Desmoids: a revelation in biology and treatment.

Abstract

INTRODUCTION:

Using a preoperative neoadjuvant chemoradiation protocol, followed by complete excision, we have achieved local control rates exceeding that found in most large series.

METHODS:

From October 1990 through May 2008, resectable desmoids were initially treated with a preoperative protocol using Adriamycin 30 mg x 3 days continuous intravenous infusion followed by 3,000 cGy of radiation (300 cGy fractions over 10 days). Resection was performed 4-6 weeks later. After 2001, all patients were initially offered Tamoxifen 120 mg/day and Celebrex 400 mg/day for 1 year. Patients who progressed on Tamox/Celeb were treated with protocol and those with stabilization or regression were observed. Patient demographics, tumor size, history of previous recurrences, and follow-up status were recorded prospectively.

RESULTS:

There were 40 females and 12 males with a mean follow-up of 45 months. Forty patients presented with primary tumors and eight presented with recurrent disease. Thirty-nine patients had surgical resection and 13 were observed. Thirty patients underwent the neoadjuvant protocol. Tamoxifen and Celebrex were used in 16 patients, 6 had stabilization in growth, 1 had a 50% reduction in the size of the tumor, there was 1 complete regression, and 8 progressed. Of the patients who had resectable disease Tamoxifen and Celebrex obviated surgery in 30%. Overall 13% (5) of patients developed a recurrence. There were three recurrences among the protocol group for a local control rate of 90%.

CONCLUSION:

Although our neoadjuvant protocol demonstrates the best results to date in eradication of disease, an initial conservative approach is reasonable to determine who would most benefit from surgery.

• Authors: Wesley P Francis, Douglas Zippel, Lloyd A Mack, Lisa M DiFrancesco, Elizabeth Kurien, Norman S Schachar, Walley J Temple
• Journal: Annals of surgical oncology (Ann Surg Oncol) Vol. 16 Issue 6 Pg. 1650-4 (Jun 2009) ISSN: 1534-4681 [Electronic] United States
• PMID: 19306047 (Publication Type: Journal Article)

Chemical References

• Antineoplastic Agents
• Pyrazoles
• Sulfonamides
• Tamoxifen
• Doxorubicin
• Celecoxib

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Algorithms
• Antineoplastic Agents (administration & dosage)
• Celecoxib
• Chemotherapy, Adjuvant
• Doxorubicin (administration & dosage)
• Female
• Fibromatosis, Aggressive (therapy)
• Humans
• Male
• Middle Aged
• Neoadjuvant Therapy
• Neoplasm Recurrence, Local (therapy)
• Pyrazoles (administration & dosage)
• Radiotherapy, Adjuvant
• Soft Tissue Neoplasms (therapy)
• Sulfonamides (administration & dosage)
• Tamoxifen (administration & dosage)
• Young Adult