title: The treatment of desmoid tumors: a stepwise clinical approach.
abstract: Aggressive fibromatosis (AF) is a monoclonal proliferative disease but does not metastasize and does not dedifferentiate to a high-grade malignancy in case of recurrence. Biopsy is usually necessary to confirm the diagnosis. A hallmark is its apparent unpredictable clinical course producing a large heterogeneity even with an indistinguishable morphology. Additional studies of the molecular determinants of desmoid behavior are needed to guide selection of the various therapeutic modalities. During the last 10 years, the treatment of AF has evolved and the role of routine, aggressive first-line treatment (radiotherapy and surgery) is now debated. If a wait-and-see policy is used at initial presentation, it is observed that >50% of patients will have relatively indolent disease. Aggressive treatments that take their indications from retrospective studies should be re-evaluated in the light of new data. The objective of this article is to propose an algorithm that commences with more conservative approaches before treatments that have associated long-term morbidity, the more aggressive therapies being reserved only for those who really need it.
authors.affiliation: Department of Surgery, Institut Gustave Roussy, Villejuif, France. bonvalot@igr.fr
authors.forename: S
authors.initials: S
authors.lastname: Bonvalot
authors.forename: A
authors.initials: A
authors.lastname: Desai
authors.forename: S
authors.initials: S
authors.lastname: Coppola
authors.forename: C
authors.initials: C
authors.lastname: Le Péchoux
authors.forename: P
authors.initials: P
authors.lastname: Terrier
authors.forename: J
authors.initials: J
authors.lastname: Dômont
authors.forename: A
authors.initials: A
authors.lastname: Le Cesne
mesh_terms: D025601:Adenomatous Polyposis Coli Protein / Q000235:genetics; D001706:Biopsy; D003131:Combined Modality Therapy; D018222:Desmoid Tumors / Q000235:genetics / Q000473:pathology / Q000628:therapy*; D018095:Germ-Line Mutation; D006801:Humans; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000532:radiotherapy; D047428:Protein Kinase Inhibitors / Q000627:therapeutic use*; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies
chemical_list: C555337:APC protein, human; D025601:Adenomatous Polyposis Coli Protein; D047428:Protein Kinase Inhibitors