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Bonvalot S, Miah A, Kasper B. Active surveillance and emerging medical treatment options for desmoid: when and for whom? Curr Opin Oncol 2024; 36:263-268. [PMID: 38726846 DOI: 10.1097/cco.0000000000001049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
PURPOSE OF REVIEW This article discusses the evolving approaches to desmoid tumors management, shedding light on recent developments. RECENT FINDINGS Active surveillance has become the primary approach for managing primary peripheral desmoid tumors. This strategy was initially based on evidence from retrospective studies. Roughly 50% of cases managed with active surveillance show spontaneous stabilization or regression. Recent prospective trials conducted in Italy, The Netherlands, and France (2022-2023) confirm the efficacy of active surveillance, revealing 3-year progression-free survival rates ranging from 53.4 to 58%. For the patients under active surveillance, decisions regarding treatment are based on significant tumor growth or progressive symptoms. Moreover, three contemporary randomized trials investigated medical treatments for progressive or recurrent desmoid tumors. Sorafenib, pazopanib, and nirogacestat demonstrated clinical activity, as evidenced by favorable progression-free survival and objective response rates. SUMMARY Active surveillance has solidified its position as the primary management approach for desmoid tumors, validated by three robust prospective studies. Three recent randomized trials explored medical treatment for progressive or recurrent desmoid tumors, revealing promising clinical activities.
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Affiliation(s)
| | - Aisha Miah
- Department of Radiation Oncology, The Royal Marsden Hospital and The Institute of Cancer Research, London, UK
| | - Bernd Kasper
- Department of Medical Oncology, University of Heidelberg, Mannheim University Medical Center, Mannheim Cancer Center (MCC), Sarcoma Unit, Mannheim, Germany
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da Silva C, Pinto FFE, Lopes A, Nakagawa SA, Aruquipa MPS, Aguiar S, de Mello CAL. CLINICAL AND EPIDEMIOLOGIC EVALUATION OF DESMOID TUMORS IN A BRAZILIAN SARCOMA REFERENCE CENTER. ACTA ORTOPEDICA BRASILEIRA 2024; 32:e274225. [PMID: 38933357 PMCID: PMC11197944 DOI: 10.1590/1413-785220243202e274225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 08/04/2023] [Indexed: 06/28/2024]
Abstract
Introduction Desmoid Tumors (DT) are rare neoplasms with higher incidence in younger women. Methods Retrospective, single-center analysis of patients with DT. Variables were age, sex, biopsy, treatment and recurrence. The disease-free survival (DFS) was calculated with the Kaplan-Meier method. Results 242 patients were evaluated, mean age was 34 years, 70.7% women, 44.4% originated in the trunk/abdomen and 54.5% had size > 5cm. Surgery was performed in 70.2%, 31% with negative margin and only 57% with previous biopsy. Recurrence rate was 38% and 1,2,5-year DFS was 75.3%, 64.2%, 57.8%, respectively. Size (p = 0.018) and tumor location in the dorsum (p = 0.001), extremities (p = 0.003) and pelvis (p = 0.003) were related to higher relapse rate. Conclusion our data reinforces the need to gather data from real world practice and the importance of awareness of DT and medical education about DT behavior and best approach due to the high rates of surgery and elevated number of patients treated without biopsy. Level of Evidence III; Retrospective Comparative Study.
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Affiliation(s)
- Cassia da Silva
- A.C. Camargo Cancer Center, Sarcoma and Bone Tumor Reference Center, Department of Surgical Oncology, Sao Paulo, SP, Brazil
| | - Fábio Fernando Eloi Pinto
- A.C. Camargo Cancer Center, Sarcoma and Bone Tumor Reference Center, Departament of Oncologic Orthopedics, Sao Paulo, SP, Brazil
| | - Ademar Lopes
- A.C. Camargo Cancer Center, Sarcoma and Bone Tumor Reference Center, Department of Surgical Oncology, Sao Paulo, SP, Brazil
| | - Suely Akiko Nakagawa
- A.C. Camargo Cancer Center, Sarcoma and Bone Tumor Reference Center, Departament of Oncologic Orthopedics, Sao Paulo, SP, Brazil
| | | | - Samuel Aguiar
- A.C. Camargo Cancer Center, Sarcoma and Bone Tumor Reference Center, Department of Surgical Oncology, Sao Paulo, SP, Brazil
| | - Celso Abdon Lopes de Mello
- A.C. Camargo Cancer Center, Sarcoma and Bone Tumor Reference Center, Department of Clinical Oncology, Sao Paulo, SP, Brazil
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Lauricella S, Rausa E, Pellegrini I, Ricci MT, Signoroni S, Palassini E, Cavalcoli F, Pasanisi P, Colombo C, Vitellaro M. Current management of familial adenomatous polyposis. Expert Rev Anticancer Ther 2024; 24:363-377. [PMID: 38785081 DOI: 10.1080/14737140.2024.2344649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 04/15/2024] [Indexed: 05/25/2024]
Abstract
INTRODUCTION APC-associated polyposis is a rare hereditary disorder characterized by the development of multiple adenomas in the digestive tract. Individuals with APC-associated polyposis need to be managed by specialized multidisciplinary teams in dedicated centers. AREAS COVERED The study aimed to review the literature on Familial adenomatous polyposis (FAP) to provide an update on diagnostic and surgical management while focusing on strategies to minimize the risk of desmoid-type fibromatosis, cancer in anorectal remnant, and postoperative complications. FAP individuals require a comprehensive approach that includes diagnosis, surveillance, preventive surgery, and addressing specific extracolonic concerns such as duodenal and desmoid tumors. Management should be personalized considering all factors: genotype, phenotype, and personal needs. Total colectomy and ileo-rectal anastomosis have been shown to yield superior QoL results when compared to Restorative Procto colectomy and ileopouch-anal anastomosis with acceptable oncological risk of developing cancer in the rectal stump if patients rigorously adhere to lifelong endoscopic surveillance. Additionally, a low-inflammatory diet may prevent adenomas and cancer by modulating systemic and tissue inflammatory indices. EXPERT OPINION FAP management requires a multidisciplinary and personalized approach. Integrating genetic advances, innovative surveillance techniques, and emerging therapeutic modalities will contribute to improving outcomes and quality of life for FAP individuals.
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Affiliation(s)
- Sara Lauricella
- Hereditary Digestive Tract Tumors Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Emanuele Rausa
- Hereditary Digestive Tract Tumors Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Ilaria Pellegrini
- Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Maria Teresa Ricci
- Hereditary Digestive Tract Tumors Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Stefano Signoroni
- Hereditary Digestive Tract Tumors Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Elena Palassini
- Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Federica Cavalcoli
- Gastroenterology and Digestive Endoscopy Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Patrizia Pasanisi
- Nutrition Research and Metabolomics Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Chiara Colombo
- Sarcoma Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marco Vitellaro
- Hereditary Digestive Tract Tumors Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- Colorectal Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Zongo N, Djiguemde AR, Yameogo PB, Ka S, Traoré B, Dem A. Surgery for primary malignant tumors of the abdominal wall: experiences of three African surgical oncology units and review of the literature. World J Surg Oncol 2023; 21:235. [PMID: 37525223 PMCID: PMC10388487 DOI: 10.1186/s12957-023-03125-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 07/24/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Tumors of the abdominal wall are uncommon but diverse. The surgical challenge is double. The tumor must be completely removed and the abdominal wall repaired. Our aim was to describe the indications, techniques, and results of surgery on these tumors in an African context. METHODS Retrospective, multicentric and descriptive study conducted in three West African surgical oncology units. We included all abdominal wall tumors followed up between January 2010 and October 2022. Histological type, size, surgical procedure, and method of abdominal wall repair were considered. Survival was calculated using the Kaplan-Meier method and comparisons of proportions were made using the Student t test. RESULTS We registered 62 tumors of the abdominal wall and we operated on 41 (66.1%). The mean size of the tumors was 14.3 ± 26 cm. Dermatofibrosarcoma and desmoid tumor were present in 33 and 3 cases respectively. In 31.7% of cases in addition to the tumour, the resections carried away the muscular aponeurotic plane. Parietal resections required the use of a two-sided prosthesis in 6 cases. In 13 cases, we used skin flaps. The resections margins were invaded in 5 cases and revision surgery was performed in all of them. Incisional hernia was noticed in 2 cases. The tumor recurrence rate was 12.2% with an average time of 13 months until occurrence. Overall survival at 3 years was 80%. CONCLUSIONS Surgery is the mainstay of treatment for abdominal wall tumors. It must combine tumor resections and parietal repair. Cancer surgeons need to be trained in abdominal wall repair.
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Affiliation(s)
- Nayi Zongo
- Digestive and General Surgery Unit, Yalgado Ouedraogo Teaching Hospital of Ouagadougou, Joseph Ki-Zerbo University of Ouagadougou, 03 BP 7021, Ouagadougou, Burkina Faso.
| | - Adeline R Djiguemde
- Digestive and General Surgery Unit, Yalgado Ouedraogo Teaching Hospital of Ouagadougou, Joseph Ki-Zerbo University of Ouagadougou, 03 BP 7021, Ouagadougou, Burkina Faso
| | - Paratyandé Bonaventure Yameogo
- Digestive and General Surgery Unit, Yalgado Ouedraogo Teaching Hospital of Ouagadougou, Joseph Ki-Zerbo University of Ouagadougou, 03 BP 7021, Ouagadougou, Burkina Faso
| | - Sidy Ka
- Joliot Curie Institute of Dakar (Senegal)Cheikh Anta Diop University of DakarCheikh Anta Diop University, 10700, Dakar, Senegal
| | - Bangaly Traoré
- Surgical Oncology Unit, Donka Hospital of Conakry, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
| | - Ahmadou Dem
- Joliot Curie Institute of Dakar (Senegal)Cheikh Anta Diop University of DakarCheikh Anta Diop University, 10700, Dakar, Senegal
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Benech N, Bonvalot S, Lopez-Trabada D, Orbach D, Bouché O, Saurin JC. Author's reply: "A lesion suspected of being a desmoid tumor in the context of familial adenomatous polyposis should be biopsied". Dig Liver Dis 2022; 54:1448. [PMID: 35840485 DOI: 10.1016/j.dld.2022.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 06/27/2022] [Indexed: 12/29/2022]
Affiliation(s)
- Nicolas Benech
- Service d'Hépato-Gastroentérologie, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, 69003, France.
| | | | - Daniel Lopez-Trabada
- Service d'Oncologie Médicale, Hôpital Saint-Antoine, 184, rue du Faubourg Saint-Antoine, Paris, 75012, France
| | - Daniel Orbach
- SIREDO Oncology Center (Care, Innovation and Research for Children, Adolescents and Young Adults with Cancer), Institut Curie, Paris, France
| | - Olivier Bouché
- Department of Digestive Oncology, CHU Reims, Reims, France
| | - Jean-Christophe Saurin
- Service d'Hépato-Gastroentérologie, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, 69003, France
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Lebellec L, Cren PY, Robin YM, Penel N. A lesion suspected of being a desmoid tumor in the context of familial adenomatous polyposis should be biopsied. Dig Liver Dis 2022; 54:1446-1447. [PMID: 35705457 DOI: 10.1016/j.dld.2022.05.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 05/27/2022] [Indexed: 12/29/2022]
Affiliation(s)
- Loïc Lebellec
- Centre Oscar Lambret, 3 re Combemale, 59020 CEDEX Lille, France
| | | | | | - Nicolas Penel
- Centre Oscar Lambret, 3 re Combemale, 59020 CEDEX Lille, France; Lille University, 1 avenue Eugène Avinée, Lille 59120, France.
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