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Radiation Therapy for Aggressive Fibromatosis (desmoid tumor)

University of Michigan Health System Radiation Oncology, Ann Arbor, MI

To the Editor:

We read the article by Heinrich et al¹ in the March 1, 2006, issue of the Journal of Clinical Oncology with interest. This important article discusses the clinical activity of imatinib in the treatment of advanced aggressive fibromatosis (desmoid tumor).¹ An overall 1-year tumor control rate of 36.8% was reported with the administration of imatinib 800 mg/d as part of a phase II study.

The authors describe the patient cohort as heavily pretreated, with most patients having undergone surgery (17 of 19 patients) and/or systemic therapy (15 of 19 patients) with nonsteroidal agents, doxorubicin, methotrexate, or vinblastine.¹ However, only four of 19 patients had received previous radiation therapy, which is a proven treatment modality for this disorder.

A substantial amount of evidence exists supporting the efficacy of radiation therapy for the treatment of aggressive fibromatosis.^2-4 Radiation therapy may be used alone or in combination with surgery, either preoperatively or postoperatively. For patients with positive margins or residual disease after surgery, adjuvant radiation therapy in combination with surgery results in equivalent local control to surgery with negative margins. For patients who are not surgical candidates or who refuse surgery, radiation therapy alone results in durable local control rates of 70% to 80%. Disease regression may take quite some time after radiation therapy; however, long-term local control rates are excellent. Despite these data, radiation therapy is often overlooked as an option for these patients.

Certainly, normal tissue toxicity and potential late radiation effects, including second malignancies, are important considerations in the treatment of otherwise healthy, often young patients. However, the typical radiation doses necessary for treatment of aggressive fibromatosis (approximately 50 Gy) do not exceed bowel tolerance and are associated with a low risk of complications.^4,5 The application of modern, conformal radiation treatment planning techniques allows for the minimization of normal tissue dose. When considering a patient facing disease progression that could result in significant morbidity or mortality, the potential benefits of radiation therapy can clearly outweigh the risks.

The identification of effective systemic therapies for aggressive fibromatosis refractory to surgery and/or radiation therapy remains an important area of investigation, and we congratulate Heinrich et al¹ on their work. However, we do wish to emphasize the importance of radiation therapy as a proven, effective, but underused therapy for this disorder.

Authors' Disclosures of Potential Conflicts of Interest

The authors indicated no potential conflicts of interest.

REFERENCES

1. Heinrich MC, McArthur GA, Demetri GD, et al: Clinical and molecular studies of the effect of imatinib on advanced aggressive fibromatosis (desmoid tumor). J Clin Oncol 24:1195-1203, 2006[Abstract/Free Full Text]

2. Ballo MT, Zagars GK, Pollack A, et al: Desmoid tumor: Prognostic factors and outcome after surgery, radiation therapy, or combined surgery and radiation therapy. J Clin Oncol 17:158-167, 1999[Abstract/Free Full Text]

3. Nuyttens JJ, Rust PF, Thomas CR Jr, et al: Surgery versus radiation therapy for patients with aggressive fibromatosis or desmoid tumors: A comparative review of 22 articles. Cancer 88:1517-1523, 2000[CrossRef][Medline]

4. Micke O, Seegenschmiedt MH: Radiation therapy for aggressive fibromatosis (desmoid tumors): Results of a national Patterns of Care Study. Int J Radiat Oncol Biol Phys 61:882-891, 2005[CrossRef][Medline]

5. Ballo MT, Zagars GK, Pollack A: Radiation therapy in the management of desmoid tumors. Int J Radiat Oncol Biol Phys 42:1007-1014, 1998[CrossRef][Medline]

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  George D. Demetri and Michael C. Heinrich
  JCO 2006 24: 3715 [Full Text]

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