Desmoid-type fibromatosis: a front-line conservative approach to select patients for surgical treatment.
OBJECTIVE
Surgery is still the standard treatment for desmoid-type fibromatosis (DF). Recently, the Institut Gustave Roussy (IGR), Villejuif, France, reported a series of patients treated with a front-line conservative approach (no surgery and no radiotherapy). The disease remained stable in more than half of patients. This study was designed to evaluate this approach on the natural history of the disease in a larger series of patients.


METHODS
A total of 142 patients presenting to the IGR or Istituto Nazionale Tumori (INT), Milan, Italy, were initially treated using a front-line deliberately conservative policy. Their progression-free survival (PFS) was observed and a multivariate analysis was performed for major clinical variables.


RESULTS
Seventy-four patients presented with primary tumor, 68 with recurrence. Eighty-three patients received a "wait & see" policy (W&S), whereas 59 were initially offered medical therapy (MT), mainly hormonal therapy and chemotherapy. A family history of sporadic colorectal cancer was present in 8% of patients. The 5-year PFS was 49.9% for the W&S group and 58.6% for the medically treated patients (P = 0.3196). Similar results emerged for primary and recurrent DF. Multivariate analysis identified no clinical variables as independent predictors of PFS. In the event of progression, all patients were subsequently managed safely.


CONCLUSIONS
A conservative policy could be a safe approach to primary and recurrent DF, which could avoid unnecessary morbidity from surgery and/or radiation therapy. Half of patients had medium-term stable disease after W&S or MT. A multidisciplinary, stepwise approach should be prospectively tested in DF.
Fiore
Marco
M
Department of Surgery, Istituto Nazionale Tumori, Milan, Italy.
Rimareix
Françoise
F
Mariani
Luigi
L
Domont
Julien
J
Collini
Paola
P
Le Péchoux
Cecile
C
Casali
Paolo G
PG
Le Cesne
Axel
A
Gronchi
Alessandro
A
Bonvalot
Sylvie
S
D000328:Adult; D005260:Female; D018222:Desmoid Tumors / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000601:surgery; D018579:Patient Selection; D011379:Prognosis; D011446:Prospective Studies; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome