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Ferron G, Bataillon G, Martinez A, Chibon F, Valentin T. Gynecological sarcomas, surgical management: primary, metastatic, and recurrent disease. Int J Gynecol Cancer 2024; 34:393-402. [PMID: 38438176 DOI: 10.1136/ijgc-2023-004582] [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] [Indexed: 03/06/2024] Open
Abstract
Adult-type gynecological soft tissue and visceral sarcomas are rare tumors, with an estimated incidence of 13% of all sarcomas and 4% of all gynecological malignancies. They most often develop in the uterus (83%), followed by the ovaries (8%), vulva and vagina (5%), and other gynecological organs (2%). The objective of this review is to provide an overview of the current management of gynecological sarcomas, according to international guidelines. The management of gynecological sarcomas should follow the recommendations for the management of soft tissue and visceral sarcomas. Centralizing cases in expert centers improves patient survival, both for the diagnostic phase and for multidisciplinary therapeutic management. In the case of pelvic soft tissue sarcomas, a radiological biopsy is essential before any surgical decision is taken. In the case of a myometrial tumour which may correspond to a sarcoma, if conservative surgery such as myomectomy or morcellation is planned, an ultrasound-guided biopsy with pathological analysis including comparative genomic hybridization analysis must be carried out. In all cases, en bloc surgery, without rupture, is mandatory. Many rare histological subtypes require specific surgical management.
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Affiliation(s)
- Gwenael Ferron
- Surgical Oncology, Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France
- OncoSARC (Oncogenesis of Sarcoma), INSERM UMR1037, Toulouse, France
| | - Guillaume Bataillon
- Anatomopathology, Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France
| | - Alejandra Martinez
- Surgical Oncology, Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France
- T2i (Anti-tumour immunity and immunotherapy), INSERM UMR1037, Toulouse, France
| | - Frederic Chibon
- OncoSARC (Oncogenesis of Sarcoma), INSERM UMR1037, Toulouse, France
- Surgical Pathology, Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France
| | - Thibaud Valentin
- OncoSARC (Oncogenesis of Sarcoma), INSERM UMR1037, Toulouse, France
- Medical Oncology, Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France
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Bonvalot S, Cozic N, Le Cesne A, Blay JY, Penel N, Fau M, Chevreau C, Anract P, Waast D, Laurence V, Watson S, Duffaud F, Gouin F, Taieb S, Kind M, Lam L. Initial Active Surveillance Strategy for Patients with Peripheral Sporadic Primary Desmoid-Type Fibromatosis: A Multicentric Phase II Observational Trial. Ann Surg Oncol 2023; 30:8653-8659. [PMID: 37777684 DOI: 10.1245/s10434-023-14341-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 09/05/2023] [Indexed: 10/02/2023]
Abstract
BACKGROUND Stabilization or spontaneous regressions are demonstrated in more than half of patients affected by primary desmoid-type fibromatosis (DF) in retrospective studies. The objective of this phase II study was to prospectively assess the behavior of primary sporadic DT managed by active surveillance (AS). METHODS This prospective, multicenter, observational study (NCT01801176) included patients ≥18 years of age with primary sporadic DF located in an extremity or the abdominal/thoracic wall. At inclusion, all patients were initially placed on AS. Follow-up was based on clinical and radiological evaluation by magnetic resonance imaging (MRI) performed at 1, 3, 6, 9, and 12 months, and then every 6 months for 3 years. The primary endpoint was progression-free survival (PFS) at 3 years according to Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1, as evaluated by a Central Review Board. RESULTS Between 2012 and 2015, 100 patients were enrolled. The female/male ratio was 8 and the median age was 34 years (interquartile range [IQR] 30.8-43.9). Median follow-up was 46.6 months (IQR 36.8-61.1) and the 3-year PFS was 53.4% (95% confidence interval 43.5-63.1%). At progression (48 patients), 23 patients received active treatment. Fifty-eight patients (58%) presented with spontaneous tumor regression (decrease > 0% compared with the initial size) during the first 3 months (n = 35, 35%) or after an initial progression (n = 23, 23%), of whom 26 (26%) had partial responses (PRs). The median time to PR was 31.7 months (25.3-not available). CONCLUSIONS These data support the use of AS as the primary approach to select patients with peripheral DF who require aggressive treatment.
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Affiliation(s)
| | - Nathalie Cozic
- Department of Biostatistics and Epidemiology, Gustave Roussy, Villejuif, France
| | - Axel Le Cesne
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | - Jean Yves Blay
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | - Nicolas Penel
- Department of Medical Oncology, Centre Oscar Lambret, Lille, France
| | - Magali Fau
- Department of Surgery, Institut Bergonié, Bordeaux, France
| | | | | | - Denis Waast
- Department of Orthopedics, CHU Nantes, Nantes, France
| | | | - Sarah Watson
- Department of Medical Oncology, Institut Curie, Paris, France
| | - Florence Duffaud
- Department of Medical Oncology, CHU La Timone, Marseilles, France
| | | | - Sophie Taieb
- Department of Radiology, Centre Oscar Lambret, Lille, France
| | - Michèle Kind
- Department of Radiology, Institut Bergonié, Bordeaux, France
| | - Laurent Lam
- Department of Biostatistics and Epidemiology, Gustave Roussy, Villejuif, France
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Bonvalot S, Watson S. ASO Author Reflections: Active Surveillance and Desmoid. Ann Surg Oncol 2023; 30:8669-8670. [PMID: 37819492 DOI: 10.1245/s10434-023-14411-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 09/18/2023] [Indexed: 10/13/2023]
Affiliation(s)
| | - Sarah Watson
- Department of Medical Oncology, Institut Curie, Paris, France
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Rastrelli M, Chiusole B, Cavallin F, Del Fiore P, Angelini A, Cerchiaro MC, Ruggieri P, Sbaraglia M, Mocellin S, Brunello A. Desmoid Tumors in the Active Surveillance Era: Evaluation of Treatment Options and Pain Relief in a Single-Center Retrospective Analysis. J Pers Med 2023; 13:1653. [PMID: 38138880 PMCID: PMC10744644 DOI: 10.3390/jpm13121653] [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: 10/15/2023] [Revised: 11/13/2023] [Accepted: 11/21/2023] [Indexed: 12/24/2023] Open
Abstract
In patients with desmoid tumors (DTs), active surveillance has been increasingly preferred over surgery, while treatment (including pharmacological therapy, radiotherapy, and/or surgery) is performed in cases with confirmed disease progression. This study aimed to evaluate event-free survival and pain management according to different treatment strategies. We evaluated event-free survival, including recurrence after initial surgical treatment or changes in the therapeutic management after initial non-surgical treatment and pain management according to different treatment strategies. All patients referred for DT in 2001-2021 at our institutions were stratified into four groups: those treated surgically prior to 2012 (SGPre12) or after 2012 (SGPost12), those treated pharmacologically (MG), and those under active surveillance (ASG). An event was defined as recurrence after initial surgical treatment or a change in therapeutic management. Overall, 123 patients were included in the study: 28 in SGPre12, 41 in SGPost12, 38 in MG, and 16 in ASG. Pharmacological treatment resolved painful symptoms in 16/27 (60%) patients (p = 0.0001). The median follow-up duration was 40 months (IQR 23-74). Event-free survival at 1, 3, and 5 years was: 85%, 70%, and 62% in SGPre12; 76%, 58%, and 49% in SGPost12; 49%, 31%, and 31% in MG; and 45%, 45%, and 45% in ASG. Our findings support the role of active surveillance as initial management, as demonstrated by the fact that about half the patients did not experience any progression, while surgery can be reserved as a first-line approach for selected patients. In terms of pain relief, medical therapy led to symptom resolution in more than half the cases.
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Affiliation(s)
- Marco Rastrelli
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology IOV—IRCCS, 35128 Padua, Italy
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padua, 35128 Padua, Italy
| | - Benedetta Chiusole
- Oncology 1, Department of Oncology, Veneto Institute of Oncology IOV—IRCCS, 35128 Padua, Italy
| | | | - Paolo Del Fiore
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology IOV—IRCCS, 35128 Padua, Italy
| | - Andrea Angelini
- Department of Orthopedics and Orthopedic Oncology, University of Padova, 35128 Padua, Italy (P.R.)
| | - Maria Chiara Cerchiaro
- Department of Orthopedics and Orthopedic Oncology, University of Padova, 35128 Padua, Italy (P.R.)
| | - Pietro Ruggieri
- Department of Orthopedics and Orthopedic Oncology, University of Padova, 35128 Padua, Italy (P.R.)
| | - Marta Sbaraglia
- Department of Medicine (DIMED), University of Padua School of Medicine, 35128 Padua, Italy
- Department of Pathology, Azienda Ospedale Università Padova, 35128 Padua, Italy
| | - Simone Mocellin
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology IOV—IRCCS, 35128 Padua, Italy
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padua, 35128 Padua, Italy
| | - Antonella Brunello
- Oncology 1, Department of Oncology, Veneto Institute of Oncology IOV—IRCCS, 35128 Padua, Italy
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Pinto FFE, Mello CAL, Nakagawa SA, Chung WT, Torrezan GT, Barros BDF, Cunha IW, Calsavara VF, Carraro DM, Lopes A. Does the Addition of Mutations of CTNNB1 S45F to Clinical Factors Allow Prediction of Local Recurrence in Patients With a Desmoid Tumor? A Local Recurrence Risk Model. Clin Orthop Relat Res 2023; 481:1978-1989. [PMID: 37104792 PMCID: PMC10499079 DOI: 10.1097/corr.0000000000002627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 01/16/2023] [Accepted: 02/27/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND The initial approach to the treatment of desmoid tumors has changed from surgical resection to watchful waiting. However, surgery is still sometimes considered for some patients, and it is likely that a few patients would benefit from tumor removal if the likelihood of local recurrence could be predicted. However, to our knowledge, there is no tool that can provide guidance on this for clinicians at the point of care. QUESTION/PURPOSE We sought to explore whether a combined molecular and clinical prognostic model for relapse in patients with desmoid tumors treated with surgery would allow us to identify patients who might do well with surgical excision. METHODS This was a retrospective, single-center study of 107 patients with desmoid tumors who were surgically treated between January 1980 and December 2015, with a median follow-up of 106 months (range 7 to 337 months). We correlated clinical variables (age, tumor size, and localization) and CTNNB1 gene mutations with recurrence-free survival. Recurrence-free survival was estimated using a Kaplan-Meier curve. Univariate and multivariable analyses of time to local recurrence were performed using Cox regression models. A final nomogram model was constructed according to the final fitted Cox model. The predictive performance of the model was evaluated using measures of calibration and discrimination: calibration plot and the Harrell C-statistic, also known as the concordance index, in which values near 0.5 represent a random prediction and values near 1 represent the best model predictions. RESULTS The multivariable analysis showed that S45F mutations (hazard ratio 5.25 [95% confidence interval 2.27 to 12.15]; p < 0.001) and tumor in the extremities (HR 3.15 [95% CI 1.35 to 7.33]; p = 0.008) were associated with a higher risk of local recurrence. Based on these risk factors, we created a model; we observed that patients considered to be at high risk of local recurrence as defined by having one or two factors associated with recurrence (extremity tumors and S45F mutation) had an HR of 8.4 compared with patients who had no such factors (95% CI 2.84 to 24.6; p < 0.001). From these data and based on the multivariable Cox models, we also developed a nomogram to estimate the individual risk of relapse after surgical resection. The model had a concordance index of 0.75, or moderate discrimination. CONCLUSION CTNNB1 S45F mutations combined with other clinical variables are a potential prognostic biomarker associated with the risk of relapse in patients with desmoid tumors. The developed nomogram is simple to use and, if validated, could be incorporated into clinical practice to identify patients at high risk of relapse among patients opting for surgical excision and thus help clinicians and patients in decision-making. A large multicenter study is necessary to validate our model and explore its applicability. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Fabio F. E. Pinto
- Department of Pelvic Surgery, A. C. Camargo Cancer Center, São Paulo, Brazil
| | - Celso A. L. Mello
- Department of Clinical Oncology, A. C. Camargo Cancer Center, São Paulo, Brazil
| | - Suely A. Nakagawa
- Department of Pelvic Surgery, A. C. Camargo Cancer Center, São Paulo, Brazil
| | - Wu Tu Chung
- Department of Pelvic Surgery, A. C. Camargo Cancer Center, São Paulo, Brazil
| | - Giovana T. Torrezan
- Clinical and Functional Genomics Group, International Research Center/CIPE, A. C. Camargo Cancer Center, São Paulo, Brazil
- National Institute of Science and Technology in Oncogenomics and Therapeutic Innovation, São Paulo, Brazil
| | - Bruna D. F. Barros
- Clinical and Functional Genomics Group, International Research Center/CIPE, A. C. Camargo Cancer Center, São Paulo, Brazil
| | - Isabela W. Cunha
- Department of Anatomic Pathology, A. C. Camargo Cancer Center, São Paulo, SP, Brazil
| | - Vinícius F. Calsavara
- Cedars Sinai Medical Center, Samuel Oschin Comprehensive Cancer Institute, Los Angeles, CA, USA
| | - Dirce M. Carraro
- Clinical and Functional Genomics Group, International Research Center/CIPE, A. C. Camargo Cancer Center, São Paulo, Brazil
- National Institute of Science and Technology in Oncogenomics and Therapeutic Innovation, São Paulo, Brazil
| | - Ademar Lopes
- Department of Pelvic Surgery, A. C. Camargo Cancer Center, São Paulo, Brazil
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Liu B, Sun Z, Zhou R, Shen D, Zhu S, Chen L, Huang G. Novel insights into biomarkers of progression in Desmoid tumor. Front Oncol 2023; 13:1206800. [PMID: 37601698 PMCID: PMC10434506 DOI: 10.3389/fonc.2023.1206800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 07/19/2023] [Indexed: 08/22/2023] Open
Abstract
Desmoid tumor (DT) is a rare neoplasm characterized by the proliferation of myofibroblastic cells that infiltrates and invades adjacent tissues. Due to its locally aggressive and recurrent nature, DT often causes local symptoms and can be challenging to manage clinically. Therefore, identifying biomarkers that can predict the progression of DT and guide treatment decisions is critical. This review summarizes several biomarkers that have been implicated in active surveillance (AS) and the prediction of postoperative recurrence and attempts to elucidate their underlying mechanisms. Some of these novel markers could provide prognostic value for clinicians, and ultimately help facilitate optimal and accurate therapeutic decisions for DT.
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Affiliation(s)
- Baiqi Liu
- Department of Hernia and Abdominal Wall Surgery, General Surgery, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Zefang Sun
- Department of Hernia and Abdominal Wall Surgery, General Surgery, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Rui Zhou
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Dingcheng Shen
- Department of Hernia and Abdominal Wall Surgery, General Surgery, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Shuai Zhu
- Department of Hernia and Abdominal Wall Surgery, General Surgery, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Lu Chen
- Department of Hernia and Abdominal Wall Surgery, General Surgery, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Gengwen Huang
- Department of Hernia and Abdominal Wall Surgery, General Surgery, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
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7
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Maleddu A, Zhu J, Clay MR, Wilky BA. Current therapies and future prospective for locally aggressive mesenchymal tumors. Front Oncol 2023; 13:1160239. [PMID: 37546427 PMCID: PMC10401592 DOI: 10.3389/fonc.2023.1160239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 05/11/2023] [Indexed: 08/08/2023] Open
Abstract
Locally aggressive mesenchymal tumors comprise a heterogeneous group of soft tissue and bone tumors with intermediate histology, incompletely understood biology, and highly variable natural history. Despite having a limited to absent ability to metastasize and excellent survival prognosis, locally aggressive mesenchymal tumors can be symptomatic, require prolonged and repeat treatments including surgery and chemotherapy, and can severely impact patients' quality of life. The management of locally aggressive tumors has evolved over the years with a focus on minimizing morbid treatments. Extensive oncologic surgeries and radiation are pillars of care for high grade sarcomas, however, play a more limited role in management of locally aggressive mesenchymal tumors, due to propensity for local recurrence despite resection, and the risk of transformation to a higher-grade entity following radiation. Patients should ideally be evaluated in specialized sarcoma centers that can coordinate complex multimodal decision-making, taking into consideration the individual patient's clinical presentation and history, as well as any available prognostic factors into customizing therapy. In this review, we aim to discuss the biology, clinical management, and future treatment frontiers for three representative locally aggressive mesenchymal tumors: desmoid-type fibromatosis (DF), tenosynovial giant cell tumor (TSGCT) and giant cell tumor of bone (GCTB). These entities challenge clinicians with their unpredictable behavior and responses to treatment, and still lack a well-defined standard of care despite recent progress with newly approved or promising experimental drugs.
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Affiliation(s)
- Alessandra Maleddu
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, United States
| | - Jessica Zhu
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, United States
| | - Michael Roy Clay
- Department of Pathology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Breelyn Ann Wilky
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, United States
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Zhang L, Zheng Y, Yu X, Yu K, Zhu S. Primary intra‑abdominal desmoid fibromatosis associated with familial adenomatous polyposis: A case report. Exp Ther Med 2023; 26:308. [PMID: 37273755 PMCID: PMC10236137 DOI: 10.3892/etm.2023.12007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 02/15/2023] [Indexed: 06/06/2023] Open
Abstract
Desmoid fibromatosis (DF) is a clonal proliferative disorder of myofibroblasts, which arises, with a low incidence, in soft tissue, including within the abdomen. The incidence of DF is associated with familial adenomatous polyposis (FAP), and is more common following FAP surgery. It is rare for a patient to make his/her first visit to hospital due to DF symptoms associated with FAP. In the present report, a case of mesenteric DF associated with FAP is described. This case also had incomplete intestinal obstruction due to DF. By summarizing previous studies examining DF and FAP treatment, combined with the disease characteristics of this patient, the clinical treatment strategy for DF associated with FAP was explored.
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Affiliation(s)
- Lei Zhang
- Department of Hepatobiliary Surgery, Weihai Central Hospital, Weihai, Shandong 264200, P.R. China
| | - Yaotun Zheng
- Department of Anesthesia, Weihai Central Hospital, Weihai, Shandong 264200, P.R. China
| | - Xiaoqian Yu
- Department of Obstetrics, Weihai Central Hospital, Weihai, Shandong 264200, P.R. China
| | - Kang Yu
- Department of Research and Development, Tianjin Lianchuang Technology Development Co., Ltd., Tianjin 300000, P.R. China
| | - Shengjie Zhu
- Department of Oncology, Weihai Central Hospital, Weihai, Shandong 264200, P.R. China
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9
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Borghi A, Gronchi A. Desmoid tumours (extra-abdominal), a surgeon's nightmare. Bone Joint J 2023; 105-B:729-734. [PMID: 37391208 DOI: 10.1302/0301-620x.105b7.bjj-2023-0117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/02/2023]
Abstract
Desmoid tumours are a rare fibroblastic proliferation of monoclonal origin, arising in deep soft-tissues. Histologically, they are characterized by locally aggressive behaviour and an inability to metastasize, and clinically by a heterogeneous and unpredictable course. Desmoid tumours can occur in any anatomical site, but commonly arise in the limbs. Despite their benign nature, they can be extremely disabling and sometimes life-threatening, causing severe pain and functional limitations. Their surgical management is complex and challenging, due to uncertainties surrounding the biological and clinical behaviour, rarity, and limited available literature. Resection has been the first-line approach for patients with a desmoid tumour but, during the last few decades, a shift towards a more conservative approach has occurred, with an initial 'wait and see' policy. Many medical and regional forms of treatment are also available for the management of this condition, and others have recently emerged with promising results. However, many areas of controversy remain, and further studies and global collaboration are needed to obtain prospective and randomized data, in order to develop an appropriate shared stepwise approach.
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Affiliation(s)
- Alessandra Borghi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Alessandro Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
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Schut ARW, Timbergen MJ, Nasserinejad K, van Dalen T, van Houdt WJ, Bonenkamp JJ, Sleijfer S, Grünhagen DJ, Verhoef C, Husson O. Health-related Quality of Life of Patients With Non-Intra-abdominal Desmoid-Type Fibromatosis During Active Surveillance: Results of a Prospective Observational Study. Ann Surg 2023; 277:877-883. [PMID: 36727954 PMCID: PMC10174102 DOI: 10.1097/sla.0000000000005795] [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] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To examine the impact of an active surveillance (AS) approach on the health-related quality of life (HRQoL) of patients with desmoid-type fibromatosis (DTF). BACKGROUND DATA AS is recommended as initial approach in DTF patients. AS might however negatively affect HRQoL due to physical symptoms or stress and anxiety. METHODS In a prospective observational study, the GRAFITI trial (NTR4714), DTF patients were followed during an initial AS approach for 3 years. HRQoL was assessed by the EORTC QLQ-C30 at baseline, 6, 12 and 24-month follow-up. Patients who completed questionnaires at≥1-time point were included in this analysis of the secondary endpoint. A multivariable linear mixed-effects model with random intercept was conducted to assess trends of HRQoL scores over time and to explore the effect of treatment strategy on HRQoL. RESULTS All 105 patients enrolled in the GRAFITI trial were eligible for the HRQoL analyses. During 24-month follow-up, 75 patients (71%) continued AS and 30 patients (29%) started an active treatment (AT). DTF patients who continued AS demonstrated relatively stable HRQoL scores during follow-up. HRQoL scores of patients who started AT worsened compared to patients who continued AS, although no significant changes in HRQoL score over time were found in the mixed-model analyses. Overall, DTF patients who started AT scored significantly worse on pain (β=10.08, P =0.039) compared to patients who continued AS. CONCLUSIONS An initial AS approach did not impair HRQoL of DTF patients who continued AS over time, therefore providing further support for AS as the frontline approach in DTF patients. Longitudinal assessment of HRQoL should be part of clinical follow-up to identify patients who may need a change in treatment strategy.
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Affiliation(s)
- Anne-Rose W. Schut
- Department of Surgical Oncology, Erasmus MC Cancer Institute Rotterdam, The Netherlands
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Milea J.M. Timbergen
- Department of Surgical Oncology, Erasmus MC Cancer Institute Rotterdam, The Netherlands
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Kazem Nasserinejad
- Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Thijs van Dalen
- Department of Surgical Oncology, Erasmus MC Cancer Institute Rotterdam, The Netherlands
- Department of Surgical Oncology, University Medical Center Utrecht, the Netherlands; Diakonessenhuis Utrecht, The Netherlands
| | - Winan J. van Houdt
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Johannes J. Bonenkamp
- Department of Surgical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Stefan Sleijfer
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Dirk J. Grünhagen
- Department of Surgical Oncology, Erasmus MC Cancer Institute Rotterdam, The Netherlands
| | - Cornelis Verhoef
- Department of Surgical Oncology, Erasmus MC Cancer Institute Rotterdam, The Netherlands
| | - Olga Husson
- Department of Surgical Oncology, Erasmus MC Cancer Institute Rotterdam, The Netherlands
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
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Schut ARW, Timbergen MJM, van Broekhoven DLM, van Dalen T, van Houdt WJ, Bonenkamp JJ, Sleijfer S, Grunhagen DJ, Verhoef C. A Nationwide Prospective Clinical Trial on Active Surveillance in Patients With Non-intraabdominal Desmoid-type Fibromatosis: The GRAFITI Trial. Ann Surg 2023; 277:689-696. [PMID: 35166264 PMCID: PMC9994811 DOI: 10.1097/sla.0000000000005415] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess tumor behavior and the efficacy of active surveillance (AS) in patients with desmoid-type fibromatosis (DTF). SUMMARY OF BACKGROUND DATA AS is recommended as initial management for DTF patients. Prospective data regarding the results of AS are lacking. METHODS In this multicenter prospective cohort study (NTR4714), adult patients with non-intraabdominal DTF were followed during an initial AS approach for 3 years. Tumor behavior was evaluated according to Response Evaluation Criteria in Solid Tumors. Cumulative incidence of the start of an active treatment and progression-free survival (PFS) were calculated using the Kaplan-Meier method. Factors predictive for start of active treatment were assessed by Cox regression analyses. RESULTS A total of 105 patients started with AS. Median tumor size at baseline was 4.1cm (interquartile range 3.0-6.6). Fifty-seven patients had a T41A CTNNB1 mutation; 14 patients a S45F CTNNB1 mutation. At 3 years, cumulative incidence of the start of active treatment was 30% (95% confidence interval [CI] 21-39) and PFS was 58% (95% CI 49-69). Median time to start active treatment and PFS were not reached at a median follow-up of 33.7 months. During AS, 32% of patients had stable disease, 28% regressed, and 40% demonstrated initial progression. Larger tumor size (≥5 cm; hazard ratio = 2.38 [95% CI 1.15-4.90]) and S45F mutation (hazard ratio = 6.24 [95% CI 1.92-20.30]) were associated with the start of active treatment. CONCLUSIONS The majority DTF patients undergoing AS do not need an active treatment and experience stable or regressive disease, even after initial progression. Knowledge about the natural behavior of DTF will help to tailor the follow-up schedule to the individual patient.
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Affiliation(s)
- Anne-Rose W Schut
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Milea J M Timbergen
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Danique L M van Broekhoven
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
- Department of Orthopaedics and Sports Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Thijs van Dalen
- Department of Surgical Oncology, University Medical Center Utrecht, the Netherlands
- Department of Surgery, Diakonessenhuis Utrecht, The Netherlands
| | - Winan J van Houdt
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Johannes J Bonenkamp
- Department of Surgical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Stefan Sleijfer
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Dirk J Grunhagen
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Cornelis Verhoef
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
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12
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Fujita S, Takeyama M, Kato S, Kawabata Y, Nezu Y, Hayashida K, Saito K, Kato I, Washimi K, Choe H, Hiruma T, Inaba Y. Effect of Tranilast on the Frequency of Invasive Treatment for Extra-Abdominal Desmoid Fibromatosis. J NIPPON MED SCH 2023; 90:79-88. [PMID: 36436917 DOI: 10.1272/jnms.jnms.2023_90-113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Active surveillance (AS) has been suggested for managing extra-abdominal desmoid fibromatosis (EADF), but a substantial percentage of such patients transitioned to invasive secondary treatments. The anti-keloid medication tranilast is frequently used in Japan but its effectiveness for EADF is not well understood. METHODS We retrospectively analyzed the medical records of EADF patients treated with tranilast between January 2009 and March 2021. EADF has been reported to shrink spontaneously, so the effects of all drugs must be compared with AS. To assess the effect of tranilast, we compared the clinical courses of patients receiving tranilast with those managed by AS (as identified in a systematic review). A systematic review of AS outcomes was conducted on July 22, 2021, in accordance with PRISMA guidelines. The primary endpoint was rate of conversion to secondary treatment. Secondary endpoints were progression-free survival, objective response rate (ORR), disease control rate (DCR), and adverse events. The rates of conversion to secondary treatment, ORRs, and DCRs were compared between the two groups by using the Fisher exact test. RESULTS Eighteen patients who received tranilast as initial treatment for EADF were included. Two patients (11.1%) underwent surgical resection for treatment of tumor growth and persistent pain. The rate of conversion to secondary treatment was significantly lower for tranilast than for a pure AS approach (40.1%; p = 0.01). ORR and DCR did not differ between groups. CONCLUSIONS Tranilast was better than AS for initial management of EADF.
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Affiliation(s)
- Shintaro Fujita
- Department of Orthopaedic Surgery, Yokohama City University Hospital
| | - Masanobu Takeyama
- Department of Orthopaedic Surgery, Yokohama City University Hospital
| | - Shingo Kato
- Department of Clinical Cancer Genomics, Yokohama City University Hospital
| | - Yusuke Kawabata
- Department of Orthopaedic Surgery, Yokohama City University Hospital
| | - Yutaka Nezu
- Department of Musculoskeletal Tumor Surgery, Kanagawa Cancer Center
| | - Kenta Hayashida
- Department of Orthopaedic Surgery, Yokohama City University Hospital
| | - Keiju Saito
- Department of Orthopaedic Surgery, Yokohama City University Hospital
| | - Ikuma Kato
- Department of Molecular Pathology, Yokohama City University Hospital
| | | | - Hyonmin Choe
- Department of Orthopaedic Surgery, Yokohama City University Hospital
| | - Toru Hiruma
- Department of Musculoskeletal Tumor Surgery, Kanagawa Cancer Center
| | - Yutaka Inaba
- Department of Orthopaedic Surgery, Yokohama City University Hospital
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13
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Desmoid-type fibromatosis: imaging features and course. Skeletal Radiol 2023; 52:1293-1303. [PMID: 36646850 DOI: 10.1007/s00256-023-04275-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 12/30/2022] [Accepted: 12/30/2022] [Indexed: 01/18/2023]
Abstract
Desmoid-type fibromatosis (DF) is a soft tissue tumor characterized by infiltrative growth and a tendency toward local recurrence, while it exhibits self-limiting behavior and shows spontaneous regression. With its unpredictable behavior, a change in treatment strategies from initial surgery to nonsurgical management has been proposed, and active surveillance is currently widely chosen as the initial treatment strategy for DF. We reviewed the imaging features of DF regarding its clinical course, focusing on regression cases, postoperative cases, and imaging changes after systemic treatment.
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14
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Elnekave E, Ben Ami E, Shamai S, Peretz I, Tamir S, Bruckheimer E, Stemmer A, Erinjeri J, Abu Quider A, Seidensticker M, Wildgruber M, Ricke J, Anazodo A, Fung KF, Zer A, Ash S. Selective Intra-Arterial Doxorubicin Eluting Microsphere Embolization for Desmoid Fibromatosis: A Combined Prospective and Retrospective Study. Cancers (Basel) 2022; 14:cancers14205045. [PMID: 36291829 PMCID: PMC9599870 DOI: 10.3390/cancers14205045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 10/03/2022] [Accepted: 10/08/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Desmoid fibromatoses (DFs) are locally aggressive tumors composed of monoclonal fibroblasts within an abundant extracellular matrix. Systemic treatment with doxorubicin is effective, but associated with significant toxicity. We investigated arterial doxorubicin eluting embolization (DEE), an approach that delivers high doxorubicin concentrations to the tumor with limited systemic drug exposure, in 24 patients (median age, 24 years; interquartile range, 16–34). Most patients (71%) had one or more than one prior DFs treatment (surgery, systemic therapy, or both). Patients underwent a median of two (range, 1–4) DEE treatments, with a median of 49 mg (range, 8–75) doxorubicin per treatment. Efficacy outcomes were available for 23 patients. With a median follow-up of 8 months (interquartile range, 3–13), median tumor volumes decreased by 59% (interquartile range, 40–71%). Of 23 patients, 9 (39%), 12 (52%), and 2 (9%) had a partial response, stable disease, and progressive disease, respectively. The procedure was safe and well tolerated. Abstract Desmoid fibromatoses (DFs) are locally aggressive tumors composed of monoclonal fibroblasts within an abundant extracellular matrix. Systemic doxorubicin treatment is effective, but toxic. We investigated arterial doxorubicin eluting embolization (DEE), an approach characterized by high drug concentrations in the tumor alongside limited systemic drug exposure. The primary and secondary endpoints were radiological response using MRI and RECIST 1.1, respectively. The study included 24 patients (median age, 24; interquartile range, 16–34 years). Data were collected prospectively for 9 patients and retrospectively for 15 patients. The most frequent tumor locations were chest/abdomen wall and neck/shoulder/axilla (29% each). Of 24 patients, 7 (24%) were treatment naïve, and 17 (71%) had received one or two prior treatments. Patients underwent a median of two treatments (range, 1–4), with a median of 49 mg (range, 8–75) doxorubicin/treatment. Efficacy outcomes were available for 23 patients. With a median follow-up of 8 months (interquartile range, 3–13), median tumor volumes decreased by 59% (interquartile range, 40–71%) and T2 signal intensity decreased by 36% (interquartile range, 19–55%). Of 23 patients, 9 (39%), 12 (52%), and 2 (9%) had a partial response, stable disease, and progressive disease, respectively. DEE was safe and well tolerated, with one reported grade 3–4 adverse event (cord injury). In conclusion, DEE was safe and achieved rapid clinical/volumetric responses in DFs.
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Affiliation(s)
- Eldad Elnekave
- Unit of Interventional Radiology, Shaare Tzedek Medical Center, Jerusalem 9103102, Israel
- Department of Diagnostic Radiology, Rabin Medical Center, Petah Tikva 4941492, Israel
- Correspondence: ; Tel.: +972-54-9762744
| | - Eytan Ben Ami
- Sarcoma and Bone Oncology Unit, Oncology Division, Chaim Sheba Medical Center, Ramat Gan 52621, Israel
| | - Sivan Shamai
- Sarcoma and Bone Oncology Unit, Oncology Division, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
| | - Idit Peretz
- Davidoff Cancer Institute, Rabin Medical Center, Petah Tikva 4941492, Israel
| | - Shlomit Tamir
- Department of Diagnostic Radiology, Rabin Medical Center, Petah Tikva 4941492, Israel
| | - Elchanan Bruckheimer
- Section of Pediatric Cardiology, Schneider Children’s Medical Center, Petah Tikva 4941492, Israel
| | - Amos Stemmer
- Oncology Division, Chaim Sheba Medical Center, Ramat Gan 52621, Israel
| | - Joseph Erinjeri
- Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Abed Abu Quider
- Department of Pediatric Hematology Oncology, Saban Pediatric Medical Center, Soroka University Medical Center, Beer Sheva 84101, Israel
| | - Max Seidensticker
- Department of Radiology, University Hospital, Ludwig Maximilian University, 80539 Munich, Germany
| | - Moritz Wildgruber
- Department of Radiology, University Hospital, Ludwig Maximilian University, 80539 Munich, Germany
| | - Jens Ricke
- Department of Radiology, University Hospital, Ludwig Maximilian University, 80539 Munich, Germany
| | - Antoinette Anazodo
- Kids Cancer Centre, Sydney Children’s Hospital, Randwick, Sydney, NSW 2031, Australia
| | - Kin Fen Fung
- Department of Radiology, Hong Kong Children’s Hospital, Hong Kong 999077, China
| | - Alona Zer
- Department of Oncology, Rambam Medical Center, Haifa 3109601, Israel
| | - Shifra Ash
- Department of Pediatric Hematology-Oncology, Rambam Medical Center, Haifa 3109601, Israel
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15
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The Role of Pharmacotherapeutic Agents in Children with Desmoid Tumors. Paediatr Drugs 2022; 24:433-445. [PMID: 35902507 DOI: 10.1007/s40272-022-00526-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/07/2022] [Indexed: 10/16/2022]
Abstract
Desmoid tumors (DT) are rare fibroblastic, soft-tissue tumors that do not metastasize but can aggressively infiltrate tissues causing significant chronic discomfort and/or functional impairment. In the pediatric population, the incidence of DT is greatest during infancy and adolescence but can occur at any age. Dysregulated β-catenin, most commonly resulting from mutations in either CTNNB1 or germline APC (adenomatous polyposis coli) drives DT. Most cases are sporadic but some are associated with predisposition syndromes such as familial adenomatous polyposis (FAP). Historically, treatment has been surgery. However, the recurrence rate after surgery can be high. Various systemic cytotoxic chemotherapy regimens used in other soft-tissue sarcomas have been applied to DT with differing results. Given the chronic and rarely life-threatening nature of this disease and the potential short- and long-term toxicity of these regimens, especially in children, alternative non-cytotoxic interventions have been investigated. Molecularly targeted agents such as tyrosine kinase and gamma secretase inhibitors have shown activity against DT. Innovative local control therapies are being employed as alternatives to surgery and radiation. Periods of prolonged stability and spontaneous regression in the absence of therapy in some patients has prompted wider adoption of an upfront active surveillance approach in the appropriate setting. This review will briefly summarize the epidemiology, pathophysiology, and clinical presentation of DT in children, then focus on historical, current, and future pharmacotherapeutic management and finally, propose areas for future study.
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Abstract
PURPOSE OF REVIEW The objective of this article is to summarize new treatment strategies of desmoid tumors. RECENT FINDINGS Desmoid tumor has an unpredictable evolution that may spontaneously regress or stabilize. A shift toward an initial frontline active surveillance has been acknowledged by experts. Surveillance monitoring should be performed frequently after the diagnosis to avoid missing a significant progression and then spaced in case of stabilization. Treatment is based on significant tumor growth or symptoms. Recent guidelines recommend commencing medical treatment. Kinase inhibitors and cytotoxic agents are the two classes of drugs where studies included progressive desmoid tumors and should be selected to guide medical practice. In a randomized trial, 2 years progression-free survival (PFS) was significantly better in the sorafenib group (81 versus 36% in the placebo group). In another randomized phase 2, 6 months PFS was 83.7% with pazopanib versus 45% with methotrexate and vinblastine. In a retrospective study, including progressive desmoid tumors, methotrexate + vinca alkaloids achieved 75 months median PFS. Cryotherapy is an alternative option in desmoid tumors with compatible locations and tumor sizes. Following medical treatment or cryotherapy failure, superficial sites represent the best indications for surgery in cases of continuous progression. In the event of a contra-indication or failure of medical treatment, in locations where surgery would be mutilating and incomplete, radiotherapy is an effective option. SUMMARY Active surveillance with planned imaging has become the first-line management in desmoid tumor.
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17
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Schut ARW, Lidington E, Timbergen MJM, Younger E, van der Graaf WTA, van Houdt WJ, Bonenkamp JJ, Jones RL, Grünhagen DJ, Sleijfer S, Verhoef C, Gennatas S, Husson O. Unraveling Desmoid-Type Fibromatosis-Specific Health-Related Quality of Life: Who Is at Risk for Poor Outcomes. Cancers (Basel) 2022; 14:cancers14122979. [PMID: 35740642 PMCID: PMC9221474 DOI: 10.3390/cancers14122979] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/10/2022] [Accepted: 06/12/2022] [Indexed: 11/30/2022] Open
Abstract
Simple Summary Desmoid-type fibromatosis (DTF) is an uncommon, non-metastasising soft-tissue tumour. Patients can experience a wide variety of disease-specific issues related to the unpredictable clinical course and aggressiveness of DTF, negatively impacting their health-related quality of life (HRQoL). Little is known about which DTF patients are particularly affected by an impaired HRQoL. In the current study, HRQoL was evaluated among different groups of DTF patients, using the EORTC QLQ-C30 and the DTF-QoL, a DTF-specific HRQoL questionnaire. Age, sex, presence of comorbidities, and type of treatment were found to be most strongly associated with DTF-specific HRQoL outcomes. In general, socio-demographic factors had the greatest impact on generic HRQoL, whereas the influence of clinical factors was mainly seen on the DTF-QoL, underlining the importance of a disease-specific questionnaire. Knowledge of the differences in DTF-specific HRQoL between subgroups can be used to individualize the HRQoL-measurement strategy for research and clinical practice. Abstract Desmoid-type fibromatosis (DTF) is a rare, soft-tissue tumour. These tumours do not metastasize, but their local aggressive tumour growth and unpredictable behaviour can have a significant impact on health-related quality of life (HRQoL). Little is known about which DTF patients are particularly affected by an impaired HRQoL. The objectives of this study were to assess HRQoL among different groups of DTF patients and to investigate which socio-demographic and clinical characteristics were associated with DTF-specific HRQoL. A cross-sectional study was conducted among DTF patients from the United Kingdom and the Netherlands. HRQoL was assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30), accompanied by the DTF-QoL to assess DTF-specific HRQoL. The scores were compared amongst subgroups, based on the socio-demographic and clinical characteristics of DTF patients. Multiple linear regression analyses with a backward elimination were conducted to identify the factors associated with DTF-specific HRQoL. A total of 235 DTF patients completed the questionnaires. Female patients, patients with more than two comorbidities, or patients who received treatment other than only active surveillance (AS) or surgery scored significantly worse on the subscales of both the EORTC QLQ-C30 and DTF-QoL. Patients that were ≥ 40 years scored significantly worse on the physical functioning scale of the EORTC QLQ-C30, while younger patients (18–39 years) scored significantly worse on several DTF-QoL subscales. Differences in the DTF-QoL subscales were found for tumour location, time since diagnosis and the presence of recurrent disease. Furthermore, treatments other than AS or surgery only, female sex, younger age and the presence of comorbidities were most frequently associated with worse scores on the DTF-QoL subscales. This study showed that (DTF-specific) HRQoL differs between groups of DTF patients. Awareness of these HRQoL differences could help to provide better, personalised care that is tailored to the needs of a specific subgroup.
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Affiliation(s)
- Anne-Rose W. Schut
- Department of Medical Oncology, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands; (A.-R.W.S.); (M.J.M.T.); (W.T.A.v.d.G.); (S.S.)
- Department of Surgical Oncology, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands; (D.J.G.); (C.V.)
| | - Emma Lidington
- Sarcoma Unit, Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK; (E.L.); (E.Y.); (R.L.J.); (S.G.)
| | - Milea J. M. Timbergen
- Department of Medical Oncology, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands; (A.-R.W.S.); (M.J.M.T.); (W.T.A.v.d.G.); (S.S.)
- Department of Surgical Oncology, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands; (D.J.G.); (C.V.)
| | - Eugenie Younger
- Sarcoma Unit, Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK; (E.L.); (E.Y.); (R.L.J.); (S.G.)
| | - Winette T. A. van der Graaf
- Department of Medical Oncology, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands; (A.-R.W.S.); (M.J.M.T.); (W.T.A.v.d.G.); (S.S.)
- Department of Medical Oncology, Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
| | - Winan J. van Houdt
- Department of Surgical Oncology, Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands;
| | - Johannes J. Bonenkamp
- Department of Surgical Oncology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands;
| | - Robin L. Jones
- Sarcoma Unit, Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK; (E.L.); (E.Y.); (R.L.J.); (S.G.)
- Division of Clinical Studies, Institute of Cancer Research, Royal Marsden NHS Foundation Trust, London SM2 5NG, UK
| | - Dirk. J. Grünhagen
- Department of Surgical Oncology, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands; (D.J.G.); (C.V.)
| | - Stefan Sleijfer
- Department of Medical Oncology, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands; (A.-R.W.S.); (M.J.M.T.); (W.T.A.v.d.G.); (S.S.)
| | - Cornelis Verhoef
- Department of Surgical Oncology, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands; (D.J.G.); (C.V.)
| | - Spyridon Gennatas
- Sarcoma Unit, Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK; (E.L.); (E.Y.); (R.L.J.); (S.G.)
- Department of Medical Oncology, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, UK
| | - Olga Husson
- Department of Surgical Oncology, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands; (D.J.G.); (C.V.)
- Department of Medical Oncology, Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
- Division of Clinical Studies, Institute of Cancer Research, Royal Marsden NHS Foundation Trust, London SM2 5NG, UK
- Correspondence: ; Tel.: +44-2034-376-342
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Benech N, Bonvalot S, Dufresne A, Gangi A, Le Péchoux C, Lopez-Trabada-Ataz D, Meurgey A, Nicolas N, Orbach D, Penel N, Salas S, Saurin JC, Walter T, Lecomte T, Bouché O. Desmoid tumors located in the abdomen or associated with adenomatous polyposis: French intergroup clinical practice guidelines for diagnosis, treatment, and follow-up (SNFGE, FFCD, GERCOR, UNICANCER, SFCD, SFED, SFRO, ACHBT, SFR). Dig Liver Dis 2022; 54:737-746. [PMID: 35508462 DOI: 10.1016/j.dld.2022.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 03/07/2022] [Accepted: 03/10/2022] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Desmoid tumor (DT) of the abdomen is a challenging and rare disease. The level of evidence available to document their treatment is relatively low, however, recent publications of prospective studies have allowed to precise their management. METHODS This document is a summary of the French intergroup guidelines realized by all French medical and surgical societies involved in the management of DT located in the abdomen or associated with adenomatous polyposis. Recommendations are graded in four categories (A, B, C and D), according to the level of evidence found in the literature until January 2021. RESULTS When the diagnosis of DT is suspected a percutaneous biopsy should be performed when possible. A molecular analysis looking for pathogenic mutations of the CTNNB1 and APC genes should be systematically performed. When a somatic pathogenic variant of the APC gene is present, an intestinal polyposis should be searched. Due to a high rate of spontaneous regression, non-complicated DT should first benefit from an active surveillance with MRI within 2 months after diagnosis to assess the dynamic of tumor growth. The treatment decision must be discussed in an expert center, favoring the less toxic treatments which can include broad spectrum tyrosine kinase inhibitor or conventional chemotherapy (methotrexate-vinblastine). Surgery, outside the context of emergency, should only be considered for favorable location in an expert center. CONCLUSION French guidelines for DT management were elaborated to help offering the best personalized therapeutic strategy in daily clinical practice as the DT therapeutic landscape is complexifying. Each individual case must be discussed within a multidisciplinary expert team.
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Affiliation(s)
- Nicolas Benech
- Service d'Hépato-Gastroentérologie, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon 69003, France.
| | | | - Armelle Dufresne
- Département d'Oncologie Médicale, Léon Bérard Cancer Center, 28, rue Laennec, Lyon 69373 CEDEX 08, France
| | - Afshin Gangi
- Interventional Radiology, University Hospitals of Strasbourg, Strasbourg University, Strasbourg 67200, France
| | - Cécile Le Péchoux
- Département d'Oncologie Radiothérapie, Gustave- Roussy Cancer Campus, 114, rue Edouard- Vaillant, Villejuif 94800, France
| | - Daniel Lopez-Trabada-Ataz
- Service d'Oncologie Médicale, Hôpital Saint-Antoine, 184, rue du Faubourg Saint-Antoine, Paris 75012, France
| | - Alexandra Meurgey
- Department of Biopathology, Léon Bérard Cancer Center, 28, rue Laennec, Lyon 69373 CEDEX 08, France
| | - Nayla Nicolas
- Department of Radiology, Institut Curie, Paris, France
| | - Daniel Orbach
- SIREDO Oncology Center (Care, Innovation and Research for Children, Adolescents and Young Adults with Cancer), Institut Curie, Paris, France
| | - Nicolas Penel
- Centre Oscar Lambret and Lille University, Lille, France
| | - Sébastien Salas
- Oncology Unit, AP-HM, Aix-Marseille University, Marseille, France
| | - Jean-Christophe Saurin
- Service d'Hépato-Gastroentérologie, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon 69003, France
| | - Thomas Walter
- Service d'Oncologie, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon 69003, France
| | - Thierry Lecomte
- Department of Hepatogastroenterology and Digestive Oncology, CHU de Tours, Tours, France
| | - Olivier Bouché
- Department of Digestive Oncology, CHU Reims, Reims, France
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Zhao J, Cheng F, Yao Z, Zheng B, Niu Z, He W. Surgical Management of a Giant Desmoid Fibromatosis of Abdominal Wall With Vessels Invasion in a Young Man: A Case Report and Review of the Literature. Front Surg 2022; 9:851164. [PMID: 35478728 PMCID: PMC9037953 DOI: 10.3389/fsurg.2022.851164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 02/24/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundDesmoid fibromatosis (DF) is a rare clonal proliferation of fibroblasts and myofibroblasts. It develops in the connective tissues and does not metastasize but may infiltrate adjacent structures. Because of the rarity of these tumors and the unpredictable natural history of the disease, well-defined and precise guidelines of the optimal treatment for DF have not been formulated.Case PresentationHere, we present a giant abdominal DF that invaded the right spermatic cord and iliac vessels. The lesion was excised with external iliac artery dissection; however, the vein was sacrificed. The abdominal wall defect was then repaired with a polypropylene mesh. The lesional cells are positive for β-catenin.ConclusionsIn the past decades, there has been a change in the treatment of DF. The “wait and see” policy has been considered initially in most cases. Surgical intervention remains a valid option for symptomatic lesions. The optimal regimes of the tumor should not take the risk of making the patient more symptomatic than the lesion itself.
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Affiliation(s)
- Jiming Zhao
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Fajuan Cheng
- Department of Nephrology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- Department of Nephrology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Zhigang Yao
- Department of Pathology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Bin Zheng
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Zhihong Niu
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Wei He
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
- *Correspondence: Wei He orcid.org/0000-0002-4272-2891
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20
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Colombo C, Fiore M, Grignani G, Tolomeo F, Merlini A, Palassini E, Collini P, Stacchiotti S, Casali PG, Perrone F, Mariani L, Gronchi A. A prospective observational study of Active surveillance in primary desmoid fibromatosis. Clin Cancer Res 2022; 28:4027-4032. [PMID: 35247923 DOI: 10.1158/1078-0432.ccr-21-4205] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/10/2022] [Accepted: 02/22/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE To prospectively assess the behaviour of primary sporadic (not FAP associated) desmoid fibromatosis (DF) managed by active surveillance (AS). EXPERIMENTAL DESIGN This is an Italian prospective, multicenter, observational study (NCT02547831) including patients {greater than or equal to}16 years with primary sporadic DF at any site. Patients were assessed by Response Evaluation Criteria in Solid Tumor (RECIST) version 1.1 . Primary end-point was progression-free survival (PFS) at 3 years. Treatment-free survival (TFS) was also analyzed. PFS and TFS were calculated by Kaplan-Meier plots and compared by log-rank test Cox proportional-hazard multivariable regression analyses were performed. RESULTS From 2013 to 2018 108 consecutive patients were included (82% female); median age was 39-yr; median size was 51 mm. CTNNB1 mutations were: T41A (50%); S45F (12%); other (19%); WT (19%). At 32.3-month median-FU, 42/108 (39%) showed RECIST progression. Spontaneous regression (SR) was initially observed in 27/108 (25%), while it followed dimensional progression in other 33/108 (31%). PFS at 36 months was 54.5% (95% CI, 44.9%-66.1%). Thirty-five/108 (32%) patients received active treatments, 18/108 (17%) after RECIST progression and 17/108 (15%) after symptomatic progression. TFS at 36 months was 65.9% (95% CI, 57.3%-75.9%). Larger tumor size and extremity location were associated to shorter TFS and a trend for S45F mutation was also observed (p=0.06), while none of the above variables was significantly associated to PFS. CONCLUSIONS In primary DF, AS can be proposed, since disease stabilization and SR frequently occur. However extra care should be taken for patients with tumors of larger size, extremity location and S45F mutation.
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Affiliation(s)
| | - Marco Fiore
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | | | | | | | - Paola Collini
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | | | - Paolo G Casali
- Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | | | - Luigi Mariani
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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21
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Johns MS, Merritt WT, Rhodes L, Ford CN, Thompson M, Lee WM, Sheldon Y, Petrelli NJ, Tiesi GJ. A cost analysis of sorafenib for desmoid tumors. J Oncol Pharm Pract 2022; 29:663-668. [PMID: 35112974 DOI: 10.1177/10781552221077927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION A recent randomized trial demonstrated that sorafenib improved progression free survival (PFS) in patients with desmoid tumors despite many patients experiencing stable disease or spontaneous regression without treatment. Utilizing these trial data, we performed a cost analysis of sorafenib efficacy through two years of treatment. METHODS Current Medicare Part D rates for sorafenib were utilized (dose 400 mg/day, cost $309/day). Annual costs per progression and objective response were calculated. Radiologic progression and response were defined using RECIST criteria. Patients with disease progression were separately analyzed in two groups: both clinical and radiologic (CAR), and radiologic alone. RESULTS 84 previously randomized patients were analyzed (placebo: 35, sorafenib: 49). At one year, sorafenib was associated with a 43% absolute risk reduction (ARR) of CAR progression and number-needed-to-treat (NNT) of 2.3 patients/year, costing $259,406. At two years, ARR was 48% and NNT of 2.1 patients/year, costing $473,697. When evaluating only patients with RECIST defined radiologic progression, sorafenib patients experienced ARR of 13.9% with NNT 7.2 and estimated costs of $812,052 at one year. Two-year ARR was 17.5% with NNT 5.7 and estimated costs $1,285,052. Sorafenib patients experienced improved RECIST partial response rates at 1 and 2 years of 14.7% and 14.3%, with NNT 6.8 and 6.9, and costs of $766,938 and $1,556,433; respectively. CONCLUSION For the treatment of desmoid tumors, Sorafenib led to improved PFS, but at a significant cost per patient. Favorable RECIST outcomes were less likely and costlier. Patients should be informed of possible benefits of treatment versus potential financial burden.
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Affiliation(s)
- Michael S Johns
- Division of Surgical Oncology, Helen F. Graham Cancer Center and Research Institute, 5973Christiana Care, Newark, DE, USA
| | - William T Merritt
- Division of Surgical Oncology, Helen F. Graham Cancer Center and Research Institute, 5973Christiana Care, Newark, DE, USA
| | - Lori Rhodes
- Department of General Surgery, 12315Temple University Hospital, Philadelphia, PA, USA
| | - Candice N Ford
- Division of Surgical Oncology, Helen F. Graham Cancer Center and Research Institute, 5973Christiana Care, Newark, DE, USA
| | | | - William M Lee
- Division of Surgical Oncology, Helen F. Graham Cancer Center and Research Institute, 5973Christiana Care, Newark, DE, USA
| | - Yarrow Sheldon
- Division of Surgical Oncology, Helen F. Graham Cancer Center and Research Institute, 5973Christiana Care, Newark, DE, USA
| | - Nicholas J Petrelli
- Division of Surgical Oncology, Helen F. Graham Cancer Center and Research Institute, 5973Christiana Care, Newark, DE, USA
| | - Gregory J Tiesi
- Division of Surgical Oncology, Helen F. Graham Cancer Center and Research Institute, 5973Christiana Care, Newark, DE, USA
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22
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Wang J, Li H, Wang H, Li Q, Bai X, Lv H, Nie C, Chen B, Xu W, Tu S, Chen X. Combination of Anlotinib and Celecoxib for the Treatment of Abdominal Desmoid Tumor: A Case Report and Literature Review. Front Oncol 2022; 11:830672. [PMID: 35096630 PMCID: PMC8792388 DOI: 10.3389/fonc.2021.830672] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 12/20/2021] [Indexed: 11/20/2022] Open
Abstract
Desmoid tumor is a rare disease, which is histologically characterized by local invasion, monoclonality, and fibroblast proliferation; and clinically characterized by a variable and often unpredictable course. The treatment of desmoid tumor is mainly surgical resection, but the recurrence rate is high. In recent years, a variety of treatment methods, including endocrine therapy, surgery, radiotherapy, chemotherapy, non-steroidal anti-inflammatory drugs, targeted drugs, interferon and more, have been used and achieved certain curative effects. In addition, in view of the inertia characteristics of desmoid tumor, observation is also a first-line scheme recommended by multiple guidelines. In the past, the research progress of targeted therapy for desmoid tumor is relatively slow and the curative effect is limited. Thus, targeted therapy is usually used as a remedial treatment after the failure of other conventional treatment methods. However, in recent years, with the rapid progress in the basic research of targeted therapy, some new targeted drugs are increasingly used for the clinical treatment of desmoid tumor and have achieved good results. Herein, we described a patient with aggressive fibromatosis in the abdominal cavity. Following a combined treatment using anlotinib and celecoxib, the patient achieved a partial response with mild toxicity. Simultaneously, the patient’s pain symptoms completely disappeared. This case indicates that the combination of anlotinib and NSAIDs could be an effective treatment for desmoid tumor.
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Affiliation(s)
- Jianzheng Wang
- Department of Medical Oncology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Hongle Li
- Department of Molecular Pathology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Hui Wang
- Department of Endoscope Center, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Qingli Li
- Department of Oncology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Xuanye Bai
- Department of Pathology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, Henan, China
| | - Huifang Lv
- Department of Medical Oncology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Caiyun Nie
- Department of Medical Oncology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Beibei Chen
- Department of Medical Oncology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Weifeng Xu
- Department of Medical Oncology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Shuiping Tu
- Department of Oncology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Xiaobing Chen
- Department of Medical Oncology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
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23
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Schut ARW, Vriends AL, Sacchetti A, Timbergen MJ, Alman BA, Al-Jazrawe M, Grünhagen DJ, Verhoef C, Sleijfer S, Wiemer EA. In desmoid-type fibromatosis cells sorafenib induces ferroptosis and apoptosis, which are enhanced by autophagy inhibition. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2022; 48:1527-1535. [DOI: 10.1016/j.ejso.2022.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 02/07/2022] [Accepted: 02/16/2022] [Indexed: 10/19/2022]
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24
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Damiani G, Mikhael R, Tzanis D, El Zein S, Bonvalot S. Desmoid Tumors Arising on the Mesenteric Surgical Scar of Abdominal Sarcomas. Cureus 2022; 14:e21727. [PMID: 35251801 PMCID: PMC8887548 DOI: 10.7759/cureus.21727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2022] [Indexed: 11/05/2022] Open
Abstract
A sporadic desmoid tumor (DT) is a rare type of tumor of the mesenchymal connective tissues is now considered an intermediate disease or locally aggressive. They may develop on scars or after traumatism, favored by growth factors released during the initial phase of wound healing. Most of the abdominal DT arising on a scar is described on the wall incision. In this report, we describe two cases of DT arising on the intraperitoneal surgical scar, shortly after the resection of a low-grade retroperitoneal liposarcoma and a low-risk gastric gastrointestinal stromal tumor (GIST). Inconsistency between low risk according to the classification of the primary sarcoma and early local recurrence (LR) should raise the possibility of DT. Core needle biopsy (CNB) should be performed when it is feasible, including on local recurrences (LR). Surveillance has become the first-line treatment for DT. In case of progression between two imaging during the surveillance phase, surgery, when it's not mutilating, is indicated for selected cases as second-line treatment.
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25
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Development of a Disease-Specific Health-Related Quality of Life Questionnaire (DTF-QoL) for Patients with Desmoid-Type Fibromatosis. Cancers (Basel) 2022; 14:cancers14030709. [PMID: 35158976 PMCID: PMC8833407 DOI: 10.3390/cancers14030709] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 01/26/2022] [Indexed: 02/04/2023] Open
Abstract
Simple Summary Desmoid-type fibromatosis (DTF) is an uncommon soft-tissue tumour that is incapable of metastasising. Patients can experience a variety of physical and psychological symptoms, making assessment of health-related quality of life (HRQoL) highly relevant. Measuring the impact of DTF on HRQoL can be challenging due to the rare character and variable clinical presentation of the disease. Therefore, a HRQoL instrument assessing DTF-specific issues is needed. Previously, a provisional DTF-specific HRQoL tool was developed (the DTF-QoL). The aim of the current study was to pre-test the DTF-QoL. Pre-testing of the questionnaire led to the selection of 96 questions, conceptualised into three symptom subscales, eleven disease-impact subscales and six single items, together forming the final DTF-QoL. This questionnaire can be used in both clinical and research settings to evaluate HRQoL of DTF patients, which could help to provide personalised care and improve overall patient experience. Abstract Sporadic desmoid-type fibromatosis (DTF) is a rare, non-metastasising soft-tissue tumour. Patients can experience a variety of disease-specific issues related to the unpredictable clinical course and aggressiveness of DTF, which negatively impacts health-related quality of life (HRQoL). These DTF-specific issues are not captured by generic HRQoL tools. A 102-item provisional DTF-specific HRQoL tool, the DTF-QoL, was previously developed. The aim of this study was to pre-test the psychometric properties of the DTF-QoL by administering it together with the EORTC Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) to 236 DTF patients from the United Kingdom and the Netherlands. Construct validity and reliability were determined based on factor analysis, multi-trait scaling analysis, Cronbach’s alpha, and correlations with the EORTC QLQ-C30 scales. Ninety-six items were selected, conceptualised into three symptom scales, eleven disease-impact scales and six single items, together forming the final DTF-QoL. Scaling assumptions were fully or moderately met for ten out of fourteen scales. Cronbach’s alpha ranged from 0.551–0.908. Most scales of the DTF-QoL were weakly or moderately correlated with the EORTC QLQ-C30. The DTF-QoL is a promising tool capturing the whole spectrum of DTF-specific issues. Implementation of the DTF-QoL in research and clinical practice will help to personalise HRQoL measurement and clinical care for DTF patients.
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26
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Fertility preservation and PGT-M in women with familial adenomatous polyposis-associated desmoid tumours. Reprod Biomed Online 2021; 43:637-644. [PMID: 34429254 DOI: 10.1016/j.rbmo.2021.07.010] [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: 06/11/2021] [Revised: 07/08/2021] [Accepted: 07/13/2021] [Indexed: 11/23/2022]
Abstract
RESEARCH QUESTION Is ovarian stimulation and pregnancy in women with familial adenomatous polyposis (FAP)-associated desmoid tumours safe? DESIGN The study included women with FAP-associated desmoid tumours who underwent fertility treatments at the authors' tertiary medical centre between the years 2011 and 2021. Data were collected from the fertility unit's charts and from the oncological registries. The main outcome measures were the number of vitrified oocytes and embryos, and the number of live births in preimplantation genetic testing for monogenic/single gene defects (PGT-M) cycles. RESULTS Overall, 17 women were identified suitable for this study. A total of 117 mature oocytes were vitrified for fertility preservation and 106 embryos were submitted to PGT-M. One patient returned to claim her cryopreserved oocytes, and five patients who underwent PGT-M embryo transfer reported three live births. A statistically significant decrease in selected fertility cycle parameters was observed in one woman who co-administered sorafenib (a multikinase inhibitor) during her first cycles of treatment, as the mean number of oocytes before and after was 2.7 (±1.3) versus 13.2 (±3.3) (P = 0.02), the mean number of metaphase II oocytes was 2.2 (±2.1) versus 7.7 (±2.6) (P = 0.007), and the mean number of two-pronuclei oocytes was 0.5 (±1.1) versus 3.5 (±1.7) (P = 0.09). Three patients had a median desmoid tumour growth on magnetic resonance imaging of 6.2 (2.9-7.2) cm when compared with prior ovarian stimulation imaging. CONCLUSIONS Ovarian stimulation for women with desmoid tumours was characterized in some patients with an acceleration in tumour growth, regardless of the use of aromatase inhibitors. The use of sorafenib should be carefully considered during the course of fertility treatment.
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27
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Yin JQ, Fu YW, Gao ZH, Zou CY, Xie XB, Wang B, Zhong ZH, Huang G, Shen JN. A Novel Method to Treat Progressive Desmoid Tumors Involving Neurovascular Bundles: A Retrospective Cohort Study. Neurosurgery 2021; 88:1095-1102. [PMID: 33556169 PMCID: PMC8117464 DOI: 10.1093/neuros/nyaa589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 11/18/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND More effective therapies are needed to treat progressive desmoid tumors when active surveillance and systemic therapy fail. OBJECTIVE To assess the efficacy and safety of sandwich isolation surgery on the local control of progressive desmoid tumors involving neurovascular bundles. METHODS A total of 27 patients with progressive desmoid tumors at extremities involving neurovascular bundles who received surgery at our hospital between August 2014 and August 2018 were identified. A total of 13 patients received sandwich isolation surgery, in which R2 resection was performed in neurovasculature-involving regions, and a biomaterial patch was used to envelop involved neurovascular structures and isolate residual tumors. In non-neurovasculature-involving regions, wide resection was performed without isolation. A total of 14 patients received traditional surgery, which included tumor resection without isolation procedure. RESULTS In sandwich isolation group, tumor progressions and local recurrences occurred in 3 patients outside the isolated neurovasculature-involving regions. However, no progressions or recurrences occurred in any patients in the isolated neurovasculature-involving regions where R2 resection was performed. Sandwich isolation surgery group and traditional surgery group shared similar baseline clinical characteristics. The estimated 3-yr event-free survival rate was 76.9% after sandwich isolation surgery, and 32.7% after traditional surgery (P = .025). Patients who received sandwich isolation surgery were less likely to have local recurrence (hazard ratio: 0.257, P = .040). No complications were noted except intermittent mild pain in operative regions (2 cases). CONCLUSION Sandwich isolation surgery is effective and safe for local control of desmoid tumors involving neurovascular bundles.
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Affiliation(s)
- Jun-Qiang Yin
- Department of Orthopedic Oncology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.,Department of Musculoskeletal Oncology, Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, Guangzhou, China
| | - Yi-Wei Fu
- Department of Orthopedic Oncology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Zhen-Hua Gao
- Department of Radiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Chang-Ye Zou
- Department of Orthopedic Oncology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xian-Biao Xie
- Department of Orthopedic Oncology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Bo Wang
- Department of Orthopedic Oncology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Zhi-Hai Zhong
- Department of Pediatric Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Gang Huang
- Department of Orthopedic Oncology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Jing-Nan Shen
- Department of Orthopedic Oncology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.,Department of Musculoskeletal Oncology, Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, Guangzhou, China
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28
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Pandrowala S, Jones RL, Gupta S, Gulia A. Desmoid fibromatosis: is the current picture changing? Future Oncol 2021; 17:3397-3408. [PMID: 34227399 DOI: 10.2217/fon-2021-0003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Desmoid fibromatosis is a locally aggressive tumor with an unpredictable clinical course. Surgery was once the mainstay of treatment, but the treatment protocol has been constantly evolving and currently active surveillance is the front-line approach. There have been significant insights into the molecular biology with the addition of mutational analysis of CTNNB1 adding to prognostic information. We present a review of the literature with current practice guidelines, also including novel therapeutic targets and ongoing clinical trials, to unravel the next step in the management of sporadic desmoid fibromatosis.
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Affiliation(s)
- Saneya Pandrowala
- Department of Surgical Oncology, Bone & Soft Tissue Service, Tata Memorial Hospital and Homi Bhabha National Institute (HBNI), Mumbai, 400012, India
| | - Robin L Jones
- Department of Medicine, Sarcoma Unit, Royal Marsden Hospital, Fulham Road, London, SW3 6JJ, UK
| | - Sanjay Gupta
- Department of Musculoskeletal Oncology, Glasgow Royal Infirmary, Scotland, UK
| | - Ashish Gulia
- Department of Surgical Oncology, Bone & Soft Tissue Service, Tata Memorial Hospital and Homi Bhabha National Institute (HBNI), Mumbai, 400012, India
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29
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Gronchi A. Surgery in soft tissue sarcoma: the thin line between a surgical or more conservative approach. Future Oncol 2021; 17:3-6. [PMID: 34107729 DOI: 10.2217/fon-2021-0449] [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] [Indexed: 01/18/2023] Open
Abstract
Surgery is the primary treatment for localized, clinically resectable soft tissue sarcoma (STS). Chemotherapy and radiotherapy, administered in the pre- or post-operative settings, have important ancillary roles in the multimodal management of primary STS. Some sarcoma centers also employ locoregional therapies such as isolated limb perfusion and deep wave hyperthermia in multimodal therapy. In advanced or metastatic STS, surgery is recommended when complete resection is feasible. Nevertheless, in certain situations there is thin line between a surgical or non-surgical approach, generally related to STS histological type/subtype, disease stage and technical considerations. In advanced STS, factors favoring surgery are isolated oligometastatic disease, long disease-free interval, suitable histology, response to chemotherapy and high probability of a complete resection.
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Affiliation(s)
- Alessandro Gronchi
- Department of Surgery, IRCCS, Istituto Nazionale dei Tumori, Via Venezian 1, 20133, Milan, Italy
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30
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Yan YY, Walsh JP, Munk PL, Mallinson PI, Simmons C, Clarkson PW, Jayaram PR, Heran MKS, Ouellette HA. A Single-Center 10-Year Retrospective Analysis of Cryoablation for the Management of Desmoid Tumors. J Vasc Interv Radiol 2021; 32:1277-1287. [PMID: 34089889 DOI: 10.1016/j.jvir.2021.05.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 05/20/2021] [Accepted: 05/27/2021] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To determine the efficacy and safety of cryoablation in patients with desmoid tumors (DTs) retrospectively over a 10-year period at a single institution. MATERIALS AND METHODS Between February 25, 2010, and February 25, 2020, 25 patients (age, 12-80 years) with 26 lesions (mean preprocedural tumor volume was 237 cm3) were treated over 44 cryoablation procedures. Eleven patients were treated with first-line therapy. Fourteen patients had previous medical therapy, radiotherapy, and/or surgery. Subsequent clinical follow-up, imaging outcomes, and safety were analyzed for technical success, change in total lesion volume (TLV) and viable tumor volume (VTV), modified response evaluation criteria in solid tumors (mRECIST), progression-free survival (PFS) for tumor progression and symptom recurrence, symptom improvement, and procedure-related complications. Symptomatic improvement was defined as documentation of relief of pain (partial or complete) and/or functional impairment. RESULTS All procedures were technically successful. At 7-12 months, median changes in TLV and VTV were -6.7% (P = .809) and -43.7% (P = .01), respectively. At 10-12 months, the mRECIST responses were complete response, 0%; partial response, 61.5% (8/13); stable disease, 30.8% (4/13); and progressive disease, 7.7% (1/13). The median PFS for tumor progression and symptom recurrence were not reached, with a median follow-up of 15.3 and 21.0 months, respectively. Symptomatic relief (partial or complete) was achieved in 96.9% (32/33) of patients. One major complication was noted (2.4%). CONCLUSIONS In this retrospectively identified cohort, cryoablation was effective and safe for the local control of extra-abdominal DTs in short-term follow-up.
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Affiliation(s)
- Yet Y Yan
- Musculoskeletal Section, Department of Radiology, Vancouver General Hospital, Vancouver, British Columbia, Canada; Department of Radiology, Changi General Hospital, Singapore.
| | - John P Walsh
- Musculoskeletal Section, Department of Radiology, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Peter L Munk
- Musculoskeletal Section, Department of Radiology, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Paul I Mallinson
- Musculoskeletal Section, Department of Radiology, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Christine Simmons
- Medical Oncology Service, British Columbia Cancer Agency Vancouver Center, Vancouver, British Columbia, Canada
| | - Paul W Clarkson
- Musculoskeletal Oncology Service, British Columbia Cancer Agency Vancouver Center, Vancouver, British Columbia, Canada
| | - Prem R Jayaram
- Musculoskeletal Section, Department of Radiology, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Manraj K S Heran
- Division of Neuroradiology, Department of Radiology, Vancouver General Hospital, Vancouver, British Columbia, Canada; Department of Radiology, British Columbia's Children's Hospital Vancouver, British Columbia, Canada
| | - Hugue A Ouellette
- Musculoskeletal Section, Department of Radiology, Vancouver General Hospital, Vancouver, British Columbia, Canada
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31
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Efrima B, Ovadia J, Drukman I, Khoury A, Rath E, Dadia S, Gortzak Y, Albagli A, Sternheim A, Segal O. Cryo-surgery for symptomatic extra-abdominal desmoids. A proof of concept study. J Surg Oncol 2021; 124:627-634. [PMID: 34043245 DOI: 10.1002/jso.26528] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 05/05/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND OBJECTIVE Extra abdominal desmoid tumors are rare, highly aggressive, and invasive benign soft tissue tumors. Current treatment modalities show high levels of recurrence and comorbidities. Cryo-surgery as an alternative was subsequently investigated. METHODS In this retrospective, single center study 11 patients showing symptomatic tumors were treated with individualized cryo-surgery. Treatment protocol included preoperative planning using computer rendered 3D models, intraoperative navigation and execution using cone beam guidance, and postoperative magnetic resonance imaging image analysis using a gaussian mixture model software. Subjective outcomes were reported using Short Form Health Survey (SF-36) questionnaires. RESULTS Sixteen ablations were performed, each demonstrating a complete match with the determined preoperative plan and model. A total of 9/11 (82%) of patients showed improvements in symptoms and a reduction in tumor volume while 2/11 (18%) did not. Average reduction in tumor volume and viable segments were 36.7% (p = 0.0397) and 63.3% (p = 0.0477), respectively. Mild complications according to the SIR Adverse Event Classification Guidelines were experienced in 3/16 (19%) ablations. SF-36 scores showed a statistically significant improvement (p = 0.0194) in the mental health category and a nonsignificant (p = 0.8071) improvement in the physical health category. CONCLUSION Cryo-surgery using the three-phase protocol as described may improve the overall outcome of future ablation procedures.
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Affiliation(s)
- Ben Efrima
- Division of Orthopaedic Surgery, Tel Aviv Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Joshua Ovadia
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ido Drukman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Division of Radiology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Amal Khoury
- Division of Orthopaedic Surgery, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Ehud Rath
- Division of Orthopaedic Surgery, Tel Aviv Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Solomon Dadia
- Division of Orthopaedic Surgery, Tel Aviv Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yair Gortzak
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,National Department of Orthopaedic Oncology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Assaf Albagli
- Division of Orthopaedic Surgery, Tel Aviv Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Sternheim
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,National Department of Orthopaedic Oncology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Ortal Segal
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,National Department of Orthopaedic Oncology, Tel Aviv Medical Center, Tel Aviv, Israel
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Sobczuk P, Agnieszczak IM, Grycuk W, Czarnecka AM, Świtaj T, Koseła-Paterczyk H, Morysiński T, Zdzienicki M, Rutkowski P. What is the best front-line approach in patients with desmoid fibromatosis? - A retrospective analysis from a reference center. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2021; 47:2602-2608. [PMID: 33994241 DOI: 10.1016/j.ejso.2021.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 04/26/2021] [Accepted: 05/05/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Desmoid fibromatosis (DF) is a locally aggressive, not metastasizing tumor associated with high local recurrence rates. Surgery was a standard-of-care for DF treatment; however, recently, conservative treatment and active surveillance are preferred. This study aimed to evaluate the real-life outcomes of DF treatment. MATERIALS AND METHODS All consecutive patients diagnosed with DF and treated between 01.1999 and 12.2018 at one sarcoma reference institution were included in this retrospective analysis. Kaplan-Meier estimator, long-rank test, Cox regression model, and Chi2 tests were used for statistical analyses. RESULTS The analyses included 363 patients (254 female, 109 male). 195 patients (53.7%) underwent surgical resection, and 139 (38.3%) experienced a watch-and-wait approach with or without concomitant therapy with nonsteroid anti-inflammatory drugs (NSAIDs) in the first line. Disease recurrence/progression occurred in 43.2% of patients treated with surgery and 42.6% in the watch-and-wait group, resulting in 5-year event-free survival (EFS) rates of 60% and 55%, respectively. There was no difference in EFS between both groups (HR1.28, 95%CI 0.91-1.79). Surgery without prior biopsy and extra-abdominal wall location was associated with inferior outcomes. CONCLUSIONS Results of DF treatment in our center showed that watch-and-wait approach ± NSAIDs has similar efficacy to upfront surgery and allows to avoid unnecessary surgery in approximately half of the patients, primarily when tumors are located in unfavorable sites, like extremities.
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Affiliation(s)
- Paweł Sobczuk
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland; Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, Warsaw, Poland.
| | - Izabela M Agnieszczak
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland; Faculty of Medicine, Medical University of Warsaw, Poland
| | - Wiktoria Grycuk
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland; Faculty of Medicine, Medical University of Warsaw, Poland
| | - Anna M Czarnecka
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland; Department of Experimental Pharmacology, Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland
| | - Tomasz Świtaj
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Hanna Koseła-Paterczyk
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Tadeusz Morysiński
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Marcin Zdzienicki
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Piotr Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
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Cuomo P, Scoccianti G, Schiavo A, Tortolini V, Wigley C, Muratori F, Matera D, Kukushkina M, Funovics PT, Lingitz MT, Windhager R, Dijkstra S, Jasper J, Müller DA, Kaiser D, Perlaky T, Leithner A, Smolle MA, Campanacci DA. Extra-abdominal desmoid tumor fibromatosis: a multicenter EMSOS study. BMC Cancer 2021; 21:437. [PMID: 33879110 PMCID: PMC8059004 DOI: 10.1186/s12885-021-08189-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 04/12/2021] [Indexed: 11/29/2022] Open
Abstract
Background Extra-abdominal desmoid tumor fibromatosis (DTF) is a rare, locally aggressive soft tissue tumour. The best treatment modality for this patient cohort is still object of debate. Questions/purpose This paper aimed to (1) to compare the outcomes of DTF after different treatment modalities, (2) to assess prognostic factors for recurrence following surgical excision, and (3) to assess prognostic factors for progression during observation. Methods This was a retrospective multicenter study under the patronage of the European Musculoskeletal Oncology Society (EMSOS). All seven centres involved were tertiary referral centres for soft tissue tumours. Baseline demographic data was collected for all patients as well as data on the diagnosis, tumour characteristics, clinical features, treatment modalities and whether they had any predisposing factors for DTF. Results Three hundred eighty-eight patients (240 female, 140 male) with a mean age of 37.6 (±18.8 SD, range: 3–85) were included in the study. Two hundred fifty-seven patients (66%) underwent surgical excision of ADF, 70 patients (18%) were observed without therapy, the residual patients had different conservative treatments. There were no significant differences in terms of tumour recurrence or progression between the different treatment groups. After surgical excision, younger age, recurrent disease and larger tumour size were risk factors for recurrence, while tumours around the shoulder girdle and painful lesions were at risk of progression in the observational group. Conclusion Local recurrence rate after surgery was similar to progression rates under observation. Hence, observation in DTF seems to be justified, considering surgery in case of dimensional progression in 2 consecutive controls (3 and 6 months) and in painful lesions, with particular attention to lesions around the shoulder girdle.
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Affiliation(s)
- Pierluigi Cuomo
- Orthopaedic Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy. .,Sarcoma Unit, Royal National Orthopaedic Hospital, Stanmore, UK.
| | - Guido Scoccianti
- Orthopaedic Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Alberto Schiavo
- Orthopaedic Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | | | - Catrin Wigley
- Sarcoma Unit, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Francesco Muratori
- Orthopaedic Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Davide Matera
- Orthopaedic Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Mariia Kukushkina
- Department of Skin and Soft Tissue Tumors, National Cancer Institute, Kiev, Ukraine
| | | | - Marie-Theres Lingitz
- Department of Orthopaedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Reinhard Windhager
- Department of Orthopaedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Sander Dijkstra
- Department of Orthopaedic Surgery, University of Leiden, Leiden, The Netherlands
| | - Jorrit Jasper
- Department of Orthopaedic Surgery, University of Leiden, Leiden, The Netherlands
| | | | | | - Tamás Perlaky
- Department of Orthopaedics, Semmelweis University, Budapest, Hungary
| | - Andreas Leithner
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Maria Anna Smolle
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
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Sommer F. Rare Diseases of the Nose, the Paranasal Sinuses, and the Anterior Skull Base. Laryngorhinootologie 2021; 100:S1-S44. [PMID: 34352902 PMCID: PMC8354577 DOI: 10.1055/a-1331-2469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Due to their low incidence and thus resulting limited diagnostic criteria as well as therapeutic options, rare diseases of the nose, the paranasal sinuses, and the anterior skull base are a significant challenge. The value as of which a disease has to be considered as rare amounts to a maximum of 5 patients per 10 000 people. Within these diseases, however, there are extreme differences. Some rare or orphan diseases like for example the inverted papilloma belong to regularly diagnosed and treated diseases of larger departments of oto-rhino-laryngology whereas other rare diseases and malformations have only been described in less than 100 case reports worldwide. This fact emphasizes the necessity of bundling the available experience of diagnostics and therapy. The present article gives an overview about rare diseases of the nose, the paranasal sinuses, and the anterior skull base from the field of diseases/syndromes of the olfactory system, malformations of the nose and paranasal sinuses, ventilation and functional disorders as well as benign and malignant tumors. The classification and data on diagnostic and therapeutic options were established based on the current literature.
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Affiliation(s)
- Fabian Sommer
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Hals-Chirurgie, Universitätsklinik Ulm
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35
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Yamada Y, Hirata M, Sakamoto A, Noguchi T, Ito K, Nishida Y, Matsuda S, Haga H. A comparison of the usefulness of nuclear beta-catenin in the diagnosis of desmoid-type fibromatosis among commonly used anti-beta-catenin antibodies. Pathol Int 2021; 71:392-399. [PMID: 33788979 DOI: 10.1111/pin.13096] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 03/08/2021] [Indexed: 11/29/2022]
Abstract
Desmoid-type fibromatosis (DF) is a locally aggressive but non-metastatic (myo)fibroblastic neoplasm. A hallmark of the tumor is nuclear positivity for beta-catenin in immunohistochemistry due mostly to CTNNB1 mutations. However, a recent study has reported that even beta-catenin 'nuclear-negative' DFs can harbor CTNNB1 mutations and that the positive ratio of nuclear beta-catenin in DF is different among antibodies. Here, we reviewed soft tissue lesions for which the possibility of DF was considered and compared the sensitivity and specificity of nuclear beta-catenin for the diagnosis of DF among commonly used anti-beta-catenin antibodies, i.e., clone beta-catenin 1, 17C2 and 14. We analyzed 26 cases of DF, 28 cases of benign fibroblastic lesions, and 27 cases of other soft tissue tumors. The sensitivity and specificity of nuclear beta-catenin for the diagnosis of DF were different among antibodies; 54% and 98% in clone beta-catenin 1, 85% and 84% in 17C2, and 96% and 62% in 14. IHC of LEF1 showed comparable results with IHC of beta-catenin, with a sensitivity of 88% and specificity of 76%. Additionally, when beta-catenin 1 was used, DFs showed characteristic dotted cytoplasmic staining, often appearing as rings. Our results might be helpful for making a correct diagnosis of DF.
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Affiliation(s)
- Yosuke Yamada
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan
| | - Masahiro Hirata
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan
| | - Akio Sakamoto
- Department of Orthopaedic Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Takashi Noguchi
- Department of Orthopaedic Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Kan Ito
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Yoshihiro Nishida
- Department of Rehabilitation, Nagoya University Hospital, Aichi, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Hironori Haga
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan
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Ratan R, Roland CL, Bishop AJ. Desmoid Fibromatosis: Management in an Era of Increasing Options. Curr Oncol Rep 2021; 23:41. [PMID: 33719012 DOI: 10.1007/s11912-021-01026-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Desmoid fibromatosis (DF) is a locally aggressive clonal neoplasm with locally aggressive behavior and no metastatic potential. Historical treatment of DF has consisted primarily of up-front surgery when feasible. In recent years, recognition that DF can spontaneously stabilize or involute has allowed for many patients to be managed with watchful waiting rather than intervention. This review is intended to review recent developments in the treatment of DF. RECENT FINDINGS Recent studies have demonstrated prospectively that patients with DF often have improvement in their lesions without intervention, enabling an initial period of surveillance as a standard option for patients with mild symptoms. Given the lengthening list of effective systemic treatments, including sorafenib, pazopanib, and experimental agents, there has been a less reliance on local therapies for those patients who require treatment. For patients with DF that require treatment, there is a growing list of options that includes radiation therapy (RT), percutaneous ablation, and a growing list of systemic agents with favorable toxicity profiles.
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Affiliation(s)
- Ravin Ratan
- Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd Unit 450, Houston, TX, 77030, USA.
| | - Christina L Roland
- Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd Unit 1484, Houston, TX, 77030, USA
| | - Andrew J Bishop
- Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd Unit 0097, Houston, TX, 77030, USA
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Abstract
OPINION STATEMENT Desmoid tumors have a variable clinical course that ranges from indolence or spontaneous regression to an aggressive pattern marked by local invasion. Up to half may remain stable or regress; watchful waiting is the preferred approach in the initial management of desmoid tumors. Symptomatic or progressive tumors or those that may affect adjacent critical structures require surgery, radiotherapy, or systemic therapy. Although radiotherapy effectively controls desmoid tumors in most cases, concerns regarding late toxicity exist. Definitive radiotherapy for macroscopic disease is indicated when a non-morbid complete surgical resection cannot be accomplished and provides similar control rates to surgery plus radiotherapy but avoids toxicity from combined-modality treatment (surgery and radiotherapy). Adjuvant radiotherapy can be considered for microscopically involved margins, particularly for recurrent cases or when a future recurrence may be challenging to treat. Large size, extremity site, and younger age are poor prognostic factors after radiotherapy. In the extremity, radiotherapy may have superior outcomes to surgery. Younger patients, especially children, are challenging to manage as they are at particular risk for late toxicity due to the number of potential years at risk. For patients under 20 years old, for whom a non-morbid complete resection is not possible, we recommend systemic therapy as the first line of treatment. Although the long-term efficacy of systemic therapy is unproven, this strategy allows additional time for growth and development prior to radiotherapy. In younger patients and those with axial desmoid tumors adjacent to critical organs, consideration should be given to using proton therapy as the dosimetric advantages may mitigate some of the toxicity associated with conventional radiotherapy.
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38
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Kumar P, Mishra TS, Sethi M, Mishra S. Giant desmoid tumour of abdominal wall: resection and reconstruction by posterior component separation. BMJ Case Rep 2021; 14:14/1/e239046. [PMID: 33509884 PMCID: PMC7845713 DOI: 10.1136/bcr-2020-239046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Management of large abdominal wall desmoid tumours is complicated due to the unpredictable behaviour of desmoids and the need for laborious reconstruction of the abdominal wall after wide local excision. A multidisciplinary team approach, including surgeons, oncologists and plastic surgeons, is necessary for proper management. This case highlights the diagnostic and surgical challenges related to the reconstruction of abdominal wall defect, after radical excision of a 30×30×25 cm desmoid tumour, originating from left rectus muscle. The defect was closed successfully by a perspicuous technique of posterior component separation. The awareness of this straightforward technique will allow the surgeons to do these radical procedures with confidence and without any consternation of complex reconstructive procedures.
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Affiliation(s)
- Pankaj Kumar
- Department of General Surgery, All India Institute of Medical Sciences, Bhubaneswar, India
| | | | - Mahesh Sethi
- Department of General Surgery, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Swastik Mishra
- Department of General Surgery, All India Institute of Medical Sciences, Bhubaneswar, India
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Zheng C, Fang J, Wang Y, Zhou Y, Tu C, Min L. Efficacy and safety of apatinib for patients with advanced extremity desmoid fibromatosis: a retrospective study. J Cancer Res Clin Oncol 2021; 147:2127-2135. [PMID: 33452581 DOI: 10.1007/s00432-020-03498-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 12/05/2020] [Indexed: 02/08/2023]
Abstract
PURPOSE Desmoid fibromatosis (DF) is a locally aggressive connective-tissue tumor arising in deep soft tissues. Although multiple therapeutic modalities have been demonstrated effective for DF, there is no standard systemic treatment for progressive and recurrent DF. As a part of systemic treatment, tyrosine kinase inhibitors have shown promising activity against DF with tolerable toxicity profiles. Thus, the aim of this study was to investigate the efficacy and safety of apatinib, a novel multi-target angiogenesis inhibitor, in patients with DF. METHODS We retrospectively analyzed the medical records of patients with advanced extremity DF regularly treated with apatinib between October 2017 and January 2020 in our center. Apatinib was initially administered with a dose of 250 mg daily and the dose was adjusted according to the toxicity. Tumor response was assessed by the Response Evaluation Criteria in Solid Tumors 1.1 criteria. The primary endpoint was progression-free survival (PFS); objective response rates and drug-related adverse events were also evaluated. RESULTS A total of 22 (6 male, 16 female) patients with advanced extremity DF were included. The mean medication time was 17 months. None of the patients reached a complete response, but ten (45.5%) patients achieved partial response, and 11 patients (50%) achieved stable disease. One (4.5%) patient developed progressive disease, and the 1-year PFS rate was 95.2%. The disease control rate was 95.4% (21/22) and the objective response rate was 45.5% (10/22). Meanwhile, 18 (81.8%) patients with a tumor shrinkage were accompanied by a decreased signal intensity of lesions in T2-weighted magnetic resonance imaging. The most frequent adverse events included hand-foot syndrome (n = 7, 31.8%), fatigue (n = 6, 27.2%), local pain (n = 4, 18.1%), diarrhea (n = 4, 18.1%). CONCLUSION Apatinib is an effective and well-tolerated option for patients with advanced extremity DF. Indeed, further prospective, randomized studies with larger cases are required to fully explore the clinical utility of apatinib in DF.
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Affiliation(s)
- Chuanxi Zheng
- Department of Orthopedics, West China Hospital, Sichuan University, Guoxue Xiang No. 37, Chengdu, 610041, Sichuan, People's Republic of China
| | - Jianguo Fang
- Department of Orthopedics, West China Hospital, Sichuan University, Guoxue Xiang No. 37, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yitian Wang
- Department of Orthopedics, West China Hospital, Sichuan University, Guoxue Xiang No. 37, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yong Zhou
- Department of Orthopedics, West China Hospital, Sichuan University, Guoxue Xiang No. 37, Chengdu, 610041, Sichuan, People's Republic of China
| | - Chongqi Tu
- Department of Orthopedics, West China Hospital, Sichuan University, Guoxue Xiang No. 37, Chengdu, 610041, Sichuan, People's Republic of China
| | - Li Min
- Department of Orthopedics, West China Hospital, Sichuan University, Guoxue Xiang No. 37, Chengdu, 610041, Sichuan, People's Republic of China.
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40
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Tsukamoto S, Tanzi P, Mavrogenis AF, Akahane M, Kido A, Tanaka Y, Cesari M, Donati DM, Longhi A, Errani C. Upfront surgery is not advantageous compared to more conservative treatments such as observation or medical treatment for patients with desmoid tumors. BMC Musculoskelet Disord 2021; 22:12. [PMID: 33402184 PMCID: PMC7784367 DOI: 10.1186/s12891-020-03897-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 12/21/2020] [Indexed: 01/02/2023] Open
Abstract
Background This study compared the clinical and functional outcomes of patients initially treated with observation or medical treatment with those of patients treated with local treatment (surgery alone or surgery with adjuvant radiotherapy) to confirm whether observation or medical treatment is an appropriate first-line management approach for patients with desmoid tumors. Methods We retrospectively reviewed the medical records of 99 patients with histologically confirmed primary desmoid tumors treated between 1978 and 2018. The median follow-up period was 57 months. We evaluated event-free survival, defined as the time interval from the date of initial diagnosis to the date of specific change in treatment strategy or recurrence or the last follow-up. Results An event (specific change in treatment strategy or recurrence) occurred in 28 patients (28.3%). No significant difference in event-free survival was found between the first-line observation/medical treatment and local treatment groups (p = 0.509). The median Musculoskeletal Tumor Society score of the patients treated with first-line local treatment was 29 (interquartile range [IQR], 23–30), whereas that of the patients managed with first-line observation or medical treatment was 21 (IQR, 19–29.5). First-line observation or medical treatment was more frequently chosen for larger tumors (p = 0.045). In the patients treated with local treatment, local recurrence was not related to the surgical margin (p = 0.976). Conclusion Upfront surgery is not advantageous compared to more conservative treatments such as observation or medical treatment for patients with desmoid tumors. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-020-03897-9.
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Affiliation(s)
- Shinji Tsukamoto
- Department of Orthopaedic Surgery, Nara Medical University, 840, Shijo-cho, Kashihara-city, Nara, 634-8521, Japan.
| | - Piergiuseppe Tanzi
- Department of Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
| | - Andreas F Mavrogenis
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, 41 Ventouri Street, Holargos, 15562, Athens, Greece
| | - Manabu Akahane
- Department of Health and Welfare Services, National Institute of Public Health, 2-3-6 Minami, Wako-shi, Saitama, 351-0197, Japan
| | - Akira Kido
- Department of Rehabilitation Medicine, Nara Medical University, 840 Shijo-cho, Kashihara-city, Nara, 634-8521, Japan
| | - Yasuhito Tanaka
- Department of Orthopaedic Surgery, Nara Medical University, 840, Shijo-cho, Kashihara-city, Nara, 634-8521, Japan
| | - Marilena Cesari
- Department of Medical Oncology, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
| | - Davide Maria Donati
- Department of Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
| | - Alessandra Longhi
- Department of Medical Oncology, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
| | - Costantino Errani
- Department of Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
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Fiore M, Crago A, Gladdy R, Kasper B. The Landmark Series: Desmoid. Ann Surg Oncol 2021; 28:1682-1689. [PMID: 33386543 DOI: 10.1245/s10434-020-09395-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 11/05/2020] [Indexed: 12/12/2022]
Abstract
Desmoid-type fibromatosis represents a challenge in the landscape of surgical oncology, for several reasons. The tumors can be infiltrative and locally aggressive, surgery may be morbid, and patients are usually young, and thus treatment sequelae must be managed for decades. Desmoids do not have metastatic potential, therefore management strategies for desmoids have evolved to employ frontline treatments that are largely non-operative. In fact, with unpredictable and benign behavior, we now recognize that desmoids can also stabilize and regress, making active observation an option for many patients. Moreover, many medical therapies are active in the disease. We reviewed landmark studies describing contemporary issues that affect treatment recommendations for desmoid patients: prognostic factors, indication to active surveillance, role of surgical margins, postoperative radiotherapy, and the most recent expert consensus papers.
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Affiliation(s)
- Marco Fiore
- Sarcoma Service, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133, Milan, Italy.
| | - Aimee Crago
- Gastric and Mixed Tumor Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Rebecca Gladdy
- Mount Sinai Hospital, Princess Margaret Hospital, University of Toronto, Toronto, ON, Canada
| | - Bernd Kasper
- Sarcoma Unit, Mannheim University Medical Center, University of Heidelberg, Mannheim, Germany
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Srinivasan S, Saha S. A rare tumor of the large bowel in a young boy. CANCER RESEARCH, STATISTICS, AND TREATMENT 2021. [DOI: 10.4103/crst.crst_186_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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43
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Zhang Z, Shi J, Yang T, Liu T, Zhang K. Management of aggressive fibromatosis. Oncol Lett 2021; 21:43. [PMID: 33262835 PMCID: PMC7693298 DOI: 10.3892/ol.2020.12304] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 10/30/2020] [Indexed: 01/12/2023] Open
Abstract
Aggressive fibromatosis or desmoid tumor is a rare disease resulting from fibroblasts which do not metastasize. However, desmoid tumors belong to low-grade malignant tumors since they have high potential to infiltrate surrounding tissues, causing high local recurrence rates and may affect surrounding organs, threatening life quality and expectancy. Although surgery, watch and wait, radiotherapy, chemotherapy, high intensity focused ultrasound, ablation techniques or several agents have all been frequently investigated for the treatment of this type of disease, none are deemed as standard therapy for high recurrence rates that have been supported by any data. The present review retrieved literature on treatment options for desmoids to summarize the latest treatment modalities and refine their efficacy, as well as their side effects, in order to provide a more comprehensive treatment reference for clinicians.
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Affiliation(s)
- Zhijun Zhang
- Department of Colorectal and Anal Surgery, The Second Hospital of Jilin University, Changchun, Jilin 130012, P.R. China
| | - Jian Shi
- Department of Colorectal and Anal Surgery, The Second Hospital of Jilin University, Changchun, Jilin 130012, P.R. China
| | - Tao Yang
- Department of Colorectal and Anal Surgery, The Second Hospital of Jilin University, Changchun, Jilin 130012, P.R. China
| | - Tongjun Liu
- Department of Colorectal and Anal Surgery, The Second Hospital of Jilin University, Changchun, Jilin 130012, P.R. China
| | - Kai Zhang
- Department of Colorectal and Anal Surgery, The Second Hospital of Jilin University, Changchun, Jilin 130012, P.R. China
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Desmoid Tumors Characteristics, Clinical Management, Active Surveillance, and Description of Our FAP Case Series. J Clin Med 2020; 9:jcm9124012. [PMID: 33322514 PMCID: PMC7764110 DOI: 10.3390/jcm9124012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 11/24/2020] [Accepted: 12/08/2020] [Indexed: 01/03/2023] Open
Abstract
(1) Background: desmoid tumors (DTs) are common in patients with familial adenomatous polyposis (FAP). An active surveillance approach has been recently proposed as a valuable alternative to immediate treatment in some patients. However, no clear indication exists on which patients are suitable for active surveillance, how to establish the cut-off for an active treatment, and which imaging technique or predictive factors should be used during the surveillance period. (2) Results: we retrospectively analyzed 13 FAP patients with DTs. A surveillance protocol consisting of scheduled follow-up evaluations depending on tumor location and tissue thickening, abdominal computed tomography (CT) scan/Magnetic resonance imaging (MRI) allowed prompt intervention in 3/11 aggressive intra-abdominal DTs, while sparing further interventions in the remaining cases, despite worrisome features detected in three patients. Moreover, we identified a possible predictive marker of tumor aggressiveness, i.e., the "average monthly growth rate" (AMGR), which could distinguish patients with very aggressive/life-threatening tumor behavior (AMGR > 0.5) who need immediate active treatment, from those with stable DTs (AMGR < 0.1) in whom follow-up assessments could be delayed. (3) Conclusion: surveillance protocols may be a useful approach for DTs. Further studies on larger series are needed to confirm the usefulness of periodic CT scan/MRI and the value of AMGR as a prognostic tool to guide treatment strategies.
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Gogiya BS, Alyautdinov RR, Lebedeva AN, Karmazanovsky GG, Baitman TP. [Abdominal wall repair after total resection of desmoid fibroma in a patient with diabetes mellitus type 1]. Khirurgiia (Mosk) 2020:127-133. [PMID: 33210518 DOI: 10.17116/hirurgia2020111127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Desmoid fibroma (DF) is a rare connective tissue tumor comprising about 0.03-0.13% of all neoplasms. DF has a low potential for malignant transformation, but it is characterized by aggressive course and unfavorable prognosis. The main contingent of patients consists of women of reproductive age. Despite the nearly two-century history of study, there are certain unsolved problems including endocrine problems associated with this disease. We report a 30-year-old female with DF and diabetes mellitus type 1. Total resection of the affected right rectus abdominis muscle was performed in a single block with aponeurotic sheath and peritoneum after normalization of carbohydrate metabolism. Muscular aponeurotic defect 27�10 cm was closed after separation of abdominal wall structures and implantation of polypropylene prosthesis. There are no X-ray and clinical signs of DF recurrence or postoperative hernia after 8 months.
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Affiliation(s)
- B Sh Gogiya
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
| | - R R Alyautdinov
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
| | - A N Lebedeva
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
| | - G G Karmazanovsky
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
| | - T P Baitman
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
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Xiao Y, He J, Gong C, Liu L, Huang S. Desmoid-type fibromatosis of the chest wall: a case report. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1322. [PMID: 33209902 PMCID: PMC7661858 DOI: 10.21037/atm-20-5237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Desmoid-type fibromatosis (DF), also known as deep fibromatosis or desmoid tumor, is an extremely rare neoplasm that develops from fascia and musculoaponeurotic tissue. These tumors are characterized by slow progressive growth, local invasion, and local recurrence after surgical excision, but they lack metastatic potential. DF accounts for 3.5% of all fibrous tumors, with an annual incidence of approximately 2–4/million. Until now, only a small number of cases have been found in the chest wall. Herein, we present a rare case of chest wall DF in a 43-year-old female, which was discovered accidentally due to a thoracic wall mass that extended outward from the sternum. Computed tomography scans revealed a subcutaneous soft tissue mass anterior to the sternum, which was considered to be a mesenchymal tumor or an inflammatory lesion. The patient underwent surgical excision of the mass. The mass was completely removed and all margins were negative. According to the pathological results, the patient was finally diagnosed as DF. Postoperative radiotherapy was suggested subsequently, especially considering the locally aggressive and infiltrative nature of the tumor. However, this was rejected by the patient, and biannual re-examination was recommended instead. Despite the absence of postoperative radiotherapy, there was no evidence of local recurrence 2 years later. We consider regular postoperative follow-up may be able to replace postoperative radiotherapy, and if there exist an opportunity to completely resect the mass, surgical is a worthwhile choice.
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Affiliation(s)
- Yi Xiao
- The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jinyuan He
- The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Chulian Gong
- The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Libao Liu
- The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Shaohong Huang
- The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Jin L, Tan Y, Su Z, Huang S, Pokhrel S, Shi H, Chen Y. Gardner syndrome with giant abdominal desmoid tumor during pregnancy: a case report. BMC Surg 2020; 20:282. [PMID: 33183289 PMCID: PMC7664105 DOI: 10.1186/s12893-020-00944-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 11/03/2020] [Indexed: 11/10/2022] Open
Abstract
Background Gardner syndrome is a subtype of familial adenomatous polyposis (FAP), characterized by a combination of adenomatous intestinal polyps and extracolonic lesions such as multiple osteomas, dental abnormalities, and soft tissue tumors. Although 12% of patients with intestinal polyposis of FAP may occur intra-abdominal desmoid tumors, pregnancy complicating with giant abdominal desmoid tumors is a relatively rare case. Case presentation A 28-year-old pregnant woman was diagnosed with Gardner syndrome in whom an intra-abdominal tumor was found a year after undergoing a laparoscopic total colectomy due to family adenomatous polyposis. At 32 weeks’ gestation, she presented to our department for the third time complaining upper abdominal pain caused by the giant abdominal mass about 21 × 12 cm2 in size. After multidisciplinary consultation and discussion, the decision of fetal preservation treatment was made. After the delivery of a baby girl, abdominal mass resection was performed, and pathological examination revealed a fibrous adenoma. The patient was discharged after a week and was uneventful in the follow-up for half a year. Conclusions Gardner syndrome is characterized by typical syndrome including family adenomatous polyposis and extra-intestinal tissue tumor. Were desmoid tumors rarely as large as fetus and local aggressively. In our case, we selected surgery to remove the intra-abdominal desmoid tumor after the natural delivery of the fetus and no abnormalities were observed during the 6 months follow-up. Women during pregnancy have an increased risk for the development of desmoid tumors, likely with the sex hormone to be one of the triggers. Therefore, we suggested that when a patient with Gardner syndrome desire to conceive again, they should go to the hospital for a regular review at least once every 3 months.
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Affiliation(s)
- Liquan Jin
- 1St Department of General Surgery, The First Affiliated Hospital of Dali University, 32 Carlsberg Ave, Dali, 671000, Yunnan, China
| | - Yunbo Tan
- 1St Department of General Surgery, The First Affiliated Hospital of Dali University, 32 Carlsberg Ave, Dali, 671000, Yunnan, China
| | - Ziting Su
- 1St Department of General Surgery, The First Affiliated Hospital of Dali University, 32 Carlsberg Ave, Dali, 671000, Yunnan, China
| | - Shan Huang
- 1St Department of General Surgery, The First Affiliated Hospital of Dali University, 32 Carlsberg Ave, Dali, 671000, Yunnan, China
| | - Sita Pokhrel
- Universal College of Medical Sciences, Bhairahawa, Nepal
| | - Hongbo Shi
- 1St Department of General Surgery, The First Affiliated Hospital of Dali University, 32 Carlsberg Ave, Dali, 671000, Yunnan, China
| | - Yiming Chen
- 1St Department of General Surgery, The First Affiliated Hospital of Dali University, 32 Carlsberg Ave, Dali, 671000, Yunnan, China. .,Institute of Translational Medicine for Metabolic Diseases, Dali University, Dali, Yunnan Province, China.
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Sioda NA, Wakim AA, Wong T, Patel S, Coan K, Row D. A Large Sporadic Intra-abdominal Desmoid-Type Fibromatosis in a Young Male: A Case Report. Front Surg 2020; 7:60. [PMID: 33117845 PMCID: PMC7493805 DOI: 10.3389/fsurg.2020.00060] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 07/22/2020] [Indexed: 11/16/2022] Open
Abstract
Desmoid type fibromatosis (DTF) is a rare benign tumor of connective tissue origin. While these tumors are typically not malignant, they can exhibit aggressive growth patterns causing mass effect on surrounding organs. These tumors typically present in the extremities and abdominal wall, rarely occurring in the mesentery, and abdominal organs. Due to the rarity of this tumor and the variable size and origin, it is difficult to provide exact prognosis, recurrence, and treatment efficacy regarding desmoid tumors arising from the ileocolic mesentery. We present a case of a young male with a sporadic 31 × 25 × 12 cm DTF arising from the ileocolic mesentery that was complicated by mass effect on bowel and intra-abdominal organs requiring surgical intervention. On presentation, the patient exhibited weight gain and abdominal pressure. Abdominal distension without tenderness on palpation was noted on physical examination. The tumor biopsy confirmed the diagnosis of DTF. No evidence of familial adenomatous polyposis or Gardner syndrome was identified. The tumor was surgically excised and intimately associated with the bowel requiring ileocolonic resection with primary anastomosis. At 3-months follow up, surveillance MRI showed no residual or recurrent lesion. A multi-disciplinary approach to this patient's diagnosis and treatment allowed for an accurate diagnosis, efficient treatment, and follow up plan.
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Affiliation(s)
- Natasha A Sioda
- Creighton University School of Medicine, Phoenix, AZ, United States
| | - Andre A Wakim
- Creighton University School of Medicine, Phoenix, AZ, United States
| | - Tina Wong
- Department of Surgery, Creighton University Arizona Health Education Alliance, Phoenix, AZ, United States
| | - Shyamal Patel
- Department of Radiation Oncology, St. Joseph's Hospital and Medical Center, Phoenix, AZ, United States
| | - Kathryn Coan
- Department of Surgery, St. Joseph's Hospital and Medical Center, Phoenix, AZ, United States
| | - David Row
- Department of Surgery, St. Joseph's Hospital and Medical Center, Phoenix, AZ, United States
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Desmoid-type fibromatosis of the lower extremity: A unique case of complete lesion resolution following core needle biopsy. Clin Imaging 2020; 69:213-218. [PMID: 32920469 DOI: 10.1016/j.clinimag.2020.08.030] [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: 07/20/2020] [Revised: 08/19/2020] [Accepted: 08/28/2020] [Indexed: 11/22/2022]
Abstract
Desmoid-type fibromatosis (DF) is a rare neoplasm characterized by fibroblastic and myofibroblastic proliferation. While characterized as a benign lesion that does not metastasize, desmoid-type fibromatosis exhibits a wide range of behavior from aggressive local tissue invasion and post-surgical recurrence to spontaneous regression. Tumor regression can occur following systemic medical therapy or rarely may occur in the absence of therapy. We present a case of a 50-year-old female with a left thigh vastus medialis intramuscular mass which underwent imaging work-up and subsequent core needle ultrasound-guided biopsy showing results of desmoid-type fibromatosis. Following biopsy, the tumor showed prompt, complete regression with complete MRI resolution 2 months following biopsy. The patient showed no evidence of disease recurrence out to one year on MRI surveillance. This case report will discuss desmoid-type fibromatosis imaging features, treatment strategies, spectrum of disease behavior, and atypical behavior such as the spontaneous tumor regression as seen in this case report. To our knowledge there have been no reported cases of DF spontaneous regression 2 months following a core needle biopsy. Understanding the variable behavior of desmoid-type fibromatosis can assist the radiologist in guiding management of these lesions with the goal of optimizing clinical outcomes and preventing unnecessary aggressive treatments for stable or regressing disease.
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Timbergen MJ, Schut ARW, Grünhagen DJ, Sleijfer S, Verhoef C. Active surveillance in desmoid-type fibromatosis: A systematic literature review. Eur J Cancer 2020; 137:18-29. [DOI: 10.1016/j.ejca.2020.06.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/11/2020] [Accepted: 06/22/2020] [Indexed: 02/06/2023]
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