An Evaluation of Brachytherapy and External Beam Radiation Used With Wide-Margin Surgical Resection in the Treatment of Extra-abdominal Desmoid Tumors

Surgical resection has had control rates of 53% to 77% in the treatment of extra-abdominal desmoid tumors. Surgical excision combined with external beam radia­tion therapy (EBRT) has had local control rates of up to 83% in some series. The purpose of this study was to evaluate the effectiveness of resection combined with radiotherapy (brachytherapy, EBRT, or both) in the treat­ment of extra-abdominal desmoid tumors.

We retrospectively reviewed the charts of 24 consecu­tive patients (27 histologically confirmed extra-abdomi­nal desmoid tumors). Patients were included in the study if they had a lesion that was potentially resectable with a wide margin, allowing for limb salvage, and if they did not have a contraindication to radiotherapy. Limb func­tioning was assessed with the Musculoskeletal Tumor Society (MSTS) scoring system.

Seventeen patients (7 men, 10 women) with 19 tumors met the inclusion criteria. Mean age at diagnosis was 23.8 years. Follow-up (mean, 4.28 years) involved serial clinical examinations and magnetic resonance imaging of tumor sites. After surgery, the tumors were treated with brachytherapy (n = 6), EBRT (n = 10), or both (n = 3). Two of the 17 tumors in patients with negative margins of resection recurred locally (local control rate, 88.2%). Mean MSTS score was 29/30 (96.7%).

The role of surgery, radiotherapy, chemotherapy, hor­mone therapy, and other treatments for extra-abdominal desmoid tumors is not well defined. When wide-margin resection and radiotherapy can be performed with limb preservation surgery, local control and complication rates compare favorably with those of other reported methods of treatment. Given the results and limitations of our study, we cannot make a definitive recommenda­tion as to which modality—brachytherapy or EBRT— should be used in the treatment of extra-abdominal desmoid tumors.