Transition of Treatment for Patients with Extra-Abdominal Desmoid Tumors: Nagoya University Modality

Abstract

Treatment modalities for desmoid tumors have been changed because of the high recurrence rate, even after wide resection, and some cases experience spontaneous self-regression during clinical course. The treatment modality in our institutions before 2003 was surgical resection with wide surgical margin, however, meloxicam, which is a NSAID and a selective COX-2 inhibitor has been applied consecutively since 2003. We reviewed the previously reported outcomes of surgical and conservative treatment in our institutions. Among 30 patients receiving surgical treatment, 16 (53%) recurred. Younger age (p < 0.05) was a significant poor factor. According to RECIST for meloxicam treatment, CR was in one, PR in 10, SD in eight, PD in one evaluated at 2011. Older age (p < 0.01) was significantly associated with good outcome for meloxicam treatment. Results of the previous study indicated that surgical treatment alone could not control desmoid tumors, even with negative surgical margin. Considering the functional impairment resulting from surgery with negative surgical margin, a conservative and effective treatment modality with fewer complications is desired. Conservative treatment with meloxicam is a promising novel modality for patients with extra-abdominal desmoid tumors.

Simple resection of truncal desmoid tumors: A case series

“…with or without radiotherapy) and different surgical margin statuses [microscopically negative (R0) or positive (R1) margins] (10)(11)(12). In previous studies by the present authors, patients with extraperitoneal desmoid tumors were prospectively and consecutively treated with meloxicam, a cyclooxygenase-2 (COX-2) inhibitor (13,14), and a significant predictive value of CTNNB1 for this conservative treatment was demonstrated (15).…”

MRI characteristics predict the efficacy of meloxicam treatment in patients with desmoid‐type fibromatosis

“…Based on these pre‐clinical or clinical proofs, COX‐2 selective inhibitors are sometimes used for DF patients aiming at inhibition of tumour growth and pain control . Several studies showed the clinical results of meloxicam, a selective COX‐2 inhibitor, with which consecutive DF patients were prospectively treated . The efficacy of meloxicam treatment varied, and the prediction of efficacy in individual cases was difficult.…”

“…16 Several studies showed the clinical results of meloxicam, a selective COX-2 inhibitor, with which consecutive DF patients were prospectively treated. [17][18][19] The efficacy of meloxicam treatment varied, and the prediction of efficacy in individual cases was difficult. Patients with DF require significant predictors as ineffective treatment should be avoided before treatment begins.…”

A Systematic Review of Active Treatment Options in Patients with Desmoid Tumours

“…In three comparative studies 26,30,31 , patient characteristics either were not compared at baseline or were significantly different between the groups at baseline, and no multivariate analysis for outcomes was conducted. Those studies are summarized in our tables, but are not included in the interpretive synthesis of intervention effectiveness because of the potential likelihood of biased outcomes resulting from confounding variables at baseline.…”

“…Study Design and Quality Four articles reported prospective single-arm studies 15,18,23,28 , one was a historical prospective comparative study 31 , and the other twenty-three were retrospective comparative studies (Table ii). Study quality was assessed using the modified Newcastle-Ottawa Scale 51 (detailed table available from the corresponding author).…”