Erschienen in:
01.12.2013 | Bone and Soft Tissue Sarcomas
Spontaneous Regression of Primary Abdominal Wall Desmoid Tumors: More Common than Previously Thought
verfasst von:
Sylvie Bonvalot, MD, PhD, Nils Ternès, MS, Marco Fiore, MD, Georgina Bitsakou, MD, Chiara Colombo, MD, Charles Honoré, MD, Andrea Marrari, MD, Axel Le Cesne, MD, Federica Perrone, MD, Ariane Dunant, MS, Alessandro Gronchi, MD
Erschienen in:
Annals of Surgical Oncology
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Ausgabe 13/2013
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Abstract
Purpose
The relevance of the initial observational approach for desmoid tumors (DTs) remains unclear. We investigated a new conservative management treatment for primary abdominal wall DTs.
Methods
Data were collected from 147 patients between 1993 and 2012. The initial therapeutic approaches were categorized as front-line surgery [surgery group (SG), n = 41, 28 %] and initial observation or medical treatment [nonsurgery group (NSG), n = 106, 72 %]. The cumulative incidence of the last strategy modification was estimated using competing risk methods with variable censoring times.
Results
Of the 147 patients, 143 were female (97 %). In the SG, 27 patients (66 %) required full-thickness abdominal wall mesh repair. In the NSG, 102 patients (96 %) underwent initial observation and four received medical treatment. In the NSG, the 1- and 3-year incidences of changing to medical treatment (no further changes during the follow-up) were 19 % [95 % confidence interval (CI) 11–28] and 25 % (95 % CI 17–35), respectively, and the 1- and 3-year incidences of a final switch to surgery were 14 % (95 % CI 8–22) and 16 % (95 % CI 9–24), respectively. An initial tumor size of >7 cm was associated with a higher strategy modification risk (p = 0.004). Of the 102 patients initially observed, 29 experienced spontaneous regression over a median follow-up period of 32 months. All second-intent resections were macroscopically completed, with R0 resections achieved in 82 % of patients.
Conclusions
This study supports an initial nonsurgical approach to abdominal wall DTs ≤7 cm, followed by surgery based on tumor growth in select cases.