DOI: 10.12809/hkmj187250
© Hong Kong Academy of Medicine. CC BY-NC-ND 4.0
LETTER TO THE EDITOR
Optimal management of desmoid fibromatosis
Herbert HF Loong, FHKCP, FHKAM (Medicine)
Department of Clinical Oncology, Prince of Wales
Hospital, Shatin, Hong Kong
Corresponding author: Dr Herbert HF Loong (h_loong@clo.cuhk.edu.hk)
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To the Editor—I read with great interest the
recent report by Ng et al1 of
mesenteric fibromatosis. I would like to take this opportunity to clarify
the internationally accepted treatment approach for desmoid fibromatosis.
In the concluding remarks, the authors have rightfully stated that
“…surgical resection is usually indicated in large symptomatic cases of MF
or in MF with complications” and “…decision for radiotherapy or systemic
treatment…should be made after discussion with oncologists”. I cannot help
but notice that they give the readers the impression that surgery remains
the treatment modality of choice before the consideration of systemic or
hormonal treatments. The authors have also referenced an outdated version
of the European consensus that, incidentally, was further updated in 2017.2 Evidence suggests that surgery
should only be considered as an option if the morbidity from the procedure
is limited, and medical therapy, be it with hormonal agents, non-steroidal
anti-inflammatory drugs, cytotoxics, or targeted therapies, should also be
considered as first-line treatments. More importantly, I would like to
emphasise that surgical margins have been shown to inconsistently
correlate with recurrence.3 The
common consensus is that an R0 resection is not necessary if it is at the
expense of significant morbidities or risk of mortality. Ultimately, a
multidisciplinary team approach is necessary to ensure the best possible
outcome for patients with this rare disease.
Declaration
As an editor of this journal, the author was not
involved in the peer review process of this article. The author had full
access to the data, contributed to the study, approved the final version
for publication, and take responsibility for its accuracy and integrity.
References
1. Ng EP, Kwok SY, Lok KF, Chow MP, Lau PY.
Mesenteric fibromatosis: a rare cause of peritonitis. Hong Kong Med J
2018;24:84-6. Crossref
2. Kasper B, Baumgarten C, Garcia J, et al.
An update on the management of sporadic desmoid-type fibromatosis: a
European Consensus Initiative between Sarcoma PAtients EuroNet (SPAEN) and
European Organization for Research and Treatment of Cancer (EORTC)/Soft
Tissue and Bone Sarcoma Group (STBSG). Ann Oncol 2017;28:2399-408. Crossref
3. Salas S, Dufresne A, Bui B, et al.
Prognostic factors influencing progression-free survival determined from a
series of sporadic desmoid tumors: a wait-and-see policy according to
tumor presentation. J Clin Oncol 2011;29:3553-8. Crossref