The Role of Postoperative Irradiation in the Treatment of Locally Recurrent Incompletely Resected Extra‐Abdominal Desmoid Tumors

Abstract

PrécisFor patients who undergo re-resection for recurrent extra abdominal desmoid tumor, and in whom microscopically or grossly positive margins are found, the use of postoperative radiation is not only warranted, but is critical in the ability to establish local control. We recommend total doses of at least 50 Gy for microscopic positive surgical margins and 56 Gy for gross residual surgical margins. We recommend the use of external beam irradiation alone for patients who have involvement in the hand and plantar regions, while in the remaining areas treatment using external beam irradiation, brachytherapy alone, or a combination of external beam with brachytherapy may be utilized. Abstract Background: To define the efficacy of postoperative irradiation in patients with recurrent extra-abdominal desmoid tumors in whom surgical intervention has resulted in microscopically or grossly positive surgical margins. Methods: A retrospective analysis was performed on all patients referred to the department of radiation oncology at the Detroit Medical Center with a diagnosis of recurrent extra-abdominal desmoid tumor. This analysis includes all patients seen from 1 January 1990 through 31 December 1999. A total of 11 patients were treated to 13 sites. Ten had microscopically positive margins and three had gross residual disease. Three patients were noted to have multifocal disease at the time of initial representation. Local control, survival, follow-up, and subsequent development of new tumors are measured from the last day of treatment with irradiation. Results: Thirteen sites were treated. Seven patients had received chemotherapy/hormonal therapy prior to surgery and/or irradiation. The most commonly used drug was tamoxifen (n ¼ 6). The type of radiation delivered included external beam irradiation alone (n ¼ 3), combined external beam irradiation and brachytherapy (n ¼ 4), brachytherapy alone (n ¼ 3) and 252-Cf neutron brachytherapy alone (n ¼ 3). Follow-up has ranged from 29 to 115 months (median ¼ 76 months). Three patients have failed locally at 17, 24 and 29 months. One of these was treated for gross residual disease. No patient has died of tumor-related causes. Salvage at the failed sites was possible in twom of three with re-irradiation using external neutrons and/or aggressive surgical intervention and systemic therapy. Complications were most often noted to include decrease range in motion, especially in joint areas, and skin reactions which were normal in presentation. In one site there was development soft tissue necrosis. Conclusion: Based on our experience we recommend postoperative irradiation for all recurrent extra-abdominal desmoid lesions with microscopically or grossly positive surgical margins. Furthermore, patients with recurrent desmoid tumors involving the bony structures of the hand or feet are poor candidates for brachytherapy alone. For patients with extremity lesions, brachytherapy may be a reasonable treatment option provided adequate margins around the tumor bed are covered. The continued r...

Long-term result of 125 I seed brachytherapy for pediatric desmoid tumor in the head and neck

“…Besides, the study on pediatric survivors with parotid gland carcinoma after brachytherapy showed mild affection on the mandible growth 32 . The use of brachytherapy on DT in adult had also been reported with well local control 33,34 . However, the application of brachytherapy on pediatric DT in HN remained unclear, with long term effectiveness and safety needing to be reported.…”

Long‐term result of 125I seed brachytherapy for pediatric desmoid tumor in the head and neck

“…Besides, the study on pediatric survivors with parotid gland carcinoma after brachytherapy showed mild affection for the mandible growth 34 . The use of brachytherapy on DT in adults had also been reported with well LC 35,36 . However, the application of brachytherapy on pediatric DT in HN remained unclear, with long‐term effectiveness and safety needing to be reported.…”

“…34 The use of brachytherapy on DT in adults had also been reported with well LC. 35,36 However, the application of brachytherapy on pediatric DT in HN remained unclear, with long-term effectiveness and safety needing to be reported.…”

Juvenile female with chest wall fibromatosis located posteriorly to the right breast: radiation therapy or wait and watch?

“…Adjuvant radiation therapy has been used in many studies owing to high probability of local recurrence despite negative surgical margins 1 3 7. On the other hand, most specialists propose radiation therapy when the tumour is not resectable, gross or microscopic when the tumour residue and recurrent disease are present 10 14 15. Although radiation therapy could be helpful, it has its own acute and late side effects.…”