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Desmoid tumors of the head and neck: a review
Brendan J Collins1, Anne C Fischer, Anthony P Tufaro
1Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA.
Abstract:
Desmoid tumors of the head and neck are locally invasive neoplasms with a high propensity for inadequate resection and recurrence. The rarity of these neoplasms accounts for the fact that there are no prospective randomized data to evaluate the influence of adjuvant therapies, including radiotherapy, hormonal therapy, or cytotoxic chemotherapy. Several comprehensive retrospective series in the literature suggest that the margin status following resection does not necessarily correlate with local disease recurrence. As a result, we do not advocate the sacrifice of major neurovascular structures in an attempt to obtain negative margins. We present a review of desmoid tumors, emphasizing those occurring in the head and neck, and describe 3 cases that highlight the challenges that the anatomy of the head and neck presents in the management of this difficult disease.
Insights
Desmoid tumors in the head and neck are locally invasive. Surgical margins may not predict recurrence, so sacrificing vital structures is not recommended for head and neck desmoid tumors.
Area of Science:
- Oncology
- Head and Neck Surgery
- Surgical Pathology
Background:
- Desmoid tumors (also known as aggressive fibromatosis) are rare, locally invasive neoplasms.
- Head and neck desmoid tumors present unique management challenges due to anatomical complexity.
- Limited data exist on adjuvant therapies (radiotherapy, hormonal, or chemotherapy) for these rare tumors.
Purpose of the Study:
- To review the current understanding of desmoid tumors, focusing on head and neck presentations.
- To highlight the challenges in managing head and neck desmoid tumors.
- To discuss the implications of surgical margins and adjuvant therapies.
Main Methods:
- Review of existing literature on desmoid tumors, with emphasis on head and neck cases.
- Presentation and discussion of three illustrative case studies.
- Analysis of factors influencing local recurrence, including surgical margins and adjuvant treatments.
Main Results:
- Retrospective data suggest surgical margin status may not reliably predict local recurrence in desmoid tumors.
- The complex anatomy of the head and neck complicates complete tumor resection.
- Adjuvant therapies have not been evaluated in prospective randomized trials due to tumor rarity.
Conclusions:
- Complete resection of head and neck desmoid tumors is challenging.
- Sacrificing major neurovascular structures to achieve negative margins is not advised.
- Further research is needed to establish optimal management strategies for these rare neoplasms.
