title: Combination chemotherapy using vinblastine and methotrexate for the treatment of progressive desmoid tumor in children.
abstract: OBJECTIVE
  We report the treatment of 10 children for progressive desmoid tumor not amenable to standard surgical or radiation therapy with the use of vinblastine (VBL) and methotrexate (MTX).
  
  
  METHODS
  Ten patients aged 6.4 to 18 years with primary (two patients) or recurrent (eight patients) desmoid tumor were treated with VBL and MTX for 2 to 35 months. Patients with recurrent tumors had been previously treated with surgical resection with (two patients) or without (five patients) radiation therapy or with radiation therapy alone (one patient). No patient had previously received cytotoxic chemotherapy. The tumor response was assessed at routine intervals by physical examination and magnetic resonance imaging (MRI).
  
  
  RESULTS
  Five patients had clinical evidence of response to therapy with complete resolution (three patients) or partial resolution (two patients) of physical examination and radiographic abnormalities. Three patients had stable disease during 10 to 35 months of treatment. Two of these patients had progressive disease 9 and 37 months after treatment stopped; one patient had no progression 16 months after therapy. Two additional patients with stable disease had chemotherapy discontinued after 2 and 3 months. Common side effects included mild alopecia and myelosuppression and moderate nausea and vomiting. In patients with responding tumors, MRI showed decreased tumor size and, in two patients, changes consistent with fibrosis and decreased cellularity of the tumor.
  
  
  CONCLUSIONS
  Combination chemotherapy with VBL and MTX appears to control desmoid tumor without significant acute or long-term morbidity in most children. This may allow for further growth and development in these patients, which may decrease the morbidity of subsequent definitive therapy.
authors.affiliation: Department of Pediatric Hematology/Oncology, Wilford Hall Medical Center, Lackland Air Force Base, San Antonio, TX 78236, USA. skapek@utmscsa.edu
authors.forename: S X
authors.initials: SX
authors.lastname: Skapek
authors.forename: B J
authors.initials: BJ
authors.lastname: Hawk
authors.forename: F A
authors.initials: FA
authors.lastname: Hoffer
authors.forename: G V
authors.initials: GV
authors.lastname: Dahl
authors.forename: L
authors.initials: L
authors.lastname: Granowetter
authors.forename: M C
authors.initials: MC
authors.lastname: Gebhardt
authors.forename: W S
authors.initials: WS
authors.lastname: Ferguson
authors.forename: H E
authors.initials: HE
authors.lastname: Grier
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D005260:Female; D018222:Desmoid Tumors / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects; D011446:Prospective Studies; D016896:Treatment Outcome; D014747:Vinblastine / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D014747:Vinblastine; D008727:Methotrexate