Journal of Clinical Oncology, Vol 16, 3021-3027, Copyright © 1998 by American Society of Clinical Oncology

ARTICLES

Combination chemotherapy using vinblastine and methotrexate for the treatment of progressive desmoid tumor in children

SX Skapek, BJ Hawk, FA Hoffer, GV Dahl, L Granowetter, MC Gebhardt, WS Ferguson and HE Grier
Department of Pediatric Hematology/Oncology, Wilford Hall Medical Center, Lackland Air Force Base, San Antonio, TX 78236, USA. skapek@utmscsa.edu

PURPOSE: We report the treatment of 10 children for progressive desmoid tumor not amenable to standard surgical or radiation therapy with the use of vinblastine (VBL) and methotrexate (MTX). PATIENTS AND METHODS: Ten patients aged 6.4 to 18 years with primary (two patients) or recurrent (eight patients) desmoid tumor were treated with VBL and MTX for 2 to 35 months. Patients with recurrent tumors had been previously treated with surgical resection with (two patients) or without (five patients) radiation therapy or with radiation therapy alone (one patient). No patient had previously received cytotoxic chemotherapy. The tumor response was assessed at routine intervals by physical examination and magnetic resonance imaging (MRI). RESULTS: Five patients had clinical evidence of response to therapy with complete resolution (three patients) or partial resolution (two patients) of physical examination and radiographic abnormalities. Three patients had stable disease during 10 to 35 months of treatment. Two of these patients had progressive disease 9 and 37 months after treatment stopped; one patient had no progression 16 months after therapy. Two additional patients with stable disease had chemotherapy discontinued after 2 and 3 months. Common side effects included mild alopecia and myelosuppression and moderate nausea and vomiting. In patients with responding tumors, MRI showed decreased tumor size and, in two patients, changes consistent with fibrosis and decreased cellularity of the tumor. CONCLUSION: Combination chemotherapy with VBL and MTX appears to control desmoid tumor without significant acute or long-term morbidity in most children. This may allow for further growth and development in these patients, which may decrease the morbidity of subsequent definitive therapy.

This article has been cited by other articles:

				H. S. Hosalkar, J. T. Torbert, E. J. Fox, T. F. Delaney, A. J. Aboulafia, and R. D. Lackman Musculoskeletal Desmoid Tumors J. Am. Acad. Ortho. Surg., April 1, 2008; 16(4): 188 - 198. [Abstract] [Full Text] [PDF]

				S Basu, N Nair, and S Banavali Uptake characteristics of fluorodeoxyglucose (FDG) in deep fibromatosis and abdominal desmoids: potential clinical role of FDG-PET in the management Br. J. Radiol., September 1, 2007; 80(957): 750 - 756. [Abstract] [Full Text] [PDF]

				D. Lev, D. Kotilingam, C. Wei, M. T. Ballo, G. K. Zagars, P. W.T. Pisters, A. A. Lazar, S. R. Patel, R. S. Benjamin, and R. E. Pollock Optimizing Treatment of Desmoid Tumors J. Clin. Oncol., May 1, 2007; 25(13): 1785 - 1791. [Abstract] [Full Text] [PDF]

				S. X. Skapek, W. S. Ferguson, L. Granowetter, M. Devidas, A. R. Perez-Atayde, L. P. Dehner, F. A. Hoffer, R. Speights, M. C. Gebhardt, G. V. Dahl, et al. Vinblastine and Methotrexate for Desmoid Fibromatosis in Children: Results of a Pediatric Oncology Group Phase II Trial J. Clin. Oncol., February 10, 2007; 25(5): 501 - 506. [Abstract] [Full Text] [PDF]

				J. G. Guillem, W. C. Wood, J. F. Moley, A. Berchuck, B. Y. Karlan, D. G. Mutch, R. F. Gagel, J. Weitzel, M. Morrow, B. L. Weber, et al. ASCO/SSO Review of Current Role of Risk-Reducing Surgery in Common Hereditary Cancer Syndromes J. Clin. Oncol., October 1, 2006; 24(28): 4642 - 4660. [Abstract] [Full Text] [PDF]

				J. G. Guillem, W. C. Wood, J. F. Moley, A. Berchuck, B. Y. Karlan, D. G. Mutch, R. F. Gagel, J. Weitzel, M. Morrow, B. L. Weber, et al. ASCO/SSO Review of Current Role of Risk-Reducing Surgery in Common Hereditary Cancer Syndromes Ann. Surg. Oncol., October 1, 2006; 13(10): 1296 - 1321. [Abstract] [Full Text] [PDF]

				J. B. Wise, J. E. Cryer, J. B. Belasco, I. Jacobs, and L. Elden Management of Head and Neck Plexiform Neurofibromas in Pediatric Patients With Neurofibromatosis Type 1 Arch Otolaryngol Head Neck Surg, August 1, 2005; 131(8): 712 - 718. [Abstract] [Full Text] [PDF]

				K. Aflatoon, A. J. Aboulafia, E. F. McCarthy Jr, F. J. Frassica, and A. M. Levine Pediatric Soft-Tissue Tumors J. Am. Acad. Ortho. Surg., September 1, 2003; 11(5): 332 - 343. [Abstract] [Full Text] [PDF]

				M. A. Wright, B. Schuler, E. Szabo, and J. L. Grem Sustained partial response of an intra-abdominal desmoid tumor treated with gemcitabine, 5-fluorouracil and leucovorin Ann. Onc., April 1, 2003; 14(4): 659 - 660. [Full Text] [PDF]

				A. Gronchi, P.G. Casali, L. Mariani, S. Lo Vullo, M. Colecchia, L. Lozza, R. Bertulli, M. Fiore, P. Olmi, M. Santinami, et al. Quality of Surgery and Outcome in Extra-Abdominal Aggressive Fibromatosis: A Series of Patients Surgically Treated at a Single Institution J. Clin. Oncol., April 1, 2003; 21(7): 1390 - 1397. [Abstract] [Full Text] [PDF]

				J. Janinis, M. Patriki, L. Vini, G. Aravantinos, and J. S. Whelan The pharmacological treatment of aggressive fibromatosis: a systematic review Ann. Onc., February 1, 2003; 14(2): 181 - 190. [Abstract] [Full Text] [PDF]

				C. A. Kingston, C. M. Owens, A. Jeanes, and M. Malone Imaging of Desmoid Fibromatosis in Pediatric Patients Am. J. Roentgenol., January 1, 2002; 178(1): 191 - 199. [Full Text] [PDF]

				M. R. Robbin, M. D. Murphey, H. T. Temple, M. J. Kransdorf, and J. J. Choi Imaging of Musculoskeletal Fibromatosis RadioGraphics, May 1, 2001; 21(3): 585 - 600. [Abstract] [Full Text] [PDF]

				M. M. Johns, R. A. Taylor, and R. S. Bogdasarian Quiz Case 2 Arch Otolaryngol Head Neck Surg, July 1, 2000; 126(7): 901 - 906. [Full Text] [PDF]

				S. Reich, U. S. Overberg-Schmidt, C. Buhrer, and G. Henze Low-Dose Chemotherapy With Vinblastine and Methotrexate in Childhood Desmoid Tumors J. Clin. Oncol., March 1, 1999; 17(3): 1086 - 1086. [Full Text] [PDF]