From the Guidelines
The treatment approach for a desmoid tumor located above the bladder should initially involve a watchful waiting policy, reserving treatment for progressing cases, as per the principles outlined in the ESMO clinical practice guidelines for diagnosis, treatment, and follow-up of soft tissue and visceral sarcomas 1. This approach is based on the unpredictable natural history of the disease, including the possibility of long-lasting stable disease and occasional spontaneous regressions, along with a lack of metastatic potential.
- Key considerations in the management of desmoid tumors include:
- The anatomical location of the tumor, with extra-abdominal locations and intra-abdominal desmoids potentially requiring more aggressive management
- The use of MRI as the preferred imaging modality for monitoring tumor progression
- The individualization of treatment on a multidisciplinary basis for progressing cases, which may include surgery, radiation therapy, observation, or systemic therapy
- Systemic therapies for desmoid tumors may include hormonal therapies, nonsteroidal anti-inflammatory drugs, low-dose chemotherapy, and targeted therapies such as imatinib or sorafenib, with the choice of therapy depending on the specific clinical context and the patient's overall health status, as outlined in the guidelines 1.
- A stepwise approach to treatment, starting with less toxic therapies and reserving more toxic options for patients with progressive disease, is a reasonable strategy, as suggested by the ESMO guidelines 1.
From the Research
Treatment Approach for Desmoid Tumor Above the Bladder
The treatment approach for a desmoid tumor located above the bladder involves several options, including:
- Active surveillance with planned imaging, which has become the first-line management for desmoid tumors 2
- Medical treatment, such as kinase inhibitors and cytotoxic agents, which are recommended for significant tumor growth or symptoms 2
- Cryotherapy, which is an alternative option for desmoid tumors with compatible locations and tumor sizes 2
- Surgery, which is considered for superficial sites and cases of continuous progression after medical treatment or cryotherapy failure 2
- Radiotherapy, which is an effective option in cases where surgery would be mutilating and incomplete, or in the event of a contra-indication or failure of medical treatment 2
Factors Influencing Treatment
The treatment approach for desmoid tumors is influenced by several factors, including:
- Tumor location and size
- Presence of symptoms
- Rate of tumor growth
- Patient's overall health and medical history
- Availability of treatment options and expertise
Specific Treatment Options
Some specific treatment options for desmoid tumors include:
- Tamoxifen and sulindac, which have been shown to be effective in treating desmoid tumors, particularly in cases where surgery is not feasible 3, 4
- Sorafenib and pazopanib, which are kinase inhibitors that have been shown to be effective in treating progressive desmoid tumors 2
- Methotrexate and vinblastine, which are cytotoxic agents that have been shown to be effective in treating desmoid tumors 2