Wood Thomas J, Quinn Kathleen M, Farrokhyar Forough, Deheshi Ben, Corbett Tom, Ghert Michelle A
Michael G. DeGroote School of Medicine, ; Department of Surgery.
Rare Tumors. 2013 Feb 11;5(1):e2. doi: 10.4081/rt.2013.e2.
The local control of desmoid tumors constitutes a continuing treatment dilemma due to its high recurrence rates. The purpose of this systematic review was to critically examine the current treatment of these rare tumors and to specifically evaluate the local failure and response rates of surgery, radiation and systemic therapy. We comprehensively searched the literature for relevant studies across Cinahl, Embase, Medline and the Cochrane databases. Articles were categorized as surgery, radiation, surgery + radiation and systemic therapy (including cytotoxic and non cytotoxic). Methodological quality of included studies was assessed using the Newcastle-Ottawa Scale. Pooled odd ratios (OR) for comparative studies and weighted proportions with 95% confidence intervals (CI) are reported. Thirty-five articles were included in the final analysis. Weighted mean local failure rates were 22% [95% CI (16-28%)], 35% [95% CI (26-44%)] and 28% [95% CI (18-39%)] for radiation alone, surgery alone and surgery + radiation respectively. In the analysis of comparative studies, surgery and radiation in combination had lower local failure rates than radiation alone [OR 0.7 (0.4, 1.2)] and surgery alone [OR 0.7 (0.4, 1.0)]. Weighted mean stable disease rates were 91% [95% CI (85-96%)] and 52% [95% CI (38-65%)] for non cytotoxic and cytotoxic chemotherapy respectively. The current evidence suggests that surgery alone has a consistently high rate of local recurrence in managing extra-abdominal desmoid tumors. Radiation therapy in combination with surgery improves local control rates. However, the limited data on systemic therapy for this rare tumor suggests the benefit of using both cytotoxic and non cytotoxic chemotherapy to achieve stable disease.
由于复发率高，韧带样瘤的局部控制一直是治疗难题。本系统评价的目的是严格审查这些罕见肿瘤的当前治疗方法，并具体评估手术、放疗和全身治疗的局部失败率和缓解率。我们全面检索了Cinahl、Embase、Medline和Cochrane数据库中的相关研究文献。文章分为手术、放疗、手术+放疗和全身治疗（包括细胞毒性和非细胞毒性治疗）几类。使用纽卡斯尔-渥太华量表评估纳入研究的方法学质量。报告了比较研究的合并比值比（OR）和95%置信区间（CI）的加权比例。最终分析纳入了35篇文章。单纯放疗、单纯手术和手术+放疗的加权平均局部失败率分别为22% [95% CI（16 - 28%）]、35% [95% CI（26 - 44%）]和28% [95% CI（18 - 39%）]。在比较研究分析中，手术与放疗联合应用的局部失败率低于单纯放疗[OR 0.7（0.4，1.2）]和单纯手术[OR 0.7（0.4，1.0）]。非细胞毒性化疗和细胞毒性化疗的加权平均疾病稳定率分别为91% [95% CI（85 - 96%）]和52% [95% CI（38 - 65%）]。目前的证据表明，单纯手术治疗腹外韧带样瘤的局部复发率一直很高。手术联合放疗可提高局部控制率。然而，关于这种罕见肿瘤全身治疗的有限数据表明，使用细胞毒性和非细胞毒性化疗均可使疾病稳定。
