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Optimal radiotherapy strategy for primary or recurrent fibromatosis and long-term results

Authors
 Seo Hee Choi  ;  Hong In Yoon  ;  Seung Hyun Kim  ;  Sang Kyum Kim  ;  Kyoo-Ho Shin  ;  Chang-Ok Suh 
Citation
 PLoS One, Vol.13(5) : e0198134, 2018 
Journal Title
 PLoS One 
Issue Date
2018
Abstract
PURPOSE: Although locally invasive or recurrent fibromatosis is primarily treated with surgery, radiotherapy (RT) produces local control for recurrent/unresectable tumors or those with positive surgical margins. Herein, we describe our updated institutional experience with RT to treat fibromatosis. METHODS: Forty-seven patients with fibromatosis received RT between 1990 and 2015, and were followed for >/=12 months. Eight patients received RT for gross tumors, and 39 received postoperative RT after single/multiple prior surgeries. A median dose of 54 Gy was prescribed for definitive RT; 48.6, 50.4, and 54 Gy were prescribed for R0, R1, and R2 resected tumors, respectively. Recurrences were classified as in-field, marginal, or out-field. Prognostic factors were also evaluated. RESULTS: Seven recurrences were noted, including 2 in-field, 4 marginal, and 1 out-field, after a median follow-up of 60 months. In-field recurrences occurred in 1 patient who received 40.5 Gy of salvage RT after postoperative recurrence and another who received 45 Gy for R1 resection after multiple prior operations. All marginal failures were due to insufficient clinical target volume (CTV) margins regardless of dose (3 with 45 Gy and 1 with 54 Gy). On multivariate analysis, a CTV margin >/=5 cm and dose >45 Gy were significant predictors of non-recurrence (p = 0.039 and 0.049, respectively). Subgroup analysis showed that patients with both an CTV margin >/=5 cm and a dose >45 Gy showed a favorable outcome. CONCLUSIONS: RT is a valuable option for treating aggressive fibromatosis; doses >/=45 Gy and a large field produce optimal results. For in-field control, a higher dose is more necessary for gross residual tumors than for totally excised lesions.
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DOI
10.1371/journal.pone.0198134
Appears in Collections:
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Pathology (병리학교실)
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Orthopedic Surgery (정형외과학교실)
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Radiation Oncology (방사선종양학교실)
Yonsei Authors
김상겸(Kim, Sang Kyum) ORCID logo https://orcid.org/0000-0003-0768-9923
김승현(Kim, Seung Hyun)
서창옥(Suh, Chang Ok)
신규호(Shin, Kyoo Ho)
윤홍인(Yoon, Hong In) ORCID logo https://orcid.org/0000-0002-2106-6856
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URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/162439
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