Husain Zain, Benevenia Joseph, Uglialoro Anthony D, Beebe Kathleen S, Patterson Francis R, Hameed Meera R, Cathcart Charles S
University of Medicine and Dentisry of New Jersey, Newark, USA.
Am J Orthop (Belle Mead NJ). 2011 May;40(5):E78-82.
Surgical resection has had control rates of 53% to 77% in the treatment of extra-abdominal desmoid tumors. Surgical excision combined with external beam radiation therapy (EBRT) has had local control rates of up to 83% in some series. The purpose of this study was to evaluate the effectiveness of resection combined with radiotherapy (brachytherapy, EBRT, or both) in the treatment of extra-abdominal desmoid tumors. We retrospectively reviewed the charts of 24 consecutive patients (27 histologically confirmed extra-abdominal desmoid tumors). Patients were included in the study if they had a lesion that was potentially resectable with a wide margin, allowing for limb salvage, and if they did not have a contraindication to radiotherapy. Limb functioning was assessed with the Musculoskeletal Tumor Society (MSTS) scoring system. Seventeen patients (7 men, 10 women) with 19 tumors met the inclusion criteria. Mean age at diagnosis was 23.4 years. Follow-up (mean, 4.28 years) involved serial clinical examinations and magnetic resonance imaging of tumor sites. After surgery, the tumors were treated with brachytherapy (n = 6), EBRT (n = 10), or both (n = 3). Two of the 17 tumors in patients with negative margins of resection recurred locally (local control rate, 88.2%). Mean MSTS score was 29/30 (96.7%). The role of surgery, radiotherapy, chemotherapy, hormone therapy, and other treatments for extra-abdominal desmoid tumors is not well defined. When wide-margin resection and radiotherapy can be performed with limb preservation surgery, local control and complication rates compare favorably with those of other reported methods of treatment. Given the results and limitations of our study, we cannot make a definitive recommendation as to which modality--brachytherapy or EBRT--should be used in the treatment of extra-abdominal desmoid tumors.
手术切除治疗腹外硬纤维瘤的控制率为53%至77%。在一些系列研究中，手术切除联合外照射放疗（EBRT）的局部控制率高达83%。本研究的目的是评估手术切除联合放疗（近距离放疗、EBRT或两者联合）治疗腹外硬纤维瘤的有效性。我们回顾性分析了24例连续患者（27个经组织学证实的腹外硬纤维瘤）的病历。如果患者的病变有可能进行广泛边缘切除且能保留肢体，并且没有放疗禁忌证，则纳入本研究。采用肌肉骨骼肿瘤学会（MSTS）评分系统评估肢体功能。17例患者（7例男性，10例女性）的19个肿瘤符合纳入标准。诊断时的平均年龄为23.4岁。随访（平均4.28年）包括系列临床检查和肿瘤部位的磁共振成像。手术后，肿瘤接受近距离放疗（n = 6）、EBRT（n = 10）或两者联合治疗（n = 3）。切除边缘阴性的患者中，17个肿瘤中有2个局部复发（局部控制率为88.2%）。MSTS平均评分为29/30（96.7%）。手术、放疗、化疗、激素治疗及其他治疗方法在腹外硬纤维瘤治疗中的作用尚未明确界定。当能够通过保肢手术进行广泛边缘切除和放疗时，局部控制率和并发症发生率与其他报道的治疗方法相比具有优势。鉴于我们研究的结果和局限性，我们无法就治疗腹外硬纤维瘤应采用哪种方式——近距离放疗还是EBRT——给出明确建议。
