Function-sparing Surgery for Desmoid Tumors and Other Low-grade Fibrosarcomas Involving the Brachial Plexus

Gaposchkin, Christopher G.; Bilsky, Mark H.; Ginsberg, Robert J.; Brennan, Murray F.

doi:10.1097/00006123-199806000-00058

Cited by 34 publications

(22 citation statements)

References 23 publications

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“…Although trauma and prior surgical procedures leading to scar formation have been previously identified as risk factors for the formation of desmoid-type fibromatoses, to our knowledge only one other case series exists in the neurosurgical literature that addresses nonfamilial adult desmoid-type fibromatosis. 7,9,12,16,22 Extraabdominal desmoid-type fibromatosis has been reported to be 1.5 to 3 times more common in women and occurs with an incidence of 0.2 to 0.4 tumors per 100,000 people/year making them fairly common soft tissue tumors. 10,12,21,22 Our series is consistent with these statistics as three of our patients are female.…”

Section: Discussionmentioning

confidence: 99%

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Desmoid-type fibromatosis involving the brachial plexus

Seinfeld

Kleinschmidt‐DeMasters²,

Tayal³

et al. 2007

FOC

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✓Desmoid-type fibromatosis involving the brachial plexus is a rare and challenging disease. Due to involvement of crucial neurovascular structures, wide local excision of the associated fibromas is rarely feasible and recurrence is common. The authors describe their experience in four surgically treated patients with desmoid-type fibromatosis involving the brachial plexus and review the relevant neurosurgical literature. All tumors were assessed for c-KIT oncogene mutations in hopes of establishing a biological basis for using the tyrosine kinase inhibitor imatimib mesylate as an adjuvant therapy. Three patients experienced tumor recurrence requiring reoperation. Fractionated radiotherapy achieved local control in three patients, and the disease in one patient progressed beyond the treatment field. Single base pair changes at exon 10 of the c-KIT oncogene were identified in three tumors. One tumor with this mutation did not respond to treatment with imatimib mesylate. A review of the literature revealed 17 additional patients in two different case series. Analysis of these cases emphasizes the need for careful resection in patients with desmoid-type fibromatosis and supports the conclusion that without adjuvant radiotherapy a high local recurrence rate can be anticipated. For optimal local disease control, the authors recommend post-surgical radiation therapy regardless of the extent of resection achieved. The mutational status of the c-KIT oncogene remains an intriguing biological marker that in the future may predict which lesions will be responsive to imatimib mesylate; larger series will be necessary to test this hypothesis.

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Section: Discussionmentioning

confidence: 99%

“…The first series, reported by Gaposhkin et al, 9 and reviewed in our original publication 25 is included in our aggregate series seen in Table 1. The second case series reported by Ganju and colleagues 8 includes six patients undergoing surgical treatment for desmoids tumors at Louisiana State University Health Sciences Center.…”

Section: Literature Reviewmentioning

confidence: 99%

Desmoid-type fibromatosis involving the brachial plexus

Seinfeld

Kleinschmidt‐DeMasters²,

Tayal³

et al. 2007

FOC

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“…Authors of other studies indicate that there are no predictive factors available to determine tumor recurrence rates, however. [4][5][6]14,17 A local recurrence rate of 35 to 65% has been reported in some studies. Therefore, most authors advocate GTR only if vital structures can be spared.…”

Section: Macfarlanementioning

confidence: 99%

“…Judicious resection of lesions in a manner that spares as much function as possible with close observation of recurrence is indicated. 4,5 There is controversy in the literature concerning the use of primary or adjuvant radiation therapy to treat desmoid tumors. Wang and coworkers 24 advise that further therapy after resection of the lesion is unnecessary in tumors with microscopically residual disease.…”

Section: Macfarlanementioning

confidence: 99%

Extraabdominal desmoid tumors

Dafford

Kim

Nelson³

et al. 2007

FOC

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Object Desmoid tumors are fibrous, slow-growing, nonmalignant tumors with a low potential for metastasis. These lesions show a high propensity for infiltrative growth with local invasion. Methods The authors undertook a retrospective study of 15 desmoid tumors in 11 women and four men (ranging in age from 32 to 67 years; median 48 years) treated at their institution. This study included further resection for recurrent tumors in nine of 15 patients (60%). Results There were 13 patients (86%) with brachial plexus lesions, one patient (7%) with a lumbar plexus lesion, and one (7%) with a peroneal nerve lesion. There was a female predominance in the study group of 2.75:1. Four patients (27%) reported improvement in pain status, six (40%) reported no change from their preoperative pain levels, and five (33%) reported worsened pain symptoms. There was tumor recurrence in two patients (13%) leading to further surgical intervention. Conclusions This case series included many recurrent desmoid tumors of the brachial plexus. Most of these lesions were relatively large tumors, predominantly involved with the plexal elements adding to the challenge of the resection. Currently, function-sparing excision is considered the optimal treatment for desmoid tumors arising in extraabdominal sites. Adjunctive radiation or brachytherapy is reserved for a patient with further recurrence in whom resection would be disfiguring or in whom the disease is more refractory.

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“…The extension of the first resection seems to be the most important associated factor related to the level of recurrence 14 . Except for case #2, all the others were operated before admission in our institution and we had no reliable information about the extension of the first or second resection.…”

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confidence: 99%

Management of desmoid-type fibromatosis involving peripheral nerves

Siqueira

Tavares

Martins

et al. 2012

Arq. Neuro-Psiquiatr.

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Desmoid-type fibromatosis is an uncommon and aggressive neoplasia, associated with a high rate of recurrence. It is characterized by an infiltrative but benign fibroblastic proliferation occurring within the deep soft tissues. There is no consensus about the treatment of those tumors. We present a surgical series of four cases, involving the brachial plexus (two cases), the median nerve and the medial brachial cutaneous nerve. Except for the last case, they were submitted to multiple surgical procedures and showed repeated recurrences. The diagnosis, the different ways of treatment and the prognosis of these tumoral lesions are discussed. Our results support the indication of radical surgery followed by radiotherapy as probably one of the best ways to treat those controversial lesions.

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Function-sparing Surgery for Desmoid Tumors and Other Low-grade Fibrosarcomas Involving the Brachial Plexus

Cited by 34 publications

References 23 publications

Desmoid-type fibromatosis involving the brachial plexus

Desmoid-type fibromatosis involving the brachial plexus

Extraabdominal desmoid tumors

Management of desmoid-type fibromatosis involving peripheral nerves

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