoid tumours in familial adenomatous polyposis patients, and to describe presentation and management of desmoid tumours. METHODS AND PATIENTS We reviewed all patients with familial adenomatous polyposis followed at our institution between 1965-2013, with either identified adenomatous polyposis coli gene mutation, or a personal and family history suggesting adenomatous polyposis coli-related polyposis. Response to treatment of desmoid tumours was assessed by Response Evaluation Criteria In Solid Tumor (RECIST) criteria. RESULTS A total of 180 patients with familial adenomatous polyposis were included with a median follow-up of 19 years since diagnosis. Thirty-one (17%) patients developed 58 desmoid tumours, a median (range) 4.7 (0.8-41.6) years after their diagnosis of familial adenomatous polyposis. The only factor significantly associated with occurrence of desmoid tumours was the type of surgery: 12 (12%) desmoid tumours in 104 patients treated by colectomy, versus 19 (25%) desmoid tumours in 76 patients treated by proctocolectomy, p = 0.027. The localisation of desmoid tumours was: mesenteric (n = 25), abdominal wall (n = 30) or extra-abdominal (n = 3). Nineteen patients underwent 36 surgical procedures for desmoid tumours. Recurrence occurred in 26 (72%) cases and the recurrence-free survival was 2.6 (95% confidence interval (CI), 0.2-5.9) years. Thirteen patients received 27 medical treatments over a median 14 months. Objective response was observed in four (15%) patients and the median progression-free survival was nine (95% CI, 1.1-16.9) months. CONCLUSION If confirmed, colectomy (versus proctocolectomy) should be performed in adenomatous polyposis coli-related familial adenomatous polyposis patients to avoid desmoid tumours. We show that there is a high prevalence of post-surgical recurrence and the low efficacy of available medical treatments for desmoid tumours.
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Affiliation(s)
- T Walter
- Gastroenterology Department, Edouard Herriot Hospital, Lyon, France
| | - C Zhenzhen Wang
- Gastroenterology Department, Edouard Herriot Hospital, Lyon, France
- Ruijin Hospital, Shanghai Jiaotong University, China
| | - O Guillaud
- Gastroenterology Department, Edouard Herriot Hospital, Lyon, France
| | - E Cotte
- Surgery Department, Lyon Sud Hospital, Lyon, France
| | - A Pasquer
- Surgery Department, Edouard Herriot Hospital, Lyon, France
| | - O Vinet
- Gastroenterology Department, Edouard Herriot Hospital, Lyon, France
| | - G Poncet
- Surgery Department, Edouard Herriot Hospital, Lyon, France
| | - T Ponchon
- Gastroenterology Department, Edouard Herriot Hospital, Lyon, France
| | - J-C Saurin
- Gastroenterology Department, Edouard Herriot Hospital, Lyon, France
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10
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Skubitz KM. Biology and Treatment of Aggressive Fibromatosis or Desmoid Tumor. Mayo Clin Proc 2017; 92:947-964. [PMID: 28578783 DOI: 10.1016/j.mayocp.2017.02.012] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 01/24/2017] [Accepted: 02/16/2017] [Indexed: 12/14/2022]
Abstract
Aggressive fibromatosis, also known as desmoid-type fibromatosis (DTF) or desmoid tumor, is an uncommon locally invasive tumor. Because of its low incidence and variable behavior, DTF is often first seen by physicians who are not familiar with it, and recent advances in understanding this disease have led to changes in treatment approaches. The Wnt (β-catenin) pathway appears to play a key role in DTF pathogenesis, and recent studies of DTF biology suggest a possible model of DTF pathogenesis. Histologically, DTF shows a poorly circumscribed proliferation of myofibroblast-like cells with variable collagen deposition, similar to the proliferative phase of wound healing, and DTF has been associated with trauma and pregnancy. Desmoid-type fibromatosis may be a useful model of the tumor stroma in carcinomas as well as other fibrosing diseases such as progressive pulmonary fibrosis. The clinical course of DTF can vary greatly among patients, complicating the determination of the optimal treatment approach. Treatment options include surgery, nonsteroidal anti-inflammatory drugs with or without hormonal manipulation, chemotherapy, radiation therapy, and other forms of local therapy. Many treatments have been used, but these are not without toxicities. Because of the variable nature of the disease and the potential morbidity of treatment, some cases of DTF may do better without treatment; simple observation is often the best initial treatment. This review used a PubMed search from January 1, 1980, through October 31, 2016, using the terms fibromatosis and desmoid and discusses DTF disease characteristics, pathophysiology, and treatment options as well as examines several cases illustrating key points in the biology and treatment of this heterogeneous disease.
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Affiliation(s)
- Keith M Skubitz
- Department of Medicine, University of Minnesota Medical School, Minneapolis.
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11
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Park KH, Choi YJ, Kim KW, Ro KH, Kang CH, Song SH, Park JH. Combination chemotherapy with methotrexate and vinblastine for surgically unresectable, aggressive fibromatosis. Jpn J Clin Oncol 2016; 46:845-9. [PMID: 27365524 DOI: 10.1093/jjco/hyw081] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 05/20/2016] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To elucidate the clinical benefit and safety of low-dose chemotherapy using methotrexate and vinblastine in patients (mostly adults) with progressive and/or symptomatic fibromatosis. METHODS Patients were enrolled if they were treated with methotrexate and vinblastine chemotherapy for recurrences after surgical excision or newly diagnosed aggressive fibromatosis that was not amenable to surgical resection at the Korea University Medical Center from May 2008 to February 2016. RESULTS Twenty-two patients were treated with this regimen, and 21 were eligible for safety and efficacy analysis. Eleven (52%) of 21 patients showed a documented partial response (PR), and 11 showed stable disease (SD) by the end of treatment. All the patients who achieved PR reported a significant reduction in pain and improvement in the function of the affected lesions. Median progression-free survival was not reached at the time of analysis. The most common adverse event was abnormalities of the liver transaminases (overall 84.2%). The most common grade 3 or higher toxicity was neutropenia (36.8%), but no febrile neutropenic event was observed. The elevated levels of transaminases were normalized by reducing the dose of methotrexate or delaying treatment. CONCLUSIONS Low-dose chemotherapy with methotrexate and vinblastine for 1 year was effective and well tolerated by adult patients with aggressive, recurrent fibromatosis.
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Affiliation(s)
- Kyong-Hwa Park
- Division of Oncology/Hematology, Departments of Internal Medicine, Korea University Anam Hospital, Seoul
| | - Yoon Ji Choi
- Division of Oncology/Hematology, Departments of Internal Medicine, Korea University Anam Hospital, Seoul
| | - Kwan-Woo Kim
- Department of Orthopedic Surgery, Korea University Anam Hospital, Seoul
| | - Kyung-Han Ro
- Department of Orthopedic Surgery, Korea University Anam Hospital, Seoul
| | - Chang Ho Kang
- Department of Radiology, Korea University Anam Hospital, Seoul
| | - Sang-Heon Song
- Department of Orthopedic Surgery, Myung Ji Hospital, Gyeonggi-do, Republic of Korea
| | - Jong Hoon Park
- Department of Orthopedic Surgery, Korea University Anam Hospital, Seoul
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12
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Valdez J, Mercau G, Vitalone H, Perdigon G. Histological Study of Murine Fibrosarcoma Treated with Prostaglandin Inhibitors. Int J Immunopathol Pharmacol 2016. [DOI: 10.1177/039463209200500306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In a previous work we reported that treatment with indomethacin, aspirin and piroxicam in inbred BALB/c mice bearing a transplantable fibrosarcoma induced by methylcholanthrene produced tumor regressions in 45, 32 and 30 per cent of the animals, respectively. In the remaining mice, in which there was no tumor regression, tumor volumes varied (small 0.05<0,5 cm3 medium 0,5<1,35 cm3 and large > 1,35 cm3). In this histological study we observed that the antitumoral effect of these nonsteroidal antiinflammatory drugs occurred together with a remarkable tumor encapsulation and a decrease in the physical characteristics of malignancy of the tumor cells. The tumor-associated macrophages, which can be detected only by the iron-dextran phagocytosis but not by that of colloidal carbon or trypan blue, were found in the peritumoral area in all cases under study. Their numbers and/or phagocytic capacity were slightly increased in both regressing and small tumors with respect to large, medium and control tumors. These findings suggest that the action of these prostaglandin synthesis inhibiting drugs would permit tumor encapsulation by an improvement in the macrophage-fibroblast relationship together with a decrease in the malignancy of the tumor cells.
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Affiliation(s)
- J.C. Valdez
- Sección de Inmunología, Instituto de Microbiología, Facultad de Bioquímica, Química y Farmacia, Universidad Nacional de Tucumán. Ayacucho 491. (4000). Tucumán
| | - G.T. Mercau
- Cátedra de Histologia, Facultad de Medicina, Universidad Nacional de Tucumán, República Argentina
| | - H. Vitalone
- Cátedra de Histologia, Facultad de Medicina, Universidad Nacional de Tucumán, República Argentina
| | - G. Perdigon
- Sección de Inmunología, Instituto de Microbiología, Facultad de Bioquímica, Química y Farmacia, Universidad Nacional de Tucumán. Ayacucho 491. (4000). Tucumán
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Ricciardiello L, Ahnen DJ, Lynch PM. Chemoprevention of hereditary colon cancers: time for new strategies. Nat Rev Gastroenterol Hepatol 2016; 13:352-61. [PMID: 27095653 DOI: 10.1038/nrgastro.2016.56] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Colorectal cancer (CRC) is potentially preventable. Chemoprevention, a focus of research for the past three decades, aims to prevent or delay the onset of cancer through the regression or prevention of colonic adenomas. Ideal pharmacological agents for chemoprevention should be cheap and nontoxic. Although data indicate that aspirin can reduce the risk of CRC in the general population, the highest return from chemopreventive strategies would be expected in patients with the highest risk of developing the disease, particularly those with a defined hereditary predisposition. Despite compelling data showing that a large number of chemopreventive agents show promise in preclinical CRC models, clinical studies have yielded conflicting results. This Review provides a historical and methodological perspective of chemoprevention in familial adenomatous polyposis and Lynch syndrome, and summarizes the current status of CRC chemoprevention in humans. Our goal is to critically focus on important issues of trial design, with particular attention on the choice of appropriate trial end points, how such end points should be measured, and which patients are the ideal candidates to be included in a chemopreventive trial.
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Affiliation(s)
- Luigi Ricciardiello
- Department of Medical and Surgical Sciences, University of Bologna, Via Massarenti 9, Bologna 40124, Italy
| | - Dennis J Ahnen
- Department of Medicine, University of Colorado School of Medicine and Gastroenterology of the Rockies, 5001 E 17th Avenue Parkway, Denver, Colorado 80220, USA
| | - Patrick M Lynch
- Department of Gastroenterology, Hepatology and Nutrition, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, Texas 77054, USA
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SCHMOYER CHRISTOPHERJ, BRERETON HARMARD, BLOMAIN ERICW. Contralateral recurrence of aggressive fibromatosis in a young woman: A case report and review of the literature. Oncol Lett 2015; 10:325-328. [PMID: 26171024 PMCID: PMC4487148 DOI: 10.3892/ol.2015.3215] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2014] [Accepted: 04/24/2015] [Indexed: 01/22/2023] Open
Abstract
Aggressive fibromatosis (AF) is a benign non-encapsulated tumor of mesenchymal origin, with a tendency for local spread along fascial planes. Local invasion can lead to extensive morbidity and even mortality due to destruction of the bones, organs and soft tissues. This rare lesion is observed 1,000 times more frequently in patients with familial adenomatous polyposis or Gardner's syndrome due to the inheritance of the adenomatous polyposis coli (APC) gene. While AF does not metastasize, local recurrence is common. Distant recurrence is extremely rare, but is observed in those with a germ line APC mutation. The present study details the case of a 20-year-old woman with a melanoma of the right shoulder, treated definitively with surgery. The patient then developed a painful mass at the surgical site; a surgical biopsy demonstrated that the mass was AF. The patient was treated with surgical resection, radiation therapy, and a course of tamoxifen. Five years later, the patient presented with left forearm pain and diminished range of motion due to an infiltrating mass. This was excised and a clinical diagnosis of recurrent AF was made, in this patient lacking familial predisposition to the disease.
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Affiliation(s)
- CHRISTOPHER J. SCHMOYER
- Clinical Faculty, Department of Medicine, The Commonwealth Medical College, Scranton, PA 18509, USA
| | - HARMAR D. BRERETON
- Clinical Faculty, Department of Medicine, The Commonwealth Medical College, Scranton, PA 18509, USA
| | - ERIC W. BLOMAIN
- Clinical Faculty, Department of Medicine, The Commonwealth Medical College, Scranton, PA 18509, USA
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Abstract
OBJECTIVE To present a case of recurrent vulvar fibromatosis in an adolescent, discuss the specific difficulties of treating adolescents, and review the literature on available treatment. METHODS We present a case of recurrent vulvar fibromatosis in a 14-year-old girl, requiring several treatment modalities, including multiple surgeries, radiation therapy, and multiagent chemotherapy. We then discuss management strategies for these tumor types, and specifically examine how tumor location may impact their treatment. RESULTS Vulvar desmoids are extremely uncommon and they can be disfiguring and cause significant discomfort for women. Initial management of these tumors is surgical excision, yet failed surgery is often followed by other treatment modalities, including radiation, tyrosine kinase inhibitors, nonsteroidal anti-inflammatory drugs, hormonal therapy, and chemotherapy. This case clearly highlights the difficulties in managing these rare tumors, particularly in the adolescent population. CONCLUSIONS Desmoid tumors are nonmalignant, locally aggressive neoplasms most common in the 15 to 60 years age group. They are associated with high estrogen states, prior surgical trauma, and Gardner syndrome. Most commonly, desmoid tumors present in the abdominal wall, shoulder, neck, and chest, but can occur anywhere in the body. Given their rarity and lack of definitive therapy, vulvar desmoid tumors can be exceedingly difficult to treat, and are best managed with an interdisciplinary approach.
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16
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17
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Shakur SF, Takagi I, Jacobsohn JA, Golden BM, Karahalios DG. Spinal fibromatosis: a report of two cases and review of the literature. Spine J 2013; 13:e1-6. [PMID: 23523438 DOI: 10.1016/j.spinee.2013.02.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Revised: 09/09/2012] [Accepted: 02/08/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Spinal fibromatosis is a unique subset of fibromatosis that is only anecdotally described in the literature in sporadic case reports. According to our review of the literature, only 11 cases of spinal fibromatosis have been previously documented. This paucity of clinical data limits our understanding of its presentation and treatment. PURPOSE The authors present the first two cases of spinal fibromatosis encountered at their institution, and review the literature of reported cases to elucidate the presentation and outcomes of patients with this rare tumor. STUDY DESIGN A report of two cases and review of the literature. METHODS The two patients in our case report were women aged 45 and 38 years. Both of the patients presented to our clinic after previous excisional biopsy of a spinal mass, 17 years and 1 year later, respectively, with pain and paresthesias that recapitulated their former symptoms. Thirteen cases, including the two described in the current article, were culled from the literature. RESULTS Magnetic resonance imaging revealed an enhancing lesion in the posterior elements of the spinal column in the first case and a paraspinal soft tissue mass in the second case. The tumors were histologically defined by haphazardly arranged, elongated, and slender spindle cells separated by abundant collagen without mitoses or necrosis. Surgical management resulted in intralesional resection in the first case and en bloc resection in the second case. By 40 and 10 months after surgery, both patients remain without neurologic deficits. CONCLUSIONS Among 13 cases of spinal fibromatosis, pain with or without a mass is the most common symptom at presentation. Tumor etiology is evenly distributed between de novo origin and surgical trauma. Treatment outcomes, although, cannot be determined from the limited data currently available.
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Affiliation(s)
- Sophia F Shakur
- Section of Neurosurgery, University of Chicago Medical Center, 5841 South Maryland Ave., Chicago, IL 60637, USA.
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18
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Honeyman JN, Quaglia MPL. Desmoid tumors in the pediatric population. Cancers (Basel) 2012; 4:295-306. [PMID: 24213241 PMCID: PMC3712683 DOI: 10.3390/cancers4010295] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Revised: 02/29/2012] [Accepted: 03/06/2012] [Indexed: 11/16/2022] Open
Abstract
Desmoid tumors are benign soft tissue tumors associated with locally aggressive growth and high rates of morbidity, but they do not metastasize via lymphatic or hematogenous routes. While most of the data on desmoid tumors originates in the adult literature, many of the findings have been applied to the management of pediatric patients. This article discusses the epidemiology, etiology, clinical presentation, pathology, and treatment of this rare tumor in the pediatric population and includes a literature review of the most recent large series of pediatric patients with desmoid tumors.
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Affiliation(s)
- Joshua N Honeyman
- Department of Surgery, Pediatrics Service, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
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Ogura K, Shinoda Y, Okuma T, Ushiku T, Motoi T, Kawano H. Recurrent epithelioid hemangioma: therapeutic potential of tranilast and indomethacin. J Orthop Sci 2012; 17:194-8. [PMID: 21559957 DOI: 10.1007/s00776-011-0081-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2010] [Accepted: 01/26/2011] [Indexed: 11/25/2022]
Affiliation(s)
- Koichi Ogura
- Department of Orthopaedic Surgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan.
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20
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Desmoid tumour of the breast as a manifestation of Gardner's syndrome. Int J Surg Case Rep 2012; 3:139-42. [PMID: 22370045 DOI: 10.1016/j.ijscr.2012.01.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2011] [Revised: 01/11/2012] [Accepted: 01/12/2012] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Desmoid tumours of the breast are rare. Although benign, they can mimic breast cancer on physical examination, mammography and breast ultrasound and can also be locally invasive. Even though they occur sporadically, they can also be seen as a part of Gardner's syndrome. We describe a case of desmoid tumour in a woman with Gardner's syndrome where the lesion was mammographically occult. PRESENTATION OF CASE A 63-year old woman presented with four months history of a painful left breast lump. She had a screening mammogram seven months ago which was normal. She is known to have Gardner's syndrome and had a total colectomy, she has also had multiple abdominal desmoids excised in the past. On examination there was a 4cm×5cm firm, mobile lump in the left breast. Her mammograms in the clinic were also normal. Ultrasound suggested a benign lesion of the breast and a core biopsy showed it to be a benign spindle cell lesion. She underwent wide local excision of the lump, the intraoperative mammograms of the excised specimen also failed to detect the lesion. Histopathology of the excised specimen confirmed the tumour to be a benign desmoid tumour. She has now been offered radiotherapy and nonsteriodal anti-inflammatory drugs (NSAIDs) to reduce her chances of a local recurrence. CONCLUSION A high index of suspicion and a thorough triple examination protocol is necessary to detect rare lesions like a desmoid tumour which can masquerade as breast carcinoma.
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Nishida Y, Tsukushi S, Shido Y, Urakawa H, Arai E, Ishiguro N. Transition of treatment for patients with extra-abdominal desmoid tumors: nagoya university modality. Cancers (Basel) 2012; 4:88-99. [PMID: 24213228 PMCID: PMC3712685 DOI: 10.3390/cancers4010088] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Revised: 01/04/2012] [Accepted: 02/03/2012] [Indexed: 11/16/2022] Open
Abstract
Treatment modalities for desmoid tumors have been changed because of the high recurrence rate, even after wide resection, and some cases experience spontaneous self-regression during clinical course. The treatment modality in our institutions before 2003 was surgical resection with wide surgical margin, however, meloxicam, which is a NSAID and a selective COX-2 inhibitor has been applied consecutively since 2003. We reviewed the previously reported outcomes of surgical and conservative treatment in our institutions. Among 30 patients receiving surgical treatment, 16 (53%) recurred. Younger age ( p < 0.05) was a significant poor factor. According to RECIST for meloxicam treatment, CR was in one, PR in 10, SD in eight, PD in one evaluated at 2011. Older age ( p < 0.01) was significantly associated with good outcome for meloxicam treatment. Results of the previous study indicated that surgical treatment alone could not control desmoid tumors, even with negative surgical margin. Considering the functional impairment resulting from surgery with negative surgical margin, a conservative and effective treatment modality with fewer complications is desired. Conservative treatment with meloxicam is a promising novel modality for patients with extra-abdominal desmoid tumors.
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Affiliation(s)
- Yoshihiro Nishida
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65-Tsurumai, Showa, Nagoya 466-8550, Japan; E-Mails: (S.T.); (H.U.); (E.A.); (N.I.)
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +81-52-741-2111; Fax: +81-52-744-2260
| | - Satoshi Tsukushi
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65-Tsurumai, Showa, Nagoya 466-8550, Japan; E-Mails: (S.T.); (H.U.); (E.A.); (N.I.)
| | - Yoji Shido
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka 431-3192, Japan; E-Mail:
| | - Hiroshi Urakawa
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65-Tsurumai, Showa, Nagoya 466-8550, Japan; E-Mails: (S.T.); (H.U.); (E.A.); (N.I.)
| | - Eisuke Arai
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65-Tsurumai, Showa, Nagoya 466-8550, Japan; E-Mails: (S.T.); (H.U.); (E.A.); (N.I.)
| | - Naoki Ishiguro
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65-Tsurumai, Showa, Nagoya 466-8550, Japan; E-Mails: (S.T.); (H.U.); (E.A.); (N.I.)
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22
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Joglekar SB, Rose PS, Sim F, Okuno S, Petersen I. Current perspectives on desmoid tumors: the mayo clinic approach. Cancers (Basel) 2011; 3:3143-55. [PMID: 24212949 PMCID: PMC3759190 DOI: 10.3390/cancers3033143] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2011] [Revised: 07/06/2011] [Accepted: 08/02/2011] [Indexed: 11/16/2022] Open
Abstract
Desmoid tumors are a rare group of locally aggressive, non malignant tumors of fibroblastic origin that can lead to significant morbidity due to local invasion. Despite advances in the understanding of these tumors, their natural history is incompletely understood and the optimal treatment is still a matter of debate. Local control is the main goal of treatment and there has been a change in philosophy regarding the management of these tumors from aggressive surgical resection to function preservation. A multidisciplinary approach is essential to plan local control with acceptable morbidity. The current Mayo Clinic algorithm for the treatment of these tumors is based on institutional experience and the available evidence in the literature: asymptomatic/non progressive lesions away from vital structures are managed with observation and regular imaging; primary or recurrent desmoid tumors which are symptomatic or progressive or near vital structures are managed with wide surgical resection when wide surgical margins are possible with minimal functional and cosmetic loss. When positive or close surgical margins are likely, surgical resection with adjuvant radiotherapy or definitive radiotherapy is preferred. If likely functional or cosmetic deficit is unacceptable, radiotherapy is the treatment of choice. Unresectable lesions are considered for radiotherapy, chemotherapy or newer modalities however an unresectable lesion associated with a painful, functionless, infected extremity is managed with an amputation.
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Affiliation(s)
| | - Peter S. Rose
- Department of Orthopedics, Mayo Clinic, 200 1 ST SW, Rochester, MN 55905, USA; E-Mail:
| | - Franklin Sim
- Department of Orthopedics, Mayo Clinic, 200 1 ST SW, Rochester, MN 55905, USA; E-Mail:
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +1-507 284 8314
| | - Scott Okuno
- Department of Oncology, Mayo Clinic, Rochester, MN55905, USA; E-Mail:
| | - Ivy Petersen
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN55905, USA; E-Mail:
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Pajares B, Torres E, Jiménez B, Sevilla I, Rodríguez A, Rico JM, Trigo JM, Alba E. Multimodal treatment of desmoid tumours: the significance of local control. Clin Transl Oncol 2011; 13:189-93. [PMID: 21421464 DOI: 10.1007/s12094-011-0639-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Desmoid tumours are a rare group of tumours arising in the deep musculoaponeurotic structures and although they have no metastatic potential they can be locally aggressive with relapse rates of between 23-40%. Three sub-sites are reported: extra-abdominal, abdominal wall and intra-abdominal. The purpose of this study was to analyze patients with these tumours treated and followed at our institution and to determine factors influencing disease free survival. MATERIAL AND METHODS We conducted a retrospective study of 20 patients treated between 1997 and 2009. Data was compiled to include age, gender, surgical history, familial adenomatous polyposis (FAP), contraceptives, tumour site, first-line treatment, positive margins and adjuvant radiotherapy. A descriptive and survival statistical analysis was also performed. RESULTS Most patients were women, with a median age of 36 years, with abdominal wall involvement and treated with complete surgery without adjuvant radiotherapy. With a median follow-up of 35 months (range 0-188), local control at 5 years for any kind of treatment was 80%. Overall survival (OS) and 5-year progression-free survival (PFS) were 100% and 86%, respectively. CONCLUSION Desmoid tumours are group of rare tumours. Although complete surgical resection remains the cornerstone of treatment for resectable lesions, there is still substantial risk of recurrence. Our outcomes are comparable to those reported in the few series published to date.
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Affiliation(s)
- Bella Pajares
- Department of Clinical Oncology, Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain.
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Corsten M, Donald P, Boggan J, Gadre A, Gandour-Edwards R, Nemzek W. Extra-abdominal fibromatosis (desmoid tumor) arising in the infratemporal fossa: a case report. Skull Base Surg 2011; 8:237-41. [PMID: 17171074 PMCID: PMC1656708 DOI: 10.1055/s-2008-1058191] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Aggressive fibromatosis (or desmoid tumor) refers to a histologically benign but locally aggressive lesion arising from musculoaponeurotic structures in various anatomic sites. Extra-abdominal desmoids represent about one third of all desmoid tumors; of these only about 11 to 15% arise in the head and neck. Desmoid tumors arising in the infratemporal fossa are exceedingly rare; to our knowledge only one such tumor has been reported in the literature. We present a desmoid tumor arising in the infratemporal fossa with intracranial extension in a twenty-seven year old male and review the literature on this rare condition.
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25
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Longhi A, Errani C, Battaglia M, Alberghini M, Ferrari S, Mercuri M, Molinari M. Aggressive Fibromatosis of the Neck Treated with a Combination of Chemotherapy and Indomethacin. EAR, NOSE & THROAT JOURNAL 2011; 90:E11-5. [DOI: 10.1177/014556131109000610] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Aggressive fibromatosis (desmoid tumor) of the neck is rare. When feasible, surgery is the best treatment option. However, complete excision with negative margins is not possible in most cases because of the involvement of vascular and nervous structures. Also, surgery results in poor functional and aesthetic outcomes. Sometimes de-bulking surgery with positive margins is performed, but the anatomy of the neck is a challenge for oncologic surgeons, and recurrences are not uncommon. Radiotherapy is seldom employed for the same reasons. On the other hand, systemic treatment with chemotherapy, hormone therapy, and noncytotoxic agents such as nonsteroidal anti-inflammatory drugs (NSAIDs) has been used with good results. We report a case of inoperable aggressive fibromatosis of the neck that was successfully treated for about 21 months with a combination of chemotherapy and the NSAID indomethacin. As far as we know, this is the first reported use of a combination of chemotherapy and an anti-inflammatory drug in the treatment of aggressive fibromatosis of the neck. We also review the literature on cases of aggressive fibromatosis of the neck that have been reported over the past 12 years.
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Affiliation(s)
- Alessandra Longhi
- Musculoskeletal Department, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Costantino Errani
- Musculoskeletal Department, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Milva Battaglia
- Musculoskeletal Department, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marco Alberghini
- Musculoskeletal Department, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Ferrari
- Musculoskeletal Department, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Mario Mercuri
- Musculoskeletal Department, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Massimo Molinari
- Musculoskeletal Department, Istituto Ortopedico Rizzoli, Bologna, Italy
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Righetti AEM, Jacomini C, Parra RS, de Almeida ALNR, Rocha JJR, Féres O. Familial adenomatous polyposis and desmoid tumors. Clinics (Sao Paulo) 2011; 66:1839-42. [PMID: 22012061 PMCID: PMC3180149 DOI: 10.1590/s1807-59322011001000027] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Affiliation(s)
- Ana Elisa Moraes Righetti
- Division of Coloproctology, Department of Surgery and Anatomy, School of Medicine, University of São Paulo, Ribeirão Preto, SP, Brazil
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Goto T, Nemoto T, Ogura K, Hozumi T, Funata N. Successful treatment of desmoid tumor of the chest wall with tranilast: a case report. J Med Case Rep 2010; 4:384. [PMID: 21114809 PMCID: PMC2999613 DOI: 10.1186/1752-1947-4-384] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2009] [Accepted: 11/29/2010] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Desmoid tumor is characterized by infiltrative growth and local recurrence often occurs after surgery. To reduce the local recurrence rate, adjuvant therapy, such as radiotherapy and pharmacotherapy with cytotoxic agents, anti-estrogen agents and non-steroidal anti-inflammatory drugs, is often applied. In addition, these non-surgical treatments are also performed in patients with unresectable desmoid tumors. We successfully treated a patient with a desmoid tumor with tranilast; an anti-allergic agent. CASE PRESENTATION A 48-year-old Japanese man with a slow-growing desmoid tumor on his chest wall was treated with an oral administration of tranilast (300 mg per day, three times a day). Two years and two months after the commencement of his therapy, the tumor became impalpable. At this time, the oral administration of tranilast was discontinued. Two years after discontinuation of the treatment, a physical examination showed no recurrence of the tumor and he continued in a state of remission. We were successfully able to reduce the size of the tumor and thereafter maintain the reduced size. CONCLUSION Tranilast was clinically effective in our case, and is probably comparable to cytotoxic agents or anti-estrogen agents. Because tranilast has substantially fewer adverse effects than cytotoxic agents, it could be a very useful therapeutic agent for desmoid tumor.
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Affiliation(s)
- Takahiro Goto
- Department of Orthopaedic Surgery and Musculoskeletal Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Hon-Komagome, Bunkyo-ku, Tokyo 113-8677, Japan.
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Cho NL, Carothers AM, Rizvi H, Hasson RM, Redston M, Bertagnolli MM. Immunohistochemical and molecular analysis of tyrosine kinase activity in desmoid tumors. J Surg Res 2010; 173:320-6. [PMID: 21195420 DOI: 10.1016/j.jss.2010.10.037] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2010] [Revised: 09/24/2010] [Accepted: 10/27/2010] [Indexed: 12/11/2022]
Abstract
BACKGROUND Optimal surgical and medical therapy for the treatment of desmoid tumors (DT) is still undefined. Partial response to tyrosine kinase inhibitors (TKI) has previously been described. Here, we examined the role of the tyrosine kinases c-Src and c-Kit in driving desmoid tumorigenesis. METHODS Six consecutive DT and matched normal tissues were collected from the operating room. Tissues were embedded in paraffin for immunohistochemical analysis, and protein lysates were prepared for immunoblot and immunoprecipitation. RESULTS We found increased levels of β-catenin in five of six (83%) DT relative to matched normal tissue by immunoblot analysis. By immunohistochemistry, β-catenin expression was also increased in DT and localized to the nucleus. In contrast, we observed variable levels of total and activated c-Src and c-Kit expression in DT compared with normal tissue. Finally, β-catenin tyrosine phosphorylation (p-Y) among tumors was variably increased, despite the increased amount of total β-catenin in tumors. CONCLUSIONS Our results suggest that c-Src and c-Kit activity in DT is variable, consistent with the heterogeneous nature of this disease. Clinical response to TKI in DT may be via alternative mechanisms unrelated to c-Src or c-Kit activity. Further insight into DT biology will help identify novel drug regimens to limit the morbidity and mortality associated with this disease.
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Affiliation(s)
- Nancy L Cho
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA.
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Abstract
Fibromatosis is a rare, locally aggressive and bening breast tumor that presents problems in the diagnosis and may mimic breast cancer on physical examination, mammography and breast ultrasound. Definitive diagnosis is reached by histologic findings. This case shows the unusual presentation in our patient and management of this unfrecuent desmoid tumor.
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Duffaud F, Le Cesne A. Imatinib in the treatment of solid tumours. Target Oncol 2009; 4:45-56. [PMID: 19343301 DOI: 10.1007/s11523-008-0101-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2008] [Accepted: 12/30/2008] [Indexed: 12/11/2022]
Abstract
The extraordinary success of imatinib in gastrointestinal stromal tumors (GIST) represents a model for molecularly targeted therapy for other solid tumors. Research is currently going to identify the molecular basis of mechanisms of action and drug resistance. In this article, we review recent advances in the clinical management of patients with GISTs treated with imatinib, but also of patients with dermatofibrosarcoma protuberans, chordoma, aggressive fibromatosis, and some other common solid tumors treated with this drug. We reviewed the knowledge of the molecular mechanisms that are basic to imatinib effects in these tumors.
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Affiliation(s)
- Florence Duffaud
- Hôpital La timone, Centre Hospitalier Universitaire de l'Assistance Publique des Hôpitaux de Marseille, 264 rue Saint Pierre, 13385, Marseille, France.
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Montero Luis A, Hernanz de Lucas R, Hervás Morón A, Fernández Lizarbe E, Sancho García S, Vallejo Ocaña C, Polo Rubio A, Ramos Aguerri A. Radiation therapy for the treatment of benign vascular, skeletal and soft tissue diseases. Clin Transl Oncol 2008; 10:334-46. [PMID: 18558580 DOI: 10.1007/s12094-008-0209-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The concept of radiation therapy for the treatment of benign diseases refers to the use of moderate to high-energy ionising radiation as part of the treatment of non-malignant, but not necessarily harmless, diseases. The usefulness of radiation therapy, based on the anti-inflammatory properties of ionising radiation, has long been known. Apart from the treatment of intracranial benign tumours, such as meningiomas and neurinomas, the prevention of cardiovascular restenosis or treatment of skeletal degenerative diseases are, without doubt, the main fields of action for radiation therapy in benign conditions. Nonetheless, many other non-cancer entities may benefit from ionising radiation therapy treatment. The purpose of this review is to highlight and update indications for treatment with radiation therapy in benign conditions, focusing on skeletal degenerative processes, vascular conditions and soft tissue diseases.
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Affiliation(s)
- A Montero Luis
- Department of Radiation Oncology, Hospital Ramón y Cajal, Madrid, Spain.
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32
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Lu HW, Zhang LM, Liu JY, Chen RF. Synthesis of an Amphiphilic Polysaccharide Derivative and Its Micellization for Drug Release. J BIOACT COMPAT POL 2008. [DOI: 10.1177/0883911507088272] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A new route for the synthesis of novel amphiphilic polysaccharides was developed, in which a synthetic biodegradable poly(ε-caprolactone) was capped with a phenylalanine group (PCL-phenylalanine). The ring-opening polymerization of ε-caprolactone (ε-CL) was carried out in the absence of a metal catalyst with L-phenylalanine as the initiator; this was followed by a coupling reaction with biodegradable dextran in the presence of carbonyldimidazole. The FTIR and 1H NMR analyses confirm the coupling reaction. Fluorescence, transmission electron microscopy (TEM), and dynamic light scattering (DLS) confirm that in aqueous solution the amphiphilic polysaccharides self-assemble into the nanoscale spherical micelles with good stability. The in vitro drug release behavior of the nonsteroidal indomethacin drug exhibits sustained drug release profile as described by the Higuchi model without a burst effect.
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Affiliation(s)
- Hong-Wei Lu
- School of Chemistry and Chemical Engineering and Key Laboratory for Polymeric Composite and Functional Materials of Ministry of Education, Sun Yat-Sen (Zhongshan) University, Guangzhou 510275, China
| | - Li-Ming Zhang
- School of Chemistry and Chemical Engineering and Key Laboratory for Polymeric Composite and Functional Materials of Ministry of Education, Sun Yat-Sen (Zhongshan) University, Guangzhou 510275, China,
| | - Ji-Yan Liu
- School of Chemistry and Chemical Engineering and Key Laboratory for Polymeric Composite and Functional Materials of Ministry of Education, Sun Yat-Sen (Zhongshan) University, Guangzhou 510275, China
| | - Ru-Fu Chen
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital Sun Yet-sen (Zhongshan) University, Guangzhou 510120, China
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Lev D, Kotilingam D, Wei C, Ballo MT, Zagars GK, Pisters PWT, Lazar AA, Patel SR, Benjamin RS, Pollock RE. Optimizing Treatment of Desmoid Tumors. J Clin Oncol 2007; 25:1785-91. [PMID: 17470870 DOI: 10.1200/jco.2006.10.5015] [Citation(s) in RCA: 186] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose This study compared a large series of desmoid patients treated at a single institution to a previously published series from the same institution to determine if patient population characteristics, treatment approaches, and clinical outcomes had undergone change over the two study periods. Materials and Methods Data from a prospective soft tissue tumor database was used to analyze clinical courses of 189 desmoid patients treated at The University of Texas M.D. Anderson Cancer Center (UTMDACC) from 1995 to 2005 as compared with 189 UTMDACC desmoid patients treated between 1965 and 1994. Results A nearly three-fold increase in annualized UTMDACC desmoid referral volume with significantly higher percentages and numbers of primary desmoid tumor referrals to UTMDACC was observed in the most recent study period. Significantly increased systemic therapy use and decreased reliance on surgery alone was observed more recently. While the recent series patients had higher rates of macroscopic residual disease and equivalent rates of positive microscopic margins after definitive surgery, the estimated 5-year local recurrence rate of 20% was improved compared with the 30% rate observed in the earlier series. Conclusion Increased awareness of the complex multidisciplinary management needed for desmoid tumor control may underlie significantly increased numbers of referrals to UTMDACC, especially primary untreated desmoids. Increased neoadjuvant treatments may be associated with improved desmoid patient outcomes. These trends should be supported, particularly if personalized molecular-based therapies are to be rapidly and effectively deployed for the benefit of those afflicted by this rare and potentially debilitating disease.
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Affiliation(s)
- Dina Lev
- Department of Cancer Biology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA.
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Wcislo G, Szarlej-Wcislo K, Szczylik C. Control of aggressive fibromatosis by treatment with imatinib mesylate. A case report and review of the literature. J Cancer Res Clin Oncol 2007; 133:533-8. [PMID: 17453242 DOI: 10.1007/s00432-007-0198-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2007] [Accepted: 03/23/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE There has been only one report available that focuses on the treatment with imatinib mesylate of two individual persons with aggressive fibromatosis. The authors concluded that after long-term treatment, for 9 and 11 months, with imatinib mesylate, both patients demonstrated radiographic and clinical responses. The novel therapy should be considered as salvage in patients with aggressive fibromatosis expressed platelet-derived growth factor receptor-alfa, beta (PDGFR-alfa, PDGFR-beta), and/or c-kit, whose tumors are uncontrollable by the standard management. On the other hand, the number of kinases blocked by imatinib mesylate is notching up, for instance the tyrosine kinase, which is associated with macrophage-colony stimulating factor receptor (M-CSFR). METHODS The patient was suffering from aggressive fibromatosis after prior therapy including surgery (R2), radiotherapy, and systemic treatment with combination of tamoxifen and sulindac. The tumor specimen was immunostained for PDGFR-beta and c-kit (CD117), and PDGFR-alfa and cytokines platelet-derived growth factor-alfa and beta were not assessed. The tests for both assessed molecules revealed negative results. In spite of this, the patient underwent a unique treatment with imatinib mesylate at the dose of 400 mg orally once daily for 3 years and 2 months. RESULTS After three months of the therapy, radiographic (met criteria of SD but small decrease of the tumor was noted) and clinical responses were recorded for the first time. The same was seen after 6 and 13 months of therapy continuation with imatinib mesylate. Currently, the patient is treated with imatinib mesylate (400 mg orally once daily) without any toxicity effects. The last MRI revealed readily a smaller tumor (35 x 20 mm) after such a therapy lasted more than 3 years. CONCLUSIONS Treatment with imatinib mesylate has been a well-accepted therapy for chronic myelogenous leukemia (CML) and gastrointestinal stromal tumors (GIST). There have been established four kinases (p210(bcr/abl), c-kit, PDGFR-alfa, PDGFR-beta) suggested as the target for imatinib mesylate. Other potential targets will be discovered as it has lately been determined that M-CSFR kinase activity was blocked by imatinib mesylate. The salvage therapy for aggressive fibromatosis with imatinib mesylate seems to be an attractive opportunity for patients with the advanced disease, whose prior therapy failed.
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Affiliation(s)
- Gabriel Wcislo
- Department of Oncology, Military Institute of Medicine, 128 Szaserow Street, 00-909 Warsaw, Poland.
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35
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Baumert BG, Spahr MO, Hochstetter AV, Beauvois S, Landmann C, Fridrich K, Villà S, Kirschner MJ, Storme G, Thum P, Streuli HK, Lombriser N, Maurer R, Ries G, Bleher EA, Willi A, Allemann J, Buehler U, Blessing H, Luetolf UM, Davis JB, Seifert B, Infanger M. The impact of radiotherapy in the treatment of desmoid tumours. An international survey of 110 patients. A study of the Rare Cancer Network. Radiat Oncol 2007; 2:12. [PMID: 17343751 PMCID: PMC1828737 DOI: 10.1186/1748-717x-2-12] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2006] [Accepted: 03/07/2007] [Indexed: 12/02/2022] Open
Abstract
Purpose A multi-centre study to assess the value of combined surgical resection and radiotherapy for the treatment of desmoid tumours. Patients and methods One hundred and ten patients from several European countries qualified for this study. Pathology slides of all patients were reviewed by an independent pathologist. Sixty-eight patients received post-operative radiotherapy and 42 surgery only. Median follow-up was 6 years (1 to 44). The progression-free survival time (PFS) and prognostic factors were analysed. Results The combined treatment with radiotherapy showed a significantly longer progression-free survival than surgical resection alone (p smaller than 0.001). Extremities could be preserved in all patients treated with combined surgery and radiotherapy for tumours located in the limb, whereas amputation was necessary for 23% of patients treated with surgery alone. A comparison of PFS for tumour locations proved the abdominal wall to be a positive prognostic factor and a localization in the extremities to be a negative prognostic factor. Additional irradiation, a fraction size larger than or equal to 2 Gy and a total dose larger than 50 Gy to the tumour were found to be positive prognostic factors with a significantly lower risk for a recurrence in the univariate analysis. This analysis revealed radiotherapy at recurrence as a significantly worse prognostic factor compared with adjuvant radiotherapy. The addition of radiotherapy to the treatment concept was a positive prognostic factor in the multivariate analysis. Conclusion Postoperative radiotherapy significantly improved the PFS compared to surgery alone. Therefore it should always be considered after a non-radical tumour resection and should be given preferably in an adjuvant setting. It is effective in limb preservation and for preserving the function of joints in situations where surgery alone would result in deficits, which is especially important in young patients.
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Affiliation(s)
- Brigitta G Baumert
- Radiation Oncology, University Hospital Zurich, Switzerland
- Dept of Radiation Oncology (MAASTRO), GROW, University Hospital Maastricht, The Netherlands
| | - Martin O Spahr
- Radiation Oncology, University Hospital Zurich, Switzerland
| | | | - Sylvie Beauvois
- Dept. de Radio-Oncologie, Centre des Tumeurs de l'Université Libre de Bruxelles, Belgium
- Service de Radiothérapie, Clinique Saint Jean, Brussels, Belgium
| | | | - Katrin Fridrich
- Institute for Pathology, University Hospital Basel, Switzerland
- Pathology Clinics, Rikshospitalet-Radiumhospitalet Medical Center, Oslo, Norway
| | - Salvador Villà
- Radiation Oncology, Institut Català d'Oncologia, Barcelona, Spain
| | - Michael J Kirschner
- Klinik und Poliklinik fuer Strahlentherapie, Erlangen, Germany
- Praxis fuer Strahlentherapie, Solingen, Germany
| | - Guy Storme
- Radiation Oncology, Oncologie Centre, Vrije Universiteit Brussels, Belgium
| | - Peter Thum
- Radiation Oncology, Ospedale S. Giovanni, Bellinzona, Switzerland
| | | | | | - Robert Maurer
- Dept. of Pathology, Stadtspital Triemli, Zurich, Switzerland
| | - Gerhard Ries
- Radiation Oncology, Kantonsspital St. Gallen, Switzerland
| | | | - Alfred Willi
- Radiation Oncology, Kantonsspital Chur, Switzerland
| | | | | | - Hugo Blessing
- Chirurgische Klinik, Kantonsspital Glarus, Switzerland
- Deceased 1999
| | - Urs M Luetolf
- Radiation Oncology, University Hospital Zurich, Switzerland
| | | | | | - Manfred Infanger
- Dept. of Hand-Plastic-and Reconstructive Surgery, University Hospital Zurich, Switzerland
- Dept. of Hand, Plastic and Reconstructive Surgery, Charite, University Medicine Berlin, Germany
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Skapek SX, Ferguson WS, Granowetter L, Devidas M, Perez-Atayde AR, Dehner LP, Hoffer FA, Speights R, Gebhardt MC, Dahl GV, Grier HE. Vinblastine and Methotrexate for Desmoid Fibromatosis in Children: Results of a Pediatric Oncology Group Phase II Trial. J Clin Oncol 2007; 25:501-6. [PMID: 17290057 DOI: 10.1200/jco.2006.08.2966] [Citation(s) in RCA: 151] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To determine the efficacy and safety of using vinblastine (Vbl) and methotrexate (Mtx) in children with desmoid-type fibromatosis that is recurrent or not amenable to treatment with radiation or surgery. Patients and Methods A phase II study was conducted within the Pediatric Oncology Group. Patients were treated using Vbl (5 mg/m2/dose) and Mtx (30 mg/m2/dose), both administered by intravenous injection weekly for 26 weeks and every other week for an additional 26 weeks. Response was assessed by bidimensional measurements of tumor on axial imaging (magnetic resonance imaging or computed tomography). Results Over 35 months, 28 patients were enrolled; 27 were eligible, and 26 were assessable for response. A measurable response was documented in eight patients (31%), and 10 patients had stable disease documented as the best response to treatment. Eighteen patients had disease progression at a median time of 9.1 months. Eight patients remain free of disease progression at a median of 43.4 months from study entry. Nine patients reported no to moderate toxicity. Neutropenia was the most common toxicity (n = 22) and the most common grade 4 toxicity (n = 5). Anemia, nausea, vomiting, and elevations in hepatic transaminases were also common and were reversible with interruption of chemotherapy. Conclusion Vbl and Mtx are well tolerated in children with desmoid-type fibromatosis. Furthermore, this combination can promote tumor regression or block tumor growth in most children.
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Affiliation(s)
- Stephen X Skapek
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN 38105, USA.
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Liegl B, Leithner A, Bauernhofer T, Windhager R, Guelly C, Regauer S, Beham A. Immunohistochemical and mutational analysis of PDGF and PDGFR in desmoid tumours: is there a role for tyrosine kinase inhibitors in c-kit-negative desmoid tumours? Histopathology 2006; 49:576-81. [PMID: 17163842 DOI: 10.1111/j.1365-2559.2006.02562.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
AIM To determine the platelet-derived growth factor (PDGF) alpha and beta status of desmoid tumours. Desmoid tumours are rare monoclonal neoplasms that appear to have no metastatic potential. Surgical resection and radiotherapy in the event of a positive surgical margin is the first-line treatment. Recurrences are frequent. Treatment results using non-steroidal anti-inflammatory agents, anti-oestrogen compounds and other agents such as Imatinib mesylate have been published. Therapy with Imatinib has been proposed as a therapeutic option, although in most reports desmoid tumours are reported to be c-kit-. METHODS AND RESULTS We performed immunohistochemical analysis on 124 archived samples (85 patients) of desmoid tumours using antibodies to PDGFalpha, PDGFbeta, PDGFRalpha and PDGFRbeta. All desmoid tumours showed immunoreactivity with antibodies to PDGFalpha and PDGFRalpha, whereas with antibodies to PDGFbeta and PDGFRbeta no specific reaction could be detected. Mutational analysis of PDGFRalpha (exons 11, 12, 17 and 18) and PDGFRbeta (exon 12) on frozen material from 14 patients was performed, but no mutations leading to amino acid changes in the mature protein were identified. CONCLUSION The absence of an activating mutation in a protooncogene does not exclude the efficacy of tyrosine kinase inhibitors through other possible mechanisms, and these might be a therapeutic option for patients with desmoid tumours in whom established local and systemic approaches fail to control the disease.
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Affiliation(s)
- B Liegl
- Institute of Pathology, Medical University of Graz, Graz, Austria.
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Picariello L, Carbonell Sala S, Martineti V, Gozzini A, Aragona P, Tognarini I, Paglierani M, Nesi G, Brandi ML, Tonelli F. A comparison of methods for the analysis of low abundance proteins in desmoid tumor cells. Anal Biochem 2006; 354:205-12. [PMID: 16729958 DOI: 10.1016/j.ab.2006.03.047] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2005] [Revised: 03/24/2006] [Accepted: 03/26/2006] [Indexed: 10/24/2022]
Abstract
The desmoids are a group of rare clinically diverse, deep-seated fibrous neoplasms. The exact etiology is unknown, but several factors are considered to be positively correlated with their development and growth, i.e., genetic and hormonal factors and trauma. These tumors may be sporadic or associated with a genetic disease such as familial adenomatous polyposis (FAP). Devoid of metastatic potential, they tend to form large, infiltrative masses which, if not completely excised, recur repeatedly. Although surgery is widely accepted as the first-line treatment for extra-abdominal and abdominal wall desmoids, a proportion of cases are successfully palliated with either estrogen antagonists (tamoxifen, toremifene, and raloxifene) or nonsteroidal anti-inflammatory drugs. We describe and compare four methods for evaluating the expression of estrogen receptors alpha/beta and COX-1 and COX-2 in desmoid tumor-derived cells and tissues: immunocytochemistry, immunohistochemistry, RT-PCR, and two-color Western blot detection with the Odyssey infrared imaging system. Through this comparative analysis, Western blot with Odyssey was recognized as the best method to analyze the expression particularly of low expressed proteins in desmoid-derived cells. The use of a specific and reliable assessment method becomes fundamental in the evaluation of the presence and modulation of proteins which are important but weakly expressed in these rare tumors.
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Affiliation(s)
- L Picariello
- Department of Clinical Physiopathology, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy
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Papagelopoulos PJ, Mavrogenis AF, Mitsiokapa EA, Papaparaskeva KT, Galanis EC, Soucacos PN. Current trends in the management of extra-abdominal desmoid tumours. World J Surg Oncol 2006; 4:21. [PMID: 16584569 PMCID: PMC1456964 DOI: 10.1186/1477-7819-4-21] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2005] [Accepted: 04/03/2006] [Indexed: 11/10/2022] Open
Abstract
Extra-abdominal desmoid tumours are slow-growing, histologically benign tumours of fibroblastic origin with variable biologic behaviour. They are locally aggressive and invasive to surrounding anatomic structures. Magnetic resonance imaging is the modality of choice for the diagnosis and the evaluation of the tumours. Current management of desmoids involves a multidisciplinary approach. Wide margin surgical resection remains the main treatment modality for local control of the tumour. Amputation should not be the initial treatment, and function-preserving procedures should be the primary treatment goal. Adjuvant radiation therapy is recommended both for primary and recurrent lesions. Chemotherapy may be used for recurrent or unresectable disease. Overall local recurrence rates vary and depend on patient's age, tumour location and margins at resection.
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Affiliation(s)
| | - Andreas F Mavrogenis
- First Department of Orthopaedic Surgery, Athens University Medical School, Athens, Greece
| | - Evanthia A Mitsiokapa
- Department of Physical Medicine and Rehabilitation, Thriassion Hospital, Elefsis, Greece
| | | | - Evanthia C Galanis
- Department of Medical Oncology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota
| | - Panayotis N Soucacos
- First Department of Orthopaedic Surgery, Athens University Medical School, Athens, Greece
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Yildiz F, Kars A, Cengiz M, Yildiz O, Akyürek S, Selek U, Ozyigit G, Atahan IL. 1,25-Dihydroxy vitamin D3: can it be an effective therapeutic option for aggressive fibromatosis. Med Hypotheses 2005; 64:333-6. [PMID: 15607567 DOI: 10.1016/j.mehy.2004.07.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2004] [Accepted: 07/06/2004] [Indexed: 11/30/2022]
Abstract
Aggressive fibromatosis (AF), also known as desmoid tumor is a monoclonal fibroblastic proliferation in a collagen matrix that arises in musculoaponeurotic structures. Though considered as benign, they are locally invasive and their propensity for recurrence after conservative surgery is well documented. Addition of postoperative adjuvant radiotherapy produces higher local control rates, although recurrence rates are still high in patients with positive margins. The antineoplastic activity of vitamin D has been demonstrated both in vitro and in vivo models of several cancers. The proposed mechanisms for antineoplastic activity include inhibition of proliferation associated with cell cycle arrest, induction of apoptosis and reduction in invasiveness and angiogenesis. It has also been shown that vitamin D has a negative impact on collagen homeostasis by inhibiting the formation and increasing its degradation. Since vitamin D has an antineoplastic activity and negative effect on collagen synthesis and deposition, it is proposed that 1,25-dihydroxy vitamin D3 can be a right therapeutic option for the management of desmoid tumors.
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Affiliation(s)
- F Yildiz
- Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, 06100 Ankara, Turkey.
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Micke O, Seegenschmiedt MH. Radiation therapy for aggressive fibromatosis (desmoid tumors): results of a national Patterns of Care Study. Int J Radiat Oncol Biol Phys 2005; 61:882-91. [PMID: 15708271 DOI: 10.1016/j.ijrobp.2004.07.705] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2004] [Revised: 07/07/2004] [Accepted: 07/12/2004] [Indexed: 11/20/2022]
Abstract
PURPOSE After a general Patterns of Care Study (PCS) the German Cooperative Group on Radiotherapy for Benign Diseases (GCG-BD) initiated a multicenter cohort study to analyze the radiation therapy practice for aggressive fibromatosis. METHODS AND MATERIALS In 2002 a PCS was conducted in all German radiotherapy (RT) institutions by mailing a standardized structured questionnaire, to assess patients accrual, number, pretreatment, treatment indications, RT, and target volume concepts for irradiation in aggressive fibromatosis. In addition, the treatment outcome of individual patients was evaluated. The PCS was structured and analyzed according to the model for quality assessment by Donabedian in three major components: structure, process, and outcome evaluation. RESULTS A total of 101 institutions returned the questionnaire: 52.7% reported satisfactory clinical data and experience for inclusion in this analysis. A total accrual rate of 278 patients per year was reported with median number of 2 cases (1-7 cases) per institution. Satisfactory data for a long-term clinical evaluation was reported for 345 patients from 19 different institutions. The applied total doses ranged between 36 and 65 Gy (median, 60 Gy). The local control rate was 81.4% in primary RT for unresectable tumors and 79.6% in postoperative RT. No acute or late radiation toxicities > Grade 2 (RTOG) were observed. No clear dose-response relationship could be established, but there was a tendency toward a lower local control rate in patients with a higher number of operative procedures before RT and patients treated for recurrent aggressive fibromatosis. CONCLUSIONS This study comprises the largest database of cases reported for RT in aggressive fibromatosis. Radiotherapy provides a high local control rate in the postoperative setting and in unresectable tumors. This PCS may serve as a starting point for a national or international prospective multicenter study or registry, or both.
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Affiliation(s)
- Oliver Micke
- Department of Radiotherapy, Münster University Hospital, Albert-Schweitzer-Strasse 33, 48129 Münster, Germany.
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Picariello L, Tonelli F, Brandi ML. Selective oestrogen receptor modulators in desmoid tumours. Expert Opin Investig Drugs 2005; 13:1457-68. [PMID: 15500393 DOI: 10.1517/13543784.13.11.1457] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Selective oestrogen receptor modulators (SERMs) are compounds with a mixed agonist/antagonist activity on oestrogen receptors. An ideal SERM is a compound with an oestrogen antagonist effect on the breast and uterus but oestrogen agonist effect on bone. Beside tamoxifen, a group of well-investigated SERMs is represented by raloxifene, LY-353381 (SERM3), EM-800 and CP-336156. On an empirical basis, tamoxifen has been used to pharmacologically treat desmoid tumours. Recently, raloxifene, a second-generation SERM, has been used in the treatment of familial adenomatous polyposis patients affected by desmoid tumour. The mechanisms through which these molecules affect desmoid tumour growth appear to be due, in part, to the fact that SERMs may act independently of oestrogen receptors. The knowledge of the molecular basis of SERM action will make the development of novel synthetic compounds with engineered tissue selectivity possible.
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Affiliation(s)
- Lucia Picariello
- Department of Clinical Physiopathology, University of Florence, Italy
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Muldoon RL, Lowney JK. Familial Adenomatous Polyposis. SEMINARS IN COLON AND RECTAL SURGERY 2004. [DOI: 10.1053/j.scrs.2005.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Cotte E, Glehen O, Monneuse O, Cotton F, Vignal J. Tumeurs desmoïdes associées à la polypose adénomateuse familiale. ACTA ACUST UNITED AC 2004; 28:574-81. [PMID: 15243391 DOI: 10.1016/s0399-8320(04)95014-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Eddy Cotte
- Service de chirurgie viscérale et thoracique, Centre Hospitalier Universitaire Lyon Sud, 69495 Pierre Bénite
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Hansmann A, Adolph C, Vogel T, Unger A, Moeslein G. High-dose tamoxifen and sulindac as first-line treatment for desmoid tumors. Cancer 2004; 100:612-20. [PMID: 14745880 DOI: 10.1002/cncr.11937] [Citation(s) in RCA: 230] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Desmoid tumors are mesenchymal nonmetastasizing neoplasms. Although rare in the general population, they are a common extracolonic manifestation of familial adenomatous polyposis (FAP). Because of high tumor recurrence rates, surgery has been less than satisfactory in the treatment of desmoid tumors. In the current study, high doses of tamoxifen in combination with sulindac were used to treat severe desmoid tumors to avoid surgery. METHODS Since 1992, 25 patients at Heinrich Heine University (Dusseldorf, Germany) were treated with a combination of tamoxifen and sulindac. In the current study, 17 patients with FAP-associated and 8 patients with sporadic desmoid tumors received 120 mg of tamoxifen and 300 mg of sulindac daily. Every 6 months, the protracted course of desmoid growth was measured by computed tomography and/or magnetic resonance imaging scans. Tumor responses were characterized as progressive disease, stable disease (SD), partial regression (PR), and complete regression (CR). RESULTS Of the group of patients who received tamoxifen and sulindac as a primary treatment, all three patients with sporadic desmoid tumors demonstrated cessation of growth, and 10 of the 13 patients with FAP-associated tumors achieved either a PR or CR. In the sporadic desmoid tumor group, eight of nine patients developed tumor recurrences after undergoing surgery at other institutions. Of these, two patients had SD and two patients had a PR to CR. CONCLUSIONS The patients with desmoid tumors who were managed conservatively with high-dose tamoxifen and sulindac had the best outcome. Desmoid tumor recurrence after surgery was high and in the FAP-associated tumor group, therapy with tamoxifen and sulindac was found to be less successful. Based on this experience, the authors recommended high-dose tamoxifen and sulindac as the primary treatment for patients with FAP-associated desmoid tumors. However, to our knowledge, the best approach after surgical intervention for patients with sporadic desmoid tumors remains to be determined.
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Affiliation(s)
- Anika Hansmann
- Department of General Surgery and Traumatology, Heinrich Heine University, Duesseldorf, Germany
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Abstract
Desmoid tumours (DT) are rare benign tumours that do not metastasise, but tend to invade locally. DT are frequently seen in patients with familial adenomatous polyposis (FAP), and diagnosis and treatment are often difficult. Surgical trauma, genetic predisposition and hormonal factors are considered to be correlated with the development and growth of DT. In patients with FAP, 50% of the tumours are localised intra-abdominally, and 85-100% of these are mesenteric. DT frequently present as non- tender, slowly growing masses. The symptoms are abdominal pain, vomiting, diarrhoea or haematochezia. Mesenteric DT can cause small bowel obstruction or ischaemia, hydronephrosis or form fistulas. Diagnosis is obtained through biopsy and the extension is determined by a CT-scan. Surgical excision is recommended in patients with DT in the abdominal wall. First line treatment of mesenteric DT is a NSAID in combination with tamoxifen. Surgery may be considered in case of a small and well-defined DT with no signs of invasion of vital structures, and in cases of imminent bowel ischaemia or obstruction. The prognosis in mesenteric DT is serious, and improvement of the therapeutic strategy awaits current international studies.
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Affiliation(s)
- A L Knudsen
- The Danish Polyposis Register, Department of Surgical Gastroenterology, Hvidovre University Hospital, Hvidovre, Denmark
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Chihara Y, Mochiki M, Sugasawa M, Nibu K. Fibromatosis of the infratemporal fossa extending to the parapharyngeal space accompanied by trismus. Auris Nasus Larynx 2003; 30:319-23. [PMID: 12927302 DOI: 10.1016/s0385-8146(03)00062-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Fibromatosis is a tumor of fibroblastic origin that may arise in any musculoaponeurotic structure. Although fibromatosis is histologically benign, it has a tendency to invade surrounding tissues and often recur locally after treatment. A 34-year-old female patient was presented with pain in the left buccal region, left loss of visual acuity, and trismus. Computed tomographic scans revealed a large mass in the infratemporal fossa and parapharyngeal space. An open biopsy was performed and the pathological diagnosis was a fibromatosis. Surgical treatment for her trismus was performed simultaneously.
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Affiliation(s)
- Yasuhiro Chihara
- Department of Otolaryngology, Kanto Medical Center NTT EC, 5-9-22, Shinagawa-Ku, Tokyo 141-0022, Japan.
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Abstract
Desmoid tumors are rare fibroblastic neoplasms characterized by highly aggressive local invasion and high recurrence rates after surgical excision. Responses to chemotherapy and radiation therapy are uncommon. The use of percutaneous chemical ablation performed under imaging guidance is described in two patients with recurrent and/or unresectable disease. A complete response was achieved in one patient and a partial response was achieved in the other patient; these responses were sustained during 2 years of follow-up. This technique may hold promise in the treatment of these challenging lesions.
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Affiliation(s)
- Timothy W I Clark
- Section of Vascular and Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, Pennsylvania 19104, USA.
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Wright MA, Schuler B, Szabo E, Grem JL. Sustained partial response of an intra-abdominal desmoid tumor treated with gemcitabine, 5-fluorouracil and leucovorin. Ann Oncol 2003; 14:659-60. [PMID: 12649120 DOI: 10.1093/annonc/mdg155] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Janinis J, Patriki M, Vini L, Aravantinos G, Whelan JS. The pharmacological treatment of aggressive fibromatosis: a systematic review. Ann Oncol 2003; 14:181-90. [PMID: 12562642 DOI: 10.1093/annonc/mdg064] [Citation(s) in RCA: 234] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Despite the use of surgery and radiotherapy, 20-35% of patients with aggressive fibromatosis (AF) will have local recurrence. The purpose of this review was to collect and analyze all available information regarding the role of non-cytotoxic and cytotoxic chemotherapy in AF that has been accumulated over the past few decades. PATIENTS AND METHODS A systematic review of published clinical trials, studies and case series was carried out using the Medline Express Databases and the Cochrane Collaboration Database from 1970 to October 2000. RESULTS Most studies published in the literature are in the form of successful case reports and single-arm series with small patient numbers. Most commonly used agents include hormonal agents, non-steroidal anti-inflammatory drugs (NSAIDs), interferons and cytotoxics. The literature data support the use of hormonal agents. Several questions, however, remain unresolved, such as which is the most suitable endocrine manipulation and what is the optimal dose and duration of treatment. NSAIDs and interferons have demonstrated activity against AF either alone or in combination with hormone therapy or chemotherapy but the precise mechanism of action is still unknown. Finally, there is growing evidence in the literature that chemotherapy is effective against AF with almost one in two patients being likely to respond. CONCLUSIONS The evidence in the literature supports the opinion that both non-cytotoxic and cytotoxic chemotherapies are effective against AF. However, the lack of sufficient patient numbers and randomized trials compromises the validity of the reported results and mandates further investigation with properly designed prospective studies including larger patient numbers, with main end points to include not only tumor response rate and survival but also quality-of-life issues.
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Affiliation(s)
- J Janinis
- Social Security Organization Oncology Center, Kifissia, Greece.
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