P60: Evolution in management of upfront treatment for desmoid tumors

Thursday, March 23, 2023

3:01 PM – 3:06 PM

Location: SSO HUB: Melanoma & Sarcoma Zone

Poster Presenter(s)

Alex Bartholomew, MD (he/him/his)

General Surgery Resident
Duke University Medical Center, North Carolina, United States

Disclosure information not submitted.

Author(s)

Alex Bartholomew, MD (he/him/his)

General Surgery Resident
Duke University Medical Center, North Carolina, United States

Disclosure information not submitted.
Kristen E. Rhodin, MD

General Surgery Resident
Duke University Medical Center
Durham, North Carolina, United States

Disclosure(s): No financial relationships to disclose
LN

Laura Notware, BS

Medical Student
Duke University Medical Center, United States

Disclosure information not submitted.
DIMITRIOS P. MORIS, MD, MSc, PhD

RESIDENT
Duke
Durham, North Carolina, United States

Disclosure information not submitted.
EK

Elishama Kanu, MD

General Surgery Resident
Duke University Medical Center, United States

Disclosure information not submitted.
Sabran Masoud, MD (he/him/his)

General Surgery Resident
Duke University Medical Center, United States

Disclosure information not submitted.
TH

Thomas C. Howell, MD

General Surgery Resident
Duke University Medical Center, United States

Disclosure information not submitted.
JK

Juliann Kosovec, MD

Genera Surgery Resident
Duke University Medical Center, United States

Disclosure information not submitted.
DB

Danielle Burner, BS

Medical Student
Duke University Medical Center, United States

Disclosure information not submitted.
CK

Charles Y. Kim, MD

Professor of Radiology
Duke University Medical Center, United States

Disclosure information not submitted.
AS

Alan A. Sag, MD

Assistant Professor of Radiology
Duke University Medical Center, United States

Disclosure information not submitted.
DN

Daniel P. Nussbaum, MD

Assistant Professor of Surgery
Duke University Medical Center, United States

Disclosure information not submitted.
Sabino Zani, Jr., MD

Associate Professor of Surgery
Duke University Medical Center
Durham, North Carolina, United States

Disclosure information not submitted.
Michael E. Lidsky, MD

Assistant Professor of Surgery
Duke University
Durham, North Carolina, United States

Disclosure information not submitted.
Peter Allen, MD

chief, surgical oncology
Duke University Medical Center
Durham, NC, United States

Disclosure information not submitted.
RR

Richard F. Riedel, MD

Associate Professor of Medicine
Duke Univesity Medical Center, United States

Disclosure information not submitted.
Dan Blazer, III, MD

Associate Professor of Surgery
Duke University Medical Center
Durham, North Carolina, United States

Disclosure(s): No financial relationships to disclose

Disclosure(s):

Kristen E. Rhodin, MD: No financial relationships to disclose

Dan Blazer, MD, III: No financial relationships to disclose

Introduction: Desmoids tumors (DT) are rare, fibroblastic cell proliferations that can exhibit locally aggressive behavior but lack metastatic potential. Initial management has traditionally involved upfront resection. However, a recent shift towards initial nonoperative management has been advocated. It remains unclear how widely these practice patterns are being adopted.

Methods: A single-institution, retrospective chart review identified all patients diagnosed with primary DT at any anatomic site from 2007 to 2020. Patient demographics, tumor characteristics, and treatment interventions were collected. Primary outcome was the initial management strategy over time, stratified by first and second halves of study period (2007-2013 vs. 2014-2020). Secondary outcomes included management by disease site and recurrence free survival for patients undergoing surgical intervention.

Results: A total of 103 patients were included in the final cohort with a median age of 40 years (IQR 33 - 53) and 68% were female. DTs were associated with familial adenomatous polyposis in 10% of cases and with the peripartum period in 5%. Tumor locations included abdominal wall (27%), intra-abdominal/mesenteric (25%), chest wall (19%), extremity (10%), back (8%), head/neck (7%), breast (4%), and other (1%). Median tumor size was 7.4cm (4 - 9.8). Initial management included resection (60%), surveillance (18%), cryoablation (2%), and remainder with systemic therapies including NSAIDs (12%), tyrosine kinase inhibitors (5%), chemotherapy (3%), and raloxifene (1%). Upfront surgical resection was significantly higher in the first half of the study (81% vs. 46%, p < 0.001; Figure). At a median follow up of 56 months, 45% experienced a recurrence, with a median time to recurrence of 11 months (7 - 17). Of those initially surveilled, 61% had either regression or stable disease, while just 12% progressed to surgical intervention. A total of 7% of patients received cryoablation beginning in 2017.

Conclusions: This single-institution cohort at a tertiary medical center spanning one decade demonstrates the ongoing evolution of upfront management of DT away from initial resection. This approach is in line with recent consensus guidelines, which advocate for close surveillance when possible to limit associated morbidity.

Learning Objectives:

Discuss options for initial management of desmoid tumors.
Discuss trends in patterns in initial management of desmoid tumors.
Understand the role of cryoablation for desmoid tumors.