title: Aggressive fibromatosis--impact of prognostic variables on management.
abstract: OBJECTIVE
  To determine the impact of prognostic variables on local control in patients with aggressive fibromatosis treated with or without radiation.
  
  
  METHODS
  Forty-two patients presenting to the combined sarcoma clinic at Johannesburg Hospital with aggressive fibromatosis from 1990 to 2003 were analysed retrospectively. There were 14 males and 28 females. The lesions involved the head and neck in 6 cases (14%), the thorax in 6 (14%), the extremities in 19 (45%) and the abdomen in 11 (26%). Thirty-seven patients (88%) presented to the clinic for the first time, whereas 5 (12%) had recurrent disease at presentation. Fifteen patients (36%) underwent excision only, 15 (36%) had excision followed by postoperative radiation, 8 (19%) had biopsy only, and 4 (9%) had radiation only. The median dose of radiation was 60 Gy (range 9 - 70 Gy).
  
  
  RESULTS
  One patient had local failure following excision and postoperative radiation therapy. The local control was 100% for surgery alone and 86% for surgery followed by postoperative radiation at > or = 24 months. On univariate analysis, age, sex, positive margins, primary or recurrent presentation, site of involvement and initial treatment did not affect local control significantly. Eight of 19 patients (42%) receiving radiation developed severe moist desquamation following treatment, and all these patients had doses of 60 Gy or more.
  
  
  CONCLUSIONS
  Surgery with or without radiation therapy gave excellent local control. The addition of radiation therapy to surgery as well as other known prognostic parameters did not impact on local control. The morbidity of radiation treatment is considerable, as noted in this series, and adjuvant radiation therapy should therefore be considered only in situations where the risk of recurrence and the morbidity of re-excision are high.
authors.affiliation: Department of Radiation Oncology and Pathology, Johannesburg Hospital and University of the Witwatersrand, Johannesburg.
authors.forename: V
authors.initials: V
authors.lastname: Sharma
authors.forename: D N
authors.initials: DN
authors.lastname: Chetty
authors.forename: B
authors.initials: B
authors.lastname: Donde
authors.forename: M
authors.initials: M
authors.lastname: Mohiuddin
authors.forename: A
authors.initials: A
authors.lastname: Giraud
authors.forename: S
authors.initials: S
authors.lastname: Nayler
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D003657:Decision Making; D005260:Female; D018222:Desmoid Tumors / Q000503:physiopathology* / Q000532:radiotherapy / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016522:Oncology Service, Hospital; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D055502:Secondary Prevention; D013019:South Africa; D016896:Treatment Outcome