title: Desmoplastic small round cell tumour: characteristics and prognostic factors of 41 patients and review of the literature.
abstract: BACKGROUND
  Desmoplastic small round cell tumour (DSRCT) is a rare but frequently fatal sarcoma, and many of its characteristics still require further clarification.
  
  
  METHODS
  We retrospectively analysed 41 patients treated at or referred to two regional referral centres in the UK between 1991 and 2012. A review of the current literature was also performed.
  
  
  RESULTS
  The median age of presentation was 27 years (range 16 to 45 years), with a male-to-female ratio of 3:1. Ninety percent of patients had disease in the abdomen. The median size of the presenting tumour was 13 cm (range 3.5 to 23 cm), and 80% had metastatic disease at diagnosis, mainly in the liver (33%) and lungs (21%). Time-to-progression (TTP) was 3.9, 2.3 and 1.1 months after first-, second- and third-line chemotherapy, respectively. First-line treatment with VIDE chemotherapy appeared to confer the longest TTP (median 14.6 months). Ifosfamide and doxorubicin resulted in TTP of >3.8 months when used in any-line setting. Eleven patients received targeted agents as part of a clinical trial. After a median follow-up of 14 months, the overall median survival (MS) was 16 months. There was no difference in MS with regards to age, gender, or size of the presenting tumour. Patients with extra-abdominal disease survived longer compared to those with tumours in the abdomen (all still alive vs MS of 15 months; P = 0.0246). Patients with non-metastatic intra-abdominal disease who underwent surgery had an MS of 47 months (16 months for those who did not have surgery; P = 0.0235). Radiotherapy for locoregional control in patients with metastatic intra-abdominal DSRCT was associated with longer survival (MS of 47 vs 14 months; P = 0.0147).
  
  
  CONCLUSIONS
  DSRCT is a rare but often fatal disease that mainly affects younger male patients. Those with intra-abdominal DSRCT have a poorer prognosis, although surgical resection for localised disease and radiotherapy in the metastatic setting are associated with improved survival. A patient's age, gender and size of presenting tumour do not have prognostic significance.
authors.affiliation: Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, UK. han.wong@addenbrookes.nhs.uk.
authors.forename: Han Hsi
authors.initials: HH
authors.lastname: Wong
authors.forename: Helen M
authors.initials: HM
authors.lastname: Hatcher
authors.forename: Charlotte
authors.initials: C
authors.lastname: Benson
authors.forename: Omar
authors.initials: O
authors.lastname: Al-Muderis
authors.forename: Gail
authors.initials: G
authors.lastname: Horan
authors.forename: Cyril
authors.initials: C
authors.lastname: Fisher
authors.forename: Helena M
authors.initials: HM
authors.lastname: Earl
authors.forename: Ian
authors.initials: I
authors.lastname: Judson