The Necessity of Early Adjuvant Radiotherapy for Better Outcomes in the Treatment of a Desmoid Tumor

Lee, Me Yeon; Chang, Ah Ram; Kim, Hak Jae; Kim, Kyubo; Kim, Jin Ho; Park, Charn Il; Ha, Sung Whan; Wu, Hong Gyun; Kim, Il Han

Abstract

PURPOSE: This retrospective study was conducted to assess outcome and to determine the prognostic factors in patients with a desmoid tumor treated with postoperative radiotherapy.
MATERIALS AND METHODS
Twenty-seven patients with a desmoid tumor who were treated with postoperative radiotherapy between June 1984 and October 2005 were analyzed. There were 13 male and 14 female patients. The age of the patients ranged from 3 to 79 years (median age, 28 years). Tumors were located in an extra-abdominal area (21 cases), and in the abdominal walls (6 cases). The tumor size ranged from 2.5 to 25 cm (median size, 7.5 cm) in the largest linear dimension. Thirteen cases received radiotherapy after initial surgery, and 14 recurrent cases received radiotherapy after additional surgery. The total radiation dose given was 45~66 Gy (median dose, 59.4 Gy), and the fraction size was 1.8~2.0 Gy.
RESULTS
The median follow-up period was 61 months (range, 12~203 months). Two patients developed local progression and six patients experienced local recurrence. The 5-year disease-free survival rate and the 5-year progression-free survival rate were 61% and 70%, respectively. Wide local excision was associated with better disease free survival with statistical significance (p=0.028). Radiotherapy after initial surgery (p=0.046) and a higher radiation dose of more than 60 Gy (p=0.049) were associated with better progression free survival with statistical significance. At the time of the last follow-up, the number of additional surgeries was higher in patients that received radiotherapy after reoperation (p<0.001).
CONCLUSION
Radiotherapy after the initial operation improved local control and decreased the number of subsequent operations. Thus, postoperative radiotherapy after an initial operation is recommended in patients with a high risk of recurrence for a desmoid tumor.