Treatment of extra - abdominal desmoid tumors with chemotherapy.

Fibromatosis, or extra-abdominal desmoid tumor, is a benign disease which often has an aggressive clinical course that can be difficult to treat. We performed a retrospective review of 16 patients (12 females and four males) with a mean age of 34.2 years treated with methotrexate and vinblastine for newly diagnosed or recurrent extra-abdominal desmoid tumor. The mean age of our patient cohort was 34.2 years (range 11-70), and the mean tumor size was 11.5 cm (range 2.5-21.2 cm). The mean duration of therapy was 12 months with an average follow-up of 43 months (range 1-149 months). Fourteen of 16 patients demonstrated a clinical response to treatment. Eight of 14 patients demonstrated a radiologic decrease in tumor size. Only one patient progressed on therapy. Six patients developed recurrent symptoms after discontinuation of treatment. Chemotherapy-related symptoms including neutropenia, nausea, and vomiting were common and observed in most patients, however these side effects were mild and transient. Five patients developed peripheral neuropathy that prompted a change from vinblastine to vinorelbine during treatment. One potentially life-threatening complication (pneumocystis pneumonia) occurred which was diagnosed early and successfully treated. The use of methotrexate and vinblastine/vinorelbine in the management of fibromatosis appears to be an effective treatment with minimal treatment-related side effects.

Collagen and biphasic calcium phosphate bone graft in large osseous defects.

The cavity left by the removal of tumors represents a challenge for the orthopedic oncologic surgeon. This article takes a critical look at the use of a synthetic bone graft to fill the residual space. A combination of hydroxyapatite, tricalcium phosphate, and bovine collagen was used for intramedullary tumors. Thirty patients were followed for an average of 23 months. The majority (93%) returned to full activity with only 6 (20%) complications. Study results showed collagen and biphasic calcium phosphate ceramic bone graft makes an effective substrate for filling intramedullary cavities remaining after tumor excision.