Optimizing treatment of desmoid tumors
Optimizing treatment of desmoid tumors
复制标题
DOI：
10.1200/jco.2006.10.5015
复制
发表时间：
2007-05-01
影响因子：
45.3
通讯作者：
Pollock, Raphael E.
中科院分区：
文献类型：
--
作者：
Lev, Dina;Kotilingam, Dhanasekaran;Pollock, Raphael E.
本研究比较了在同一机构接受治疗的大量硬纤维瘤患者和同一机构先前发表的一系列研究，以确定患者的人口特征、治疗方法和临床结果在这两个研究期间是否发生了变化。材料和方法使用前瞻性软组织肿瘤数据库中的数据分析1995年至2005年在德克萨斯大学安德森癌症中心(UTMDACC)接受治疗的189名硬纤维瘤患者的临床病程，与1965至1994年间接受UTMDACC治疗的189名UTMDACC患者相比。结果在最近的研究期间，UTMDACC的年转诊量增加了近三倍，并显著增加了转诊至UTMDACC的初级硬纤维瘤转诊百分比和数量。最近观察到显著增加系统治疗的使用和减少对单纯手术的依赖。虽然最近的一系列患者在确定的手术后有更高的大体残留率和同等的镜检阳性切缘比率，但估计的5年局部复发率为20%，比早期观察到的30%有所改善。结论对控制硬纤维瘤所需复杂的多学科治疗的认识的提高可能是转诊至UTMDACC的数量显著增加的原因，尤其是原发的未经治疗的硬纤维瘤。增加新辅助治疗可能与改善硬纤维瘤患者的预后有关。这些趋势应该得到支持，特别是如果要迅速和有效地部署个性化的基于分子的疗法，以造福于那些患有这种罕见和可能使人虚弱的疾病的人。
PurposeThis study compared a large series of desmoid patients treated at a single institution to a previously published series from the same institution to determine if patient population characteristics, treatment approaches, and clinical outcomes had undergone change over the two study periods.Materials and MethodsData from a prospective soft tissue tumor database was used to analyze clinical courses of 189 desmoid patients treated at The University of Texas M. D. Anderson Cancer Center (UTMDACC) from 1995 to 2005 as compared with 189 UTMDACC desmoid patients treated between 1965 and 1994.ResultsA nearly three-fold increase in annualized UTMDACC desmoid referral volume with significantly higher percentages and numbers of primary desmoid tumor referrals to UTMDACC was observed in the most recent study period. Significantly increased systemic therapy use and decreased reliance on surgery alone was observed more recently. While the recent series patients had higher rates of macroscopic residual disease and equivalent rates of positive microscopic margins after definitive surgery, the estimated 5-year local recurrence rate of 20% was improved compared with the 30% rate observed in the earlier series.ConclusionIncreased awareness of the complex multidisciplinary management needed for desmoid tumor control may underlie significantly increased numbers of referrals to UTMDACC, especially primary untreated desmoids. Increased neoadjuvant treatments may be associated with improved desmoid patient outcomes. These trends should be supported, particularly if personalized molecular-based therapies are to be rapidly and effectively deployed for the benefit of those afflicted by this rare and potentially debilitating disease.