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Ishikawa Y, Umezawa R, Yamamoto T, Takahashi N, Takeda K, Suzuki Y, Jingu K. Successful treatment with radiation therapy for desmoid-type fibromatosis with unilateral hydronephrosis: a case report. J Med Case Rep 2021; 15:540. [PMID: 34702352 PMCID: PMC8549302 DOI: 10.1186/s13256-021-03088-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 08/31/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Desmoid-type fibromatosis is a rare disease that can result in hydronephrosis. Hydronephrosis associated with desmoid-type fibromatosis often requires surgery or ureteral stent insertion. Although radiation therapy is recommended for inoperable cases of desmoid-type fibromatosis, there has been no report of treatment for hydronephrosis associated with desmoid-type fibromatosis by radiation therapy alone. We herein report a case of successful treatment for inoperable recurrence of desmoid-type fibromatosis with unilateral hydronephrosis by radiation therapy alone. CASE PRESENTATION A 43-year-old Japanese female underwent resection of desmoid-type fibromatosis in the right inguinal region and combined resection of the right external iliac vein 5 years before. Other treatment was not performed because of her pregnancy. Four years after surgery, desmoid-type fibromatosis recurred in the right pelvic wall. Cyclooxygenase-2 selective inhibitor treatment was given for 1 year, but her desmoid-type fibromatosis enlarged to more than 10 cm, and she had swelling of her right leg and hydronephrosis of her right kidney. The patient received 50.4 Gy in 28 fractions of prophylactic irradiation using 10 MV X-ray and 9 Gy in five fractions of a sequential boost for the recurrent desmoid-type fibromatosis. Although there was temporary tumor progression at 1 month after radiation therapy, slow regression of the tumor was seen. At 5 years after radiation therapy, there was no disease progression or severe complications. CONCLUSION We experienced successful treatment for an inoperable case of desmoid-type fibromatosis with hydronephrosis. Moderate-dose radiation therapy alone is an effective and feasible approach for the management of hydronephrosis associated with desmoid-type fibromatosis.
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Affiliation(s)
- Yojiro Ishikawa
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-chou, Aoba-ku, Sendai, 980-8574, Japan.
| | - Rei Umezawa
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-chou, Aoba-ku, Sendai, 980-8574, Japan
| | - Takaya Yamamoto
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-chou, Aoba-ku, Sendai, 980-8574, Japan
| | - Noriyoshi Takahashi
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-chou, Aoba-ku, Sendai, 980-8574, Japan
| | - Kazuya Takeda
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-chou, Aoba-ku, Sendai, 980-8574, Japan
| | - Yu Suzuki
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-chou, Aoba-ku, Sendai, 980-8574, Japan
| | - Keiichi Jingu
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-chou, Aoba-ku, Sendai, 980-8574, Japan
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Xu K, Zhao QK, Liu JS, Zhou DH, Chen YL, Zhu XY, Su M, Huang KQ, Du W, Zhao HY. Misdiagnosis of ligamentoid fibromatosis of the small mesenteric: A case report. World J Clin Cases 2020; 8:5758-5764. [PMID: 33344571 PMCID: PMC7716297 DOI: 10.12998/wjcc.v8.i22.5758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 09/18/2020] [Accepted: 10/01/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Ligamentoid fibromatosis is a rare borderline tumor that occurs in the muscles, fascia, and aponeurosis. It is a kind of soft tissue tumor of fibrous origin, also known as invasive fibromatosis, desmoid fibroma, neurofibromatosis, etc. The tumor is between benign and malignant tumors and rarely has distant metastasis. Its characteristics are mainly local invasion, destruction and growth and easy recurrence. The World Health Organization defines it as a fibroblast cloning value-added lesion originating from deep soft tissue, which causes local invasion and growth leading to tissue reconstruction, extrusion and destruction of important structures and organs. The incidence rate accounts for 0.03% of all tumors and less than 3% of all soft tissue tumors. Definite diagnosis mainly depends on postoperative pathology. Surgical resection is still the main way to treat the disease, and a variety of nonsurgical treatment methods are auxiliary. Combined treatment can effectively reduce the risk of postoperative recurrence.
CASE SUMMARY The patient is a 57-year-old female. One week ago, she accidentally found a mass in the left upper abdomen while lying flat. There was no abdominal pain and abdominal distention, no fever, no black stool and blood in the stool and no nausea and vomiting. She had a 10-year history of glaucoma on the left side, underwent hysterectomy for uterine fibroids 5 years ago, had no hypertension, heart disease, diabetes, hepatitis or tuberculosis, had no history of smoking and had been drinking for 20 years.
CONCLUSION Accurate preoperative diagnosis is difficult, surgical resection is the main treatment, and a variety of nonsurgical treatment methods are auxiliary. Combined treatment can effectively reduce the risk of postoperative recurrence. The prognosis is still good, and the risk of recurrence of secondary surgery is greatly increased.
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Affiliation(s)
- Kai Xu
- Department of General Surgery, Shougang Hospital, Peking University, Beijing 100041, China
| | - Qi-Kang Zhao
- Department of General Surgery, Shougang Hospital, Peking University, Beijing 100041, China
| | - Jing-Shan Liu
- Department of General Surgery, Shougang Hospital, Peking University, Beijing 100041, China
| | - Dong-Hai Zhou
- Department of General Surgery, Shougang Hospital, Peking University, Beijing 100041, China
| | - Yong-Liang Chen
- Department of Hepatobiliary Surgery, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
| | - Xing-Yi Zhu
- Department of General Surgery, Shougang Hospital, Peking University, Beijing 100041, China
| | - Ming Su
- Department of Hepatobiliary Surgery, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
| | - Kun-Quan Huang
- Department of General Surgery, Shougang Hospital, Peking University, Beijing 100041, China
| | - Wen Du
- Department of General Surgery, Shougang Hospital, Peking University, Beijing 100041, China
| | - Hong-Yu Zhao
- Department of General Surgery, Shougang Hospital, Peking University, Beijing 100041, China
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Niu X, Jiang R, Hu C. Radiotherapy in the treatment of primary or recurrent unresectable desmoid tumors of the neck. Cancer Invest 2019; 37:387-392. [DOI: 10.1080/07357907.2019.1656731] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Xiaoshuang Niu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Rui Jiang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Chaosu Hu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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Seinen JM, Niebling MG, Bastiaannet E, Pras B, Hoekstra HJ. Four different treatment strategies in aggressive fibromatosis: A systematic review. Clin Transl Radiat Oncol 2018; 12:1-7. [PMID: 30069502 PMCID: PMC6067057 DOI: 10.1016/j.ctro.2018.03.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 02/20/2018] [Accepted: 03/02/2018] [Indexed: 12/26/2022] Open
Abstract
Relative good overall local control rate of all four different treatment groups of >75%. Multivariate analysis shows deep seated tumors, age (<30 years) and extracompartmentally situated tumors as negative predicting markers of local outcome. The radiotherapy alone group did not have better local control rates than the observation group (p = 0.355). In case of recurrent disease, adjuvant radiotherapy has a definite advantage over surgery alone (p = 0.001). Radiotherapy alone gives in 50% of cases partial or complete regression, and in 14% complete regression. Eventually 23% develop local progression. Observation could be considered as first line treatment in patients with tumors not in close adherence to important structures and no symptoms. Stabilization of the tumor arose after a median time of >1 year after observation, and a local recurrence or progression occurred after a median time of <3 years.
Background The treatment approach for aggressive fibromatosis is changing. Although surgery is the mainstay in common practice, recent literature is reporting a more conservative approach. We compared the local control rate for surgery, surgery with radiotherapy, radiotherapy alone and a wait and see policy in a systematic review. Methods A comprehensive search of the databases PubMed/Medline, Embase and Cochrane, of the medical literature published in 1999 till March 2017 was performed by two reviewers, including articles about extra abdominal aggressive fibromatosis without the genetical variants. A total of 671 studies were assessed for eligibility, and 37 studies were included for analysis, representing 2780 patients. Results The local control rates for surgery alone, surgery and radiotherapy, radiotherapy alone and observation were 75%, 78%, 85% and 78%, respectively. For patients with recurrent disease observation had a better local control rate than surgery alone (p = 0.001). In the observation group, stabilization of the tumor was seen in median 14 (range 12–35) months. The time to local recurrence in the treatment group was median 17 (range, 11–52) months. Conclusion A watchful conservative first line approach with just observation and closely monitoring, by means of physical examination and MRI, appears to be justified in a subgroup of patients without clinical symptoms and no possible health hazards if the tumor would progress.
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Affiliation(s)
- Jojanneke M Seinen
- Department of Surgical Oncology, University of Groningen, University Medical Centre Groningen, The Netherlands
| | - Maarten G Niebling
- Department of Surgical Oncology, University of Groningen, University Medical Centre Groningen, The Netherlands
| | - Esther Bastiaannet
- Department of Surgery and Department of Gerontology & Geriatrics, Leiden University Medical Centre, The Netherlands
| | - Betty Pras
- Department of Radiation Oncology, University of Groningen, University Medical Centre Groningen, The Netherlands
| | - Harald J Hoekstra
- Department of Surgical Oncology, University of Groningen, University Medical Centre Groningen, The Netherlands
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Radiotherapy in desmoid tumors : Treatment response, local control, and analysis of local failures. Strahlenther Onkol 2017; 193:269-275. [PMID: 28044201 DOI: 10.1007/s00066-016-1091-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 11/29/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND Desmoid tumors (aggressive fibromatosis) are rare soft tissue tumors which frequently recur after surgery. Desmoid tumors arise from musculoaponeurotic tissue in the extremities, head and neck, abdominal wall, or intra-abdominally. Our aim was to examine the outcome of radiotherapy of desmoid tumors in a single institution series. PATIENTS AND METHODS We evaluated 41 patients with desmoid tumors treated with 49 radiotherapies between 1987 and 2012. Radiologic images for response evaluation were reassessed and responses to treatment registered according to RECIST criteria 1.1. For patients with local failures radiation dose distribution was determined in each local failure volume using image co-registration. Recurrences were classified as in-target, marginal, or out-of-target. Prognostic factors for radiotherapy treatment failure were evaluated. RESULTS Radiotherapy doses varied from 20-63 Gy (median 50 Gy) with a median fraction size of 2 Gy. The objective response rate to definitive radiotherapy was 55% (12/22 patients). Median time to response was 14 months. A statistically significant dose-response relation for definitive and postoperative radiotherapy was observed both in univariate (p-value 0.002) and in multivariate analysis (p-value 0.02) adjusted for potential confounding factors. Surgery before radiotherapy or surgical margin had no significant effect on time to progression. Nine of 11 (82%) local failures were classified as marginal and two of 11 (18%) in-target. None of the recurrences occurred totally out-of-target. CONCLUSIONS Radiotherapy is a valuable option for treating desmoid tumors. Radiotherapy dose appears to be significantly associated to local control.
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Campara Z, Spasic A, Aleksic P, Milev B. An Aggressive Retroperitoneal Fibromatosis. Med Arch 2016; 70:154-7. [PMID: 27147794 PMCID: PMC4851536 DOI: 10.5455/medarh.2016.70.154-157] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 03/15/2016] [Indexed: 11/25/2022] Open
Abstract
Introduction: Aggressive fibromatosis (AF) is a heterogeneous group of mesenchymal tumors that have locally infiltrative growth and a tendency to relapse. The clinical picture is often conditioned by the obstruction of the ureter or small intestine. Diagnosis is based on clinical, radiological and histological parameters. A case report: We report a case of male patient, aged 35 years, with the retroperitoneal fibromatosis. He reported to the physician because of frequent urination with the feeling of pressure and pain. Computed tomography revealed the tumor mass on the front wall of the bladder with diameter of 70mm with signs of infiltration of the musculature of the anterior abdominal wall. Endoscopic transurethral biopsy showed proliferative lesion binders by type of fibromatosis. The tumor was surgically removed in a classical way. The patient feels well and has no recurrence thirty-six months after the operative procedure. Conclusion: The complete tumor resection is the therapeutic choice for the primary tumor as well as for a relapse.
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Affiliation(s)
- Zoran Campara
- Department of Urology, Military Medical Academy, Belgrade, Serbia
| | | | - Predrag Aleksic
- Department of Urology, Military Medical Academy, Belgrade, Serbia
| | - Bosko Milev
- Department of Abdominal Surgery, Military Medical Academy, Belgrade, Serbia
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Bhat V, Raju P, Rao S, Ramaiah S. Infantile Fibromatosis: A Rare Cause of Anterior Mediastinal Mass in a Child. J Clin Imaging Sci 2015; 5:34. [PMID: 26180657 PMCID: PMC4490575 DOI: 10.4103/2156-7514.159452] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Accepted: 06/15/2015] [Indexed: 01/27/2023] Open
Abstract
Fibromatosis also known as desmoid tumor is an uncommon cause of a mediastinal mass in patients of all ages. Imaging appearance of fibromatosis is generally nonspecific and demands special attention to subtle details to be correctly identified as a possibility. Management of the patient is often complicated by failure to obtain precise pre-operative diagnosis. Location of a mass in the anterior mediastinum with encasement of vital structures is not favourable for complete cure. Although histologically benign, biological behaviour of the lesion varies between benign fibrous proliferation and low-grade fibrosarcoma. We present imaging appearances, surgical management dilemma, and the histopathological details of a case of fibromatosis in the anterior mediastinum in a child.
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Affiliation(s)
- Venkatraman Bhat
- Department of Radiology, Narayana Health, Shaw Mazumdar Cancer Center, Bangalore, Karnataka, India
| | - Praveen Raju
- Department of Pediatric Surgery, Narayana Health, Shaw Mazumdar Cancer Center, Bangalore, Karnataka, India
| | - Sanjay Rao
- Department of Pediatric Surgery, Narayana Health, Shaw Mazumdar Cancer Center, Bangalore, Karnataka, India
| | - Srinivas Ramaiah
- Department of Thoracic Pathology, Narayana Health, Shaw Mazumdar Cancer Center, Bangalore, Karnataka, India
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Extra-abdominal desmoid tumor located in the axilla. Arch Plast Surg 2014; 41:780-2. [PMID: 25396198 PMCID: PMC4228228 DOI: 10.5999/aps.2014.41.6.780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 06/17/2014] [Accepted: 06/17/2014] [Indexed: 11/16/2022] Open
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Kriz J, Eich HT, Haverkamp U, Seegenschmiedt MH, Heide J, Bruns F, Micke O. Radiotherapy is effective for desmoid tumors (aggressive fibromatosis) - long-term results of a German multicenter study. Oncol Res Treat 2014; 37:255-60. [PMID: 24853785 DOI: 10.1159/000362398] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2013] [Accepted: 03/13/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Desmoids (aggressive fibromatosis) are defined as benign neoplasms of the connective tissue that arise from the deep muscle fascia, aponeurosis, tendons, and scar tissue. Recurrence rates between 40 and 80% were reported after surgery alone. We addressed the impact of radiation therapy (RT) in the management of aggressive fibromatosis. PATIENTS AND METHODS A large literature review was performed, and the data was compared with the results of a multicenter study of the German Cooperative Group on Radiotherapy for Benign Diseases (GCG-BD). RESULTS This analysis included 52 patients treated with RT. 37 patients received postoperative RT (20 patients after R2 resection and 17 patients after R1 resection). 15 patients received RT alone (6 patients with inoperable primary tumor and 9 patients with inoperable recurrent tumor). In the case of postoperative RT, a median dose of 50 Gy (range 50-60 Gy) was used; for definitive RT, a median dose of 55 Gy (range 55-65 Gy) was used. The local control rate was 79% for the whole group. The median follow-up was 44 month (range 8-62 months). CONCLUSION Given the large number of patients, these data show that RT is highly effective in the treatment of desmoid tumors. RT is an attractive alternative to mutilating surgery.
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Affiliation(s)
- Jan Kriz
- Klinik und Poliklinik für Strahlentherapie - Radioonkologie, Universitätsklinikum Münster, Münster, Germany
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Johner A, Tiwari P, Zetler P, Wiseman SM. Abdominal wall desmoid tumors associated with pregnancy: current concepts. Expert Rev Anticancer Ther 2014; 9:1675-82. [DOI: 10.1586/era.09.98] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Ghanem M, Heinisch A, Heyde CE, Freiherr von Salis-Soglio G. Diagnosis and treatment of extraabdominal desmoid fibromatosis. GMS INTERDISCIPLINARY PLASTIC AND RECONSTRUCTIVE SURGERY DGPW 2014; 3:Doc01. [PMID: 26504712 PMCID: PMC4582506 DOI: 10.3205/iprs000042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The desmoid fibromatosis is a very rare connective tissue disease which is recognized as semimalignant. The aim of this work is to review the relevant literature and to analyze the management of our patient collective. MATERIAL AND METHOD Surgery was performed on 7 patients with extraabdominal desmoid fibromatosis between August 1998 and May 2007. MRI examination as well as biopsy was carried out in all cases. All patients were operated on; the mean follow up was 4 years (1-7). Upon follow up, every patient has undergone clinical and MRI examination. RESULTS The results show that we have achieved R0 resection in 4 cases and R1 in two cases and Rx in one case. In 4 patients, no recurrence was observed after the single surgery performed in our hospital. In 2 patients a single revision surgery was performed in each case and yielded no further recurrence. In only one case, multiple surgeries (one primary and two revision surgeries) were necessary, after which no recurrence was reported. CONCLUSION The early diagnosis of the disease is of utmost importance to the success of the outcome. MRI examination and biopsy are mandatory. Surgery is the therapy of choice. The recurrence rate is high and is linked to the difficulty of recognition of the exact infiltrative extent of the tumour. This necessitates a close follow-up.
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Affiliation(s)
- Mohamed Ghanem
- Department of Orthopaedic Surgery, University Hospital of Leipzig, Germany
| | - Antje Heinisch
- Department of Orthopaedic Surgery, University Hospital of Leipzig, Germany
| | - Christoph-E Heyde
- Department of Orthopaedic Surgery, University Hospital of Leipzig, Germany
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Mortality of intra-abdominal desmoid tumors in patients with familial adenomatous polyposis: a single center review of 154 patients. Ann Surg 2012; 255:511-6. [PMID: 22323009 DOI: 10.1097/sla.0b013e31824682d4] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Intra-abdominal desmoid tumors are one of the leading causes of death in patients with familial adenomatous polyposis. Their behavior is unpredictable and their biology is poorly understood, accounting for the lack of a standardized medical and surgical approach. The aim of this study was to evaluate the mortality rate of patients with intra-abdominal desmoid tumors and to identify prognostic factors for the evolution of the disease. MATERIALS AND METHODS A total of 154 patients with intra-abdominal desmoid tumors were included in the study. Each tumor was staged and each patient was categorized according to the stage of their most advanced tumor. Mortality was analyzed and the univariate risk factors associated with survival were included in a multivariable Cox regression model. A scoring system was derived from the multivariate analysis to refine outcomes within stages. RESULTS Five-year survival of patients with stage I, II, III, and IV intra-abdominal desmoid tumor were 95%, 100%, 89%, and 76% respectively (P < 0.001). Severe pain/narcotic dependency, tumor size larger than 10 cm, and need for total parenteral nutrition were shown to further define survival within stages. Five-year survival rate of stage IV patient with all of the above-mentioned risk factors was only 53%. CONCLUSIONS Our study confirmed the validity of the staging system to predict mortality in patients with intra-abdominal desmoid tumors and identified additional risk factors able to better define the risk of death within each stage. Risk stratification is crucial in directing patients with advanced disease and poor prognosis to the most appropriate medical and surgical options.
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Gluck I, Griffith KA, Biermann JS, Feng FY, Lucas DR, Ben-Josef E. Role of Radiotherapy in the Management of Desmoid Tumors. Int J Radiat Oncol Biol Phys 2011; 80:787-92. [DOI: 10.1016/j.ijrobp.2010.02.053] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2009] [Revised: 02/22/2010] [Accepted: 02/22/2010] [Indexed: 11/16/2022]
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Mátrai Z, Papp J, Polgár C, Hitre E, Köves I, Oláh E, Andi J, Kiss A, Vámosi Nagy I, Tóth L, Orosz Z. [Long-term experience with therapy of a female patient with Gardner's syndrome, first presenting with extra-abdominal desmoid tumor, and review of the literature]. Magy Seb 2009; 62:75-82. [PMID: 19386568 DOI: 10.1556/maseb.62.2009.2.5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Gardner's syndrome is a clinical subgroup of familial adenomatous polyposis, an autosomal dominant disease. It is characterized by gastrointestinal polyps and extra-intestinal manifestations including multiple osteomas, skin and soft tissue tumours. Aggressive desmoid tumours can be very difficult to manage in patients with Gardner's syndrome. We present a case of a 17-year-old female who presented with an aggressive desmoid tumor arising of the lumbar area as part of her Gardner's syndrome. She was treated with surgery, nonsteroidal anti-inflammatory drugs, tamoxifen and radiotherapy, and was followed up for 80 months. We conclude that desmoid tumors can precede gastrointestinal manifestations of familial adenomatous polyposis or Gardner's syndrome. Such patients should be evaluated with genetic testing followed by colonoscopy. Desmoid tumours should be managed in a multidisciplinary setting, as well.
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Affiliation(s)
- Zoltán Mátrai
- Országos Onkológiai Intézet, Altalános és Mellkassebészeti Osztály, Budapest, Hungary.
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Abstract
Desmoid tumors are benign tumors that exhibit varying degrees of local aggressiveness and diverse growth patterns. Magnetic resonance imaging remains the modality of choice for assessment of the nature and size of the soft-tissue lesion and involvement of surrounding structures. Treatment strategies include surgery, chemotherapy, hormonal therapy, and radiation therapy, either individually or in combination. Despite the benign nature of these tumors, multidisciplinary care is needed to provide combined treatment options. Chemotherapy in low doses is an excellent first-round treatment in any patient in whom contemplated local treatment may produce local morbidity and adjacent tissue injury.
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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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17
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Latchford AR, Sturt NJH, Neale K, Rogers PA, Phillips RKS. A 10-year review of surgery for desmoid disease associated with familial adenomatous polyposis. Br J Surg 2006; 93:1258-64. [PMID: 16952208 DOI: 10.1002/bjs.5425] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Desmoid tumours affect 10-25 per cent of patients with familial adenomatous polyposis and represent a major cause of morbidity and mortality. Surgery for intra-abdominal desmoids has traditionally been used as a last resort or to manage obstructive complications. The aim was to review 10 years of desmoid surgery in patients with familial adenomatous polyposis from a single centre. METHODS Patients who had surgery for desmoid disease between 1994 and 2004 were identified from the Polyposis Registry database and their hospital notes reviewed. RESULTS Twenty patients had surgery to remove 32 desmoid tumours (16 intra-abdominal, 12 abdominal wall, four extra-abdominal). Complete clearance was achieved in 19 tumours and, of these, clinically significant recurrence occurred in eight. There was no difference in recurrence rates for site or sex. There was no operative mortality. Intra-abdominal desmoid resection was associated with a mean resection of 45.55 (range 10-200) cm of small bowel. One patient required long-term parenteral feeding. Median follow-up was 5 (range 0.6-10) years. During this period, one patient died (metastatic duodenal cancer); there was no mortality from desmoid disease. CONCLUSION Surgery for intra-abdominal desmoids in selected patients is less hazardous than previously reported. Surgery for abdominal wall and extra-abdominal tumours is safe. However, disease recurrence remains a major problem.
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Affiliation(s)
- A R Latchford
- Polyposis Registry, St Mark's Hospital, Northwick Park, Harrow HA1 3UJ, UK
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18
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Amerasinghe N, Rogers S, Rowlandson P, Kohler J, Hodgkins P. Fibromatosis (desmoid tumor) involving the orbit and cheek. J AAPOS 2006; 10:479-81. [PMID: 17070488 DOI: 10.1016/j.jaapos.2006.04.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2005] [Accepted: 04/24/2006] [Indexed: 11/28/2022]
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20
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Hosalkar HS, Fox EJ, Delaney T, Torbert JT, Ogilvie CM, Lackman RD. Desmoid tumors and current status of management. Orthop Clin North Am 2006; 37:53-63. [PMID: 16311111 DOI: 10.1016/j.ocl.2005.08.004] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Desmoid tumors, also known as aggressive fibromatosis, are rare fibroblastic tumors that exhibit a wide range of local aggressiveness, from largely indolent to locally destructive. Understanding of the pathogenesis and the great heterogeneity in the natural history of desmoid tumors is invaluable to the development of therapeutic strategies. The optimal treatment protocol has not yet been established and, in many cases, a multidisciplinary approach including surgery, chemotherapy, and radiation therapy has been employed. The rarity of cases in even major tumor centers has traditionally limited the ability to study this disease. Several novel pharmacologic and biologic treatment approaches are actively being developed, although long-term follow-up is needed for their substantiation.
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Affiliation(s)
- Harish S Hosalkar
- Department of Orthopedic Oncology, University of Pennsylvania, Philadelphia, 19106, USA
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21
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Abstract
Musculoaponeurotic fibromatosis or desmoid tumors are rare. We report the case of a 57 year old woman with a slowly growing tumor behind the sternocleidomastoid muscle, which was completely removed. Histological examination confirmed the clinical suspicion of a desmoid tumor. Desmoid tumors are aggressive, locally infiltrating, non-metastasizing tumors with a high local recurrence. Genetic, endocrine and physical factors have been implicated as causative agents. The diagnosis is made histologically, reactive fibromatosis and fibrosarcoma must be eliminated in differential diagnosis. By the combination of different radiographic techniques, it is possible to describe the tumors and differentiate between vessels, nerves and bones. The therapy of the choice is the surgical resection. Adjuvant therapy, such as x-ray treatment, chemo- and hormone therapy, are indicated when the tumor is inoperable or too extensive for surgery.
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Affiliation(s)
- J Ridders
- Klinik für Hals-, Nasen-, Ohrenheilkunde, Unfallkrankenhaus Berlin, 12683 Berlin
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22
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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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Phillips SR, A'Hern R, Thomas JM. Aggressive fibromatosis of the abdominal wall, limbs and limb girdles. Br J Surg 2004; 91:1624-9. [PMID: 15505878 DOI: 10.1002/bjs.4792] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Abstract
Background
Aggressive fibromatosis (AF) is a rare soft-tissue tumour. It is histologically benign but locally aggressive and destructive. Surgery is the mainstay of treatment. This was a review of patients treated at the Royal Marsden Hospital between 1986 and 2003.
Methods
Records of patients with abdominal wall (23) and limb or limb girdle (86) AF were studied to determine patient, tumour and treatment characteristics and outcome. Children and patients with intra-abdominal AF were excluded. The data were analysed by Cox regression to calculate univariate hazard ratios.
Results
Twenty-one (19·3 per cent) of 109 patients developed recurrence after a median follow-up of 39 months. Recurrence did not correlate with surgical margin or any other variable.
Conclusion
Wide excisional, function-preserving surgery is the goal in treatment of AF. Surgery for recurrent disease is often curative. Tumours are frequently irresectable at presentation and an initial period of expectant observation is advisable because growth arrest is a common feature of the disease.
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Affiliation(s)
- S R Phillips
- Sarcoma and Melanoma Unit, Department of Surgery, London SW3 6JJ, UK
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Kikkawa A, Kido A, Kumai T, Hoshida T. Extraabdominal fibromatosis in retroperitoneal space. World J Surg Oncol 2004; 2:33. [PMID: 15461790 PMCID: PMC524188 DOI: 10.1186/1477-7819-2-33] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2004] [Accepted: 10/03/2004] [Indexed: 11/25/2022] Open
Abstract
Background Fibromatosis or desmoid tumor covers a broad spectrum of benign fibrous tissue proliferations. It is characterized by infiltrative growth and a tendency towards recurrence; however, unlike sarcoma, it never metastasizes. Case presentation We report on a case of extraabdominal fibromatosis originating from the retroperitoneal space in a 43-year-old woman. Seven years earlier she had undergone ureterolysis and ureteroureterostomy for ureteral obstruction. Computed tomography revealed a tumor between the iliocostalis and the psoas muscle. Histopathological evaluation revealed uniform proliferation of spindle cells, with a moderate amount of collagen fibers, suggesting extraabdominal fibromatosis (desmoid tumor). The tumor was surgically resected, and since then, the patient has remained asymptomatic without any restrictions of daily living activities and without any signs of tumor recurrence during the two-year follow-up. Conclusions Complete resection is the treatment of choice. Adjuvant therapy using non steroidal anti-inflammatory agents, tamoxifen, interferon, anti-neoplastic agents, and radiotherapy, either alone or in combination finds application for unresectable or recurrent cases.
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Affiliation(s)
- Akira Kikkawa
- Department of Urology, Hannna Central Hospital, Nara, Japan
| | - Akira Kido
- Divison of Orthopedics and Traumatology, Medical Center for Emergency and Critical Care, Nara Prefectural Nara Hospital, Nara, Japan
- Department of Orthopedic Surgery, Nara Medical University, Nara, Japan
| | - Tsukasa Kumai
- Department of Orthopedic Surgery, Nara Medical University, Nara, Japan
| | - Toru Hoshida
- Divison of Orthopedics and Traumatology, Medical Center for Emergency and Critical Care, Nara Prefectural Nara Hospital, Nara, Japan
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