radiotherapy and fibromatosis
TRANSCRIPT
Copyright © 2006 by the American Roentgen Ray Society
Lee, J. C. et al. Am. J. Roentgenol. 2006;186:247-254
--28-year-old woman who presented with painful lump in upper arm
Copyright © 2007 by the American Roentgen Ray Society
Lee, J. C. et al. Am. J. Roentgenol. 2006;186:247-254
--60-year-old man who presented with incidental finding on conventional radiography
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S u r g e r y v e r s u s R a d ia t io n Th e r a p y f o r P a t ie n t s w it h
Ag g r e s s iv e F ib r o m a t o s is o r D e s m o id Tu m o r s
2 2 A C o m p a r a t iv e R e v ie w o f A r t ic le s
Nuttyens 2000
LOCAL CONTROL Fibromatosis meta-analysis
0
25
50
75
100
Free margins Positive margins Unknown margins
SurgeryS + RTRT
Percentage Local control according Primary or Recurrent Fibromatosis
.0
22.5
45.0
67.5
90.0
Primary Recurrent Unknown
SurgerySurgery + RTRT aloneall having RT
% local control
Local control according to Primary/Recurrent and Margins
0
25
50
75
100
Free Primary Free Recurrence Positive primary Positive recurrence
SurgerySurgery +RT
% local control
Location and frequency of recurrences after radiotherapy
0
15
30
45
60
RT alone Surgery + RT Surgery + RT or RTalone
Total (%)
In fieldMarginalOut of field
Percentage of in field recurrences by dose
0
15
30
45
60
RT alone Surgery + RT Total
<50Gy50-59Gy>60Gy
Zelefsky 1991 – role of brachytherapy in 38 patients with desmoid tumours.
Previous recurrence 75%Size >8cm 50%Gross residual disease post-op
16%
Marginal resection 79%
Zelefsky 1991 - results
Overall local control 66%
In-field local control rate 75%
Recurrence at periphery implant 4/12
Recurrence >3cm from treated volume 4/12
Local control at 5 years after salvage including 2 amputations
95%
Radiotherapy research
EORTC - Phase II study of moderate dose radiotherapy for inoperable aggressive fibromatosis. 56 Gy in 28 fractions 2 Gy per fraction 5
fractions per week Local control, defined as absence of local
progression 3 years after registration Proposed trial of adjuvant radiotherapy
following surgery for same circa 2003. IGRT sarcoma.
NCI patient information for treatment of Paediatric desmoid
Treatment of desmoid tumour will be surgery whenever possible.
If surgery to completely remove the tumour is not possible, treatment may include the following:
External Radiation therapy to shrink the tumour before surgery.
Internal radiation therapy to kill any remaining tumour cells after surgery.
A non steroidal anti-inflammatory drug (NSAID). Antiestrogen therapy. Chemotherapy.
Watchful waiting. A clinical trial of targeted drug therapy with
imatinib (Gleevec).
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Conclusions
Individualised treatment plan to balance risks of disease and surgery/radiotherapy.
Often fail locally despite clear surgical margin.
Gross local disease may remain quiescent.
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Conclusions
Consider conservative therapy or observation for lesions which have not already recurred or behaved aggressively.
Previous recurrence or multifocal presentation may predict worse prognosis.
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Radiotherapy
Radiotherapy improves recurrence free survival particularly where positive surgical margins or previous recurrence.
May be first choice therapy where surgery would result in major functional deficit.
Need to use an adequate margin e.g 5-7cm. Indications to be balanced against significant risk of
inducing malignancy particularly in young.