Desmoid tumor medical therapy: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Desmoid tumor}} | {{Desmoid tumor}} | ||
{{CMG}} {{AE}}{{Faizan}} | {{CMG}} {{AE}}{{S.M.}}{{Faizan}} | ||
==Overview== | ==Overview== | ||
Wait and watch [[Strategy (NLP)|strategy]] is applied to [[Desmoid tumor|desmoid tumors]] which are [[asymptomatic]], unresectable, non-life threatening, not causing any significant [[impairment]], and resectable [[tumors]] with increased [[morbidity]] associated with [[surgery]].Different [[drugs]] including [[chemotherapeutic agents]], [[Non-steroidal anti-inflammatory drug|NSAIDs]], anti-hormonal agents and [[tyrosine kinase inhibitors]] can be used to shrink or [[Stabilizer (chemistry)|stabilize]] the [[tumor]] size and to improve the [[symptoms]]. [[Radiation therapy]] and [[tumor]] [[ablation]] with [[heat]], [[cold]], [[microwave]] and/or high-frequency [[Ultrasound|ultrasound waves]] can also be of [[therapeutic]] use as required. | |||
==Medical Therapy== | ==Medical Therapy== | ||
Medical therapy for | *Ideally, [[patients]] with [[Desmoid tumor|desmoid tumors]] should be evaluated by a multi-disciplinary team which includes [[surgeons]], [[medical]] [[oncologists]], [[Radiation Oncology|radiation]] [[oncologists]], [[geneticists]] and [[nurses]] | ||
*[[ | *[[Patients]] with [[Desmoid tumor|desmoid tumors]] should be evaluated in a [[hospital]] with expertise in [[sarcoma]] (usually such [[hospitals]] are designated as [[National Comprehensive Cancer Network|NCCN [National Comprehensive Cancer Network] centers]]) | ||
*[[ | *'''Wait and watch or observation''' of the [[tumor]] carefully with [[images]] and/or [[physical examination]], is implied as a primary [[therapeutic]] option for [[desmoid tumor]]<nowiki/>[[desmoid tumor|s]] with following [[Features (pattern recognition)|features]]: | ||
*[[ | **Potentially resectable but [[asymptomatic]] or minimally [[symptomatic]] | ||
* | **Non-life threatening | ||
**Not causing any [[Significant figure|significant]] [[impairment]] | |||
**Stable [[appearance]] on [[Screening test|screening modalities]] | |||
**Unresectable [[tumors]] | |||
**Resectable but [[surgery]] would lead to unacceptable [[morbidity]] | |||
**How often [[Scan|scans]] and/or [[Physical examination|physical exams]] are needed during a “wait and watch” period varies with each situation | |||
*Treatment is recommended for extra-abdominal or [[abdominal]] [[Desmoid tumor|desmoid tumors]] associated with: | |||
**[[Symptoms]] | |||
**Progressively enlarging [[tumors]] irrespective of [[symptoms]] | |||
**Imminent risk to adjacent structures | |||
**[[Tumor]] creating cosmetic concerns | |||
*'''Goals of medical therapy''' are: | |||
**Shrinkage of [[tumor]] size | |||
**[[Stabilization (medicine)|Stabilization]] of [[tumor]] | |||
**Improvement in [[symptoms]] after a very wide variety of [[treatments]] | |||
*Following table shows [[drugs]] used in [[Medical therapy template|medical therapy]] for [[Desmoid tumor|desmoid tumors]]:<ref name="pmid22359346">{{cite journal |author=Wilkinson MJ, Fitzgerald JE, Thomas JM, Hayes AJ, Strauss DC|title=Surgical resection for non-familial adenomatous polyposis-related intra-abdominal fibromatosis |journal=BJS. |volume=99 |issue=5 |pages=706–13|year=2012 |doi=10.1002/bjs.8703 |pmid=22359346}}</ref><ref name="pmid22370045">{{cite journal| author=Rammohan A, Wood JJ| title=Desmoid tumour of the breast as a manifestation of Gardner's syndrome. | journal=Int J Surg Case Rep | year= 2012 | volume= 3 | issue= 5 | pages= 139-42 | pmid=22370045 | doi=10.1016/j.ijscr.2012.01.004 | pmc=PMC3312056 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22370045 }} </ref> | |||
{| class="wikitable" | |||
|+Different drugs used in medical therapy of desmoid tumors | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Drug class | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Drug name | |||
|- | |||
|style="background:#DCDCDC;" align="center" + |'''Chemotherapeutic agents''' | |||
| | |||
* [[Doxorubicin]] ([[Adriamycin]], [[Doxorubicin hydrochloride|Rubex]]) | |||
* [[Doxorubicin liposome|Doxil (liposomal doxorubicin)]] | |||
* [[Dacarbazine|Dacarbazine (DTIC-Dome)]] | |||
* [[Methotrexate]] | |||
* [[Vinorelbine]] | |||
* [[Vinblastine]] | |||
* [[Carboplatin]] ([[Paraplatin]]) | |||
|- | |||
|style="background:#DCDCDC;" align="center" + |'''NSAIDs''' | |||
| | |||
* [[Sulindac]] | |||
|- | |||
|style="background:#DCDCDC;" align="center" + |'''Anti-hormonal agents''' | |||
| | |||
* [[Tamoxifen]] ([[Soltamox]], [[Nolvadex]]) | |||
* [[Prostaglandin]] inhibitors | |||
|- | |||
|style="background:#DCDCDC;" align="center" + |'''Tyrosine kinase inhibitors''' | |||
(Novel [[molecular]] targeted therapies) | |||
| | |||
* [[Sorafenib]] | |||
* [[Imatinib]] ([[Gleevec]]) | |||
|} | |||
{| | |||
| | |||
[[File:Desmoid nsaid regression.png|thumb|600px|none|Desmoid tumour before (A, C) and 2 years after (B, D) the commencement of NSAID. Multi planner reformation (MPR)-CT demonstrates the sporadic desmoid tumours originating from the intra-abdominal cavity (arrows). Frontal (A, B) and axial (C, D) images are shown. The tumour has shown a remarkable shrinkage with a regression rate of 68.5% along with disappearance of intratumoural septa.[https://openi.nlm.nih.gov/detailedresult?img=PMC2270274_1477-7819-6-17-1&query=desmoid%20tumor&it=xg&req=4&npos=13 Source: Tanaka K. et al, Department of Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan]]] | |||
|} | |||
==Radiation Therapy== | ==Radiation Therapy== | ||
Rarely, [[radiation therapy]] is used if | *[[Desmoid tumor|Desmoids]] are radiosensitive [[tumors]] | ||
*[[Radiation therapy]] uses high-energy [[waves]] such as [[X-rays]] to kill or shrink [[Tumor cell|tumor cells]] | |||
*Rarely, [[radiation therapy]] is used if: | |||
**[[Patient]] is [[symptomatic]] | |||
**[[Medical therapy template|Medical therapy]] fails | |||
**[[Surgery]] fails | |||
**[[Patient]] is not a good surgical candidate | |||
**[[Patient]] declines [[surgery]] | |||
**Surgical [[morbidity]] would be excessive | |||
**Margins are positive post-[[resection]] | |||
**[[Tumor]] [[Recurrence plot|recurrence]] post-[[resection]] | |||
*Depending on individual [[patient]] characteristics, the [[Radiation therapy|radiation]] may be applied by following two methods: | |||
**Conventional linear accelerators ([[radiotherapy]] treatment machines) | |||
**[[Proton]] beam [[therapy]] | |||
*Depending on the size and location of the [[tumor]], [[radiation]] is delivered either in low doses over the course of 5 to 6 weeks or in a single [[High doses of ionizing radiation|high dose]] | |||
*[[Radiation]] therapy is effective in approximately 30% of cases | |||
*Following complications can occur from [[radiation therapy]] due to late [[radiation]] effects: | |||
**Secondary [[malignancies]] (especially in younger patients) | |||
**[[Fibrosis]] associated with [[radiation therapy]] | |||
==Tumor ablation== | |||
*In some rare cases, [[ablation]] of [[Desmoid tumor|desmoid tumors]] can be used as a [[therapeutic]] option | |||
*Following different kinds of [[ablation]] can be used: | |||
**[[Cold]] [[ablation]] | |||
**[[Heat]]/[[thermal ablation]] | |||
**[[Microwave]] [[ablation]] | |||
**High-frequency [[ultrasound]] [[ablation]] | |||
==Reference== | ==Reference== | ||
Latest revision as of 03:38, 25 March 2019
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Desmoid tumor Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sara Mohsin, M.D.[2]Faizan Sheraz, M.D. [3]
Overview
Wait and watch strategy is applied to desmoid tumors which are asymptomatic, unresectable, non-life threatening, not causing any significant impairment, and resectable tumors with increased morbidity associated with surgery.Different drugs including chemotherapeutic agents, NSAIDs, anti-hormonal agents and tyrosine kinase inhibitors can be used to shrink or stabilize the tumor size and to improve the symptoms. Radiation therapy and tumor ablation with heat, cold, microwave and/or high-frequency ultrasound waves can also be of therapeutic use as required.
Medical Therapy
- Ideally, patients with desmoid tumors should be evaluated by a multi-disciplinary team which includes surgeons, medical oncologists, radiation oncologists, geneticists and nurses
- Patients with desmoid tumors should be evaluated in a hospital with expertise in sarcoma (usually such hospitals are designated as NCCN [National Comprehensive Cancer Network] centers)
- Wait and watch or observation of the tumor carefully with images and/or physical examination, is implied as a primary therapeutic option for desmoid tumors with following features:
- Potentially resectable but asymptomatic or minimally symptomatic
- Non-life threatening
- Not causing any significant impairment
- Stable appearance on screening modalities
- Unresectable tumors
- Resectable but surgery would lead to unacceptable morbidity
- How often scans and/or physical exams are needed during a “wait and watch” period varies with each situation
- Treatment is recommended for extra-abdominal or abdominal desmoid tumors associated with:
- Goals of medical therapy are:
- Shrinkage of tumor size
- Stabilization of tumor
- Improvement in symptoms after a very wide variety of treatments
- Following table shows drugs used in medical therapy for desmoid tumors:[1][2]
| Drug class | Drug name |
|---|---|
| Chemotherapeutic agents | |
| NSAIDs | |
| Anti-hormonal agents |
|
| Tyrosine kinase inhibitors
(Novel molecular targeted therapies) |
 |
Radiation Therapy
- Desmoids are radiosensitive tumors
- Radiation therapy uses high-energy waves such as X-rays to kill or shrink tumor cells
- Rarely, radiation therapy is used if:
- Patient is symptomatic
- Medical therapy fails
- Surgery fails
- Patient is not a good surgical candidate
- Patient declines surgery
- Surgical morbidity would be excessive
- Margins are positive post-resection
- Tumor recurrence post-resection
- Depending on individual patient characteristics, the radiation may be applied by following two methods:
- Conventional linear accelerators (radiotherapy treatment machines)
- Proton beam therapy
- Depending on the size and location of the tumor, radiation is delivered either in low doses over the course of 5 to 6 weeks or in a single high dose
- Radiation therapy is effective in approximately 30% of cases
- Following complications can occur from radiation therapy due to late radiation effects:
- Secondary malignancies (especially in younger patients)
- Fibrosis associated with radiation therapy
Tumor ablation
- In some rare cases, ablation of desmoid tumors can be used as a therapeutic option
- Following different kinds of ablation can be used:
- Cold ablation
- Heat/thermal ablation
- Microwave ablation
- High-frequency ultrasound ablation
Reference
- ↑ Wilkinson MJ, Fitzgerald JE, Thomas JM, Hayes AJ, Strauss DC (2012). "Surgical resection for non-familial adenomatous polyposis-related intra-abdominal fibromatosis". BJS. 99 (5): 706–13. doi:10.1002/bjs.8703. PMID 22359346.
- ↑ Rammohan A, Wood JJ (2012). "Desmoid tumour of the breast as a manifestation of Gardner's syndrome". Int J Surg Case Rep. 3 (5): 139–42. doi:10.1016/j.ijscr.2012.01.004. PMC 3312056. PMID 22370045.