TY - JOUR
T1 - Long-Term Outcomes for Patients With Desmoid Fibromatosis Treated With Radiation Therapy
T2 - A 10-Year Update and Re-evaluation of the Role of Radiation Therapy for Younger Patients
AU - Bishop, Andrew J.
AU - Zarzour, Maria A.
AU - Ratan, Ravin
AU - Torres, Keila E.
AU - Feig, Barry W.
AU - Wang, Wei Lien
AU - Lazar, Alexander J.
AU - Moon, Bryan S.
AU - Roland, Christina L.
AU - Guadagnolo, B. Ashleigh
N1 - Publisher Copyright:
© 2018 Elsevier Inc.
PY - 2019/4/1
Y1 - 2019/4/1
N2 - Purpose: To update our experience with long-term outcomes in patients with desmoid fibromatosis treated with radiation therapy (RT) and to characterize factors associated with increased risk of local recurrence. Methods and Materials: We reviewed the records of 209 consecutive patients with desmoid fibromatosis treated with RT, either alone or as combined-modality therapy (CMT) with surgery, at our institution from 1965 to 2015. Results: Median follow-up time was 98 months (range, 1-509 months). The 5- and 10-year local control (LC) was 71% and 69%, respectively. Fifty-nine patients (28%) experienced a local recurrence at a median time of 23 months (interquartile range, 15-38 months). Among all patients, on multivariable analysis, adjusting for anatomic site, size, age, treatment era (>2005 vs ≤2005), treatment approach (RT alone vs CMT), and an interaction between age and treatment, we found only age ≤30 years (hazard ratio [HR], 2.94; P =.005; 95% confidence interval [CI], 1.38-6.27) and large tumor size >10 cm (HR, 2.51; P =.03; 95% CI, 1.09-5.78) to be correlated with poorer LC. Notably, for patients receiving RT alone, the 5-year LC was 43% for patients ≤30 years old versus 75% for >30 years old (P <.001). On multivariable analyses, for patients receiving RT alone, the only factor associated with inferior LC was age ≤30 years (HR, 2.87; P =.001; 95% CI, 1.51-5.47). The same was true for patients treated with CMT; age ≤30 years was the only factor associated with inferior LC (HR, 5.36; P =.01; 95% CI, 1.40-20.58). Conclusions: Among all patients with desmoid fibromatosis, RT is an effective local therapy for tumor control. However, young patients ≤ 30 years have notably high rates of local recurrence regardless of treatment strategy, which requires further study. Treatment decisions should be risk-adapted by large referral centers with multidisciplinary expertise in desmoid management.
AB - Purpose: To update our experience with long-term outcomes in patients with desmoid fibromatosis treated with radiation therapy (RT) and to characterize factors associated with increased risk of local recurrence. Methods and Materials: We reviewed the records of 209 consecutive patients with desmoid fibromatosis treated with RT, either alone or as combined-modality therapy (CMT) with surgery, at our institution from 1965 to 2015. Results: Median follow-up time was 98 months (range, 1-509 months). The 5- and 10-year local control (LC) was 71% and 69%, respectively. Fifty-nine patients (28%) experienced a local recurrence at a median time of 23 months (interquartile range, 15-38 months). Among all patients, on multivariable analysis, adjusting for anatomic site, size, age, treatment era (>2005 vs ≤2005), treatment approach (RT alone vs CMT), and an interaction between age and treatment, we found only age ≤30 years (hazard ratio [HR], 2.94; P =.005; 95% confidence interval [CI], 1.38-6.27) and large tumor size >10 cm (HR, 2.51; P =.03; 95% CI, 1.09-5.78) to be correlated with poorer LC. Notably, for patients receiving RT alone, the 5-year LC was 43% for patients ≤30 years old versus 75% for >30 years old (P <.001). On multivariable analyses, for patients receiving RT alone, the only factor associated with inferior LC was age ≤30 years (HR, 2.87; P =.001; 95% CI, 1.51-5.47). The same was true for patients treated with CMT; age ≤30 years was the only factor associated with inferior LC (HR, 5.36; P =.01; 95% CI, 1.40-20.58). Conclusions: Among all patients with desmoid fibromatosis, RT is an effective local therapy for tumor control. However, young patients ≤ 30 years have notably high rates of local recurrence regardless of treatment strategy, which requires further study. Treatment decisions should be risk-adapted by large referral centers with multidisciplinary expertise in desmoid management.
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U2 - 10.1016/j.ijrobp.2018.12.012
DO - 10.1016/j.ijrobp.2018.12.012
M3 - Article
C2 - 30552963
AN - SCOPUS:85061002248
SN - 0360-3016
VL - 103
SP - 1167
EP - 1174
JO - International Journal of Radiation Oncology Biology Physics
JF - International Journal of Radiation Oncology Biology Physics
IS - 5
ER -