The impact of radiotherapy in the treatment of desmoid tumours. An international survey of 110 patients. A study of the Rare Cancer Network.
OBJECTIVE
A multi-centre study to assess the value of combined surgical resection and radiotherapy for the treatment of desmoid tumours.


METHODS
One hundred and ten patients from several European countries qualified for this study. Pathology slides of all patients were reviewed by an independent pathologist. Sixty-eight patients received post-operative radiotherapy and 42 surgery only. Median follow-up was 6 years (1 to 44). The progression-free survival time (PFS) and prognostic factors were analysed.


RESULTS
The combined treatment with radiotherapy showed a significantly longer progression-free survival than surgical resection alone (p smaller than 0.001). Extremities could be preserved in all patients treated with combined surgery and radiotherapy for tumours located in the limb, whereas amputation was necessary for 23% of patients treated with surgery alone. A comparison of PFS for tumour locations proved the abdominal wall to be a positive prognostic factor and a localization in the extremities to be a negative prognostic factor. Additional irradiation, a fraction size larger than or equal to 2 Gy and a total dose larger than 50 Gy to the tumour were found to be positive prognostic factors with a significantly lower risk for a recurrence in the univariate analysis. This analysis revealed radiotherapy at recurrence as a significantly worse prognostic factor compared with adjuvant radiotherapy. The addition of radiotherapy to the treatment concept was a positive prognostic factor in the multivariate analysis.


CONCLUSIONS
Postoperative radiotherapy significantly improved the PFS compared to surgery alone. Therefore it should always be considered after a non-radical tumour resection and should be given preferably in an adjuvant setting. It is effective in limb preservation and for preserving the function of joints in situations where surgery alone would result in deficits, which is especially important in young patients.
Baumert
Brigitta G
BG
Radiation Oncology, University Hospital Zurich, Switzerland. brigitta.baumert@maastro.nl
Spahr
Martin O
MO
Von Hochstetter
Arthur
A
Beauvois
Sylvie
S
Landmann
Christine
C
Fridrich
Katrin
K
Villà
Salvador
S
Kirschner
Michael J
MJ
Storme
Guy
G
Thum
Peter
P
Streuli
Hans K
HK
Lombriser
Norbert
N
Maurer
Robert
R
Ries
Gerhard
G
Bleher
Ernst-Arnold
EA
Willi
Alfred
A
Allemann
Juerg
J
Buehler
Ulrich
U
Blessing
Hugo
H
Luetolf
Urs M
UM
Davis
J Bernard
JB
Seifert
Burkhardt
B
Infanger
Manfred
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005060:Europe; D018222:Desmoid Tumors / Q000532:radiotherapy* / Q000601:surgery*; D006801:Humans; D007223:Infant; D008875:Middle Aged; D011878:Radiotherapy / Q000379:methods*; D012008:Recurrence; D012983:Soft Tissue Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D013997:Time Factors