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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