Age-based treatment of aggressive fibromatosis in the head and neck region.
OBJECTIVE
To review our experience regarding the difference in management and treatment outcomes of aggressive fibromatosis of the head and neck region in children and adults, emphasizing, in particular, the role of conservative surgery in comprehensive treatment strategies.


METHODS
A retrospective analysis of patients with aggressive fibromatosis was performed during a 5-year period (2008 to 2012). Nine patients were enrolled in the present study, including 5 children (age, <18 years) and 4 adults (age, >18 years). All patients underwent surgical intervention and were treated by surgical resection with different surgical margins. Adjuvant low-dose chemotherapy and radiotherapy were given to pediatric and adult patients, respectively, with macroscopically or microscopically positive surgical margins.


RESULTS
All 5 pediatric patients (3 females and 2 males) received low-dose chemotherapy after conservative surgical resection (in 4 patients, microscopically incomplete resection; and in 1 patient, macroscopic residual tumor). Of the 4 adults (3 females and 1 male), 2 underwent complete surgical resection and 2 underwent surgery and postoperative radiotherapy (1 patient had microscopically suspected residual tumor and 1 had macroscopic residual tumor). The patients were followed up for a period of 7 to 51 months. Two pediatric patients and one adult patient had disease progression after resection and became stable after continued adjuvant therapy. None of the patients had functional or cosmetic defects. All patients had good long-term outcomes, with no disease progression.


CONCLUSIONS
For the treatment of aggressive fibromatosis, conservative resection with preservation of form and function should be given greater priority in all age groups. Also, postoperative adjuvant therapy is vital for patients with gross or microscopic residual tumor to obtain progression-free survival.
Senior Resident, Department of Oral and Maxillofacial Surgery, Fourth Military Medical University School of Stomatology, Xi'an, China.
Weiqi
W
Wang
Resident, Department of Oral and Maxillofacial Surgery, Jiamusi University School of Stomatology, Jiamusi, China.
Ujjwal
U
Koirala
Senior Resident, Department of Pediatric Dentistry, Fourth Military Medical University School of Stomatology, Xi-an, China.
Shufang
S
Ma
Associate Professor, Department of Oral and Maxillofacial Surgery, Fourth Military Medical University School of Stomatology, Xi'an, China.
Guicai
G
Liu
Senior Resident, Department of Oral and Maxillofacial Surgery, Fourth Military Medical University School of Stomatology, Xi'an, China.
Mingchao
M
Ding
Professor, Department of Oral and Maxillofacial Surgery, Fourth Military Medical University School of Stomatology, Xi'an, China. Electronic address: huxiaoguang@fmmu.edu.cn.
Xiaoguang
X
Hu
Professor, Head of Department, Department of Oral and Maxillofacial Surgery, Fourth Military Medical University School of Stomatology, Xi'an, China.
Delin
D
Lei
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D017024:Chemotherapy, Adjuvant; D002648:Child; D002675:Child, Preschool; D005260:Female; D018222:Desmoid Tumors / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery*; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery*; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D018365:Neoplasm, Residual / Q000188:drug therapy / Q000532:radiotherapy; D011877:Radionuclide Imaging; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies