Abstract
PurposeAlthough locally invasive or recurrent fibromatosis is primarily treated with surgery, radiotherapy (RT) produces local control for recurrent/unresectable tumors or those with positive surgical margins. Herein, we describe our updated institutional experience with RT to treat fibromatosis.MethodsForty-seven patients with fibromatosis received RT between 1990 and 2015, and were followed for ≥12 months. Eight patients received RT for gross tumors, and 39 received postoperative RT after single/multiple prior surgeries. A median dose of 54 Gy was prescribed for definitive RT; 48.6, 50.4, and 54 Gy were prescribed for R0, R1, and R2 resected tumors, respectively. Recurrences were classified as in-field, marginal, or out-field. Prognostic factors were also evaluated.ResultsSeven recurrences were noted, including 2 in-field, 4 marginal, and 1 out-field, after a median follow-up of 60 months. In-field recurrences occurred in 1 patient who received 40.5 Gy of salvage RT after postoperative recurrence and another who received 45 Gy for R1 resection after multiple prior operations. All marginal failures were due to insufficient clinical target volume (CTV) margins regardless of dose (3 with 45 Gy and 1 with 54 Gy). On multivariate analysis, a CTV margin ≥5 cm and dose >45 Gy were significant predictors of non-recurrence (p = 0.039 and 0.049, respectively). Subgroup analysis showed that patients with both an CTV margin ≥5 cm and a dose >45 Gy showed a favorable outcome.ConclusionsRT is a valuable option for treating aggressive fibromatosis; doses ≥45 Gy and a large field produce optimal results. For in-field control, a higher dose is more necessary for gross residual tumors than for totally excised lesions.
Highlights
Aggressive fibromatosis is histologically benign but often shows aggressive features [1,2,3], as it can infiltrate adjacent tissues and cause local symptoms
All marginal failures were due to insufficient clinical target volume (CTV) margins regardless of dose (3 with 45 Gy and 1 with 54 Gy)
Subgroup analysis showed that patients with both an CTV margin !5 cm and a dose >45 Gy showed a favorable outcome
Summary
Aggressive fibromatosis (i.e., a desmoid tumor) is histologically benign but often shows aggressive features [1,2,3], as it can infiltrate adjacent tissues and cause local symptoms. The management of fibromatosis remains controversial, and the optimal treatment policy is still unclear [4]. Physicians have tended to avoid such interventions owing to high recurrence rates, possible iatrogenic morbidity, and a better understanding of a tumor’s natural history. Several predictors of tumor recurrence have been discovered; these have further stressed the need for adjuvant treatment in patients deemed to be high-risk [8]. Radiotherapy (RT) has been suggested for patients with positive margins, recurrent lesions, or unresectable tumors. An optimal adjuvant RT protocol has yet to be adopted, many groups have reported long-term local control rates of 70–93% with a sufficient RT dose to the gross tumor
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