Surveillance feasible for patients with desmoid tumors

WAILEA, Hawaii — Most patients with desmoid tumors safely underwent surveillance only, although pain or tumor growth necessitated treatment for some patients, according to study results presented at the Connective Tissue Oncology Society Annual Meeting.

“Desmoid-type fibromatosis is a locally aggressive tumor with no metastatic potential,” Winan J. van Houdt, MD, PhD, MSc, of the department of surgical oncology at The Royal Marsden Hospital in London, said during his presentation. “Until recently, surgical resection was the treatment of choice, but it is associated with high recurrence rate, even after resection with wide margins. In recent years, many new systemic treatment options have been explored and have changed the management of this disease.”

Active surveillance has increasingly been adopted as initial management of patients with desmoid tumors. However, tumor behavior varies greatly among these patients, from complete regression to rapid progression.

“Decision-making regarding the moment and indication to start treatment can be difficult,” van Houdt said. “The aim of this study was to analyze the need and indications for treatment in desmoid-type fibromatosis patients initially managed with surveillance only.”

Researchers used a prospectively maintained database to analyze 584 patients treated for a desmoid tumor at any anatomical location between 1998 and 2016 at Royal Marsden Hospital. The analysis included 168 patients initially managed with watchful waiting, defined as as not receiving any treatment for at least 3 months, with the patient agreeing to undergo a watchful waiting period. These patients had tumor located in an extremity (n = 51), in the abdominal wall (n = 61), intra-abdominally (n = 15), in the chest wall (n = 30) or in another location (n = 11).

Of the other patients, 393 underwent surgery, four received radiotherapy and 19 received systemic treatment.

Thirty-three percent of patients initially managed by surveillance developed progressive disease, 38% had stable disease and 28% achieved remission. Researchers noted patients aged younger than 50 years appeared more likely to experience progression after surveillance in a univariate analysis (P = .046).

Seventy-eight patients (46%) in the surveillance group eventually underwent treatment after a median of 31 months, whereas 90 (54%) remained on surveillance. Most treatment included surgery (44%) or systemic therapy (40%).

Tumor size larger than 5 cm increased likelihood of treatment (P < .01), but anatomical location had no association with eventual treatment.

Patients started treatment due to pain (32%), tumor growth (31%) or both (13%). Tumors in the chest wall or upper extremity caused significantly more pain (P = .01), whereas pregnancy-associated desmoid tumors caused less pain (P = .04).

“More than half of all patients (54%) managed with initial surveillance only did not need to undergo any treatment during follow-up,” van Houdt said. – by Alexandra Todak

Reference:

van Houdt, et al. Abstract 035. Presented at: CTOS Annual Meeting; Nov. 8-11, 2017; Maui, Hawaii.

Disclosures: The authors report no relevant financial disclosures.