How desmoid tumors are managed

Currently, there are no FDA-approved treatment options indicated for desmoid tumors.1 Once an accurate diagnosis has been obtained, there are several treatment approaches that may be recommended depending on the size, location, aggressiveness, and discomfort of the tumor.2-4

A multidisciplinary team can help you determine your treatment goals

An open, honest discussion about what your treatment goals are can be helpful in developing your management plan. It is recommended that your care team include specialists across different fields of medicine who have experience managing your condition.4 You can suggest that your surgeon and medical oncologist collaborate to determine the best treatment path for you.

There’s no one-size-fits-all treatment.

Melony, patient with a desmoid tumor

Melony smiling

Current management options for desmoid tumors

Active Surveillance

The first step for some people may be to “wait and see.” This may include regular doctor check-ups and frequent imaging tests.5 This will give doctors a chance to understand if your symptoms are changing and see if or how fast the tumor is growing.3,6,7

If the tumor grows quickly, symptoms get worse, or the tumor is in a critical location, your doctor may decide to begin treatment.2

Medical Therapy

Currently, there are no FDA-approved treatment options indicated for desmoid tumors.1 However, your care team may prescribe medical therapies to help shrink and/or stabilize the tumor and manage symptoms. The recent clinical guideline recommends the following treatment options:4

  • Tyrosine kinase inhibitors (TKIs, may include sorafenib, pazopanib and imatinib)
  • Chemotherapy (options may include methotrexate and vinblastine/vinorelbine, doxorubicin-based regimens)
  • Nonsteroidal anti-inflammatory drugs (NSAIDs, for pain)

Antihormonal therapies (with or without NSAIDs) do not have guideline recommendations.4

Results and side effects can vary from person to person. It may be helpful to talk about what to expect with your care team. Together, you and your care team can come up with strategies to help handle side effects if you experience them.

Surgery

During surgery, the surgeon tries to remove the entire desmoid tumor and some surrounding healthy tissue to make sure they removed it all. Doctors call this surrounding area a “clear margin” where no tumor cells are visible.4

Surgery used to be the most common treatment for desmoid tumors, but it is generally no longer recommended as a first approach by desmoid tumor experts.4,7 This is because:

  • surgery may require the removal of large amounts of tissue6
  • desmoid tumors often come back after surgery (recurrence)8
  • desmoid tumors may remain stable or resolve on their own6

Desmoid tumors include the tumor itself and its “tendril-like” growths that radiate outward. These can be far-reaching. Because of this, completely removing the desmoid tumor and getting a clear margin can be difficult. Removing a large amount of tissue could cause some loss of function or changes in appearance.6,9

Desmoid tumors can come back after surgery. It has been reported that they come back about 24% to 77% of the time.10,11 Factors like the location and size of the tumor, as well as the age of the patient, can influence risk of recurrence.12 So, surgery may not be the best option for everyone.

Radiation therapy

Radiation therapy is only recommended for desmoid tumors in the arms, legs, outer torso, head, and neck.13

Cryoablation

Cryoablation uses extreme cold to destroy tumor tissue.14 It can be used for small to medium tumors that are not in the abdomen (belly).7 A cold gas freezes the tumor tissue. It is pumped into the tumor through a thin needle. The tissue thaws and the freezing and thawing are repeated several times to destroy the cells.14

Clinical Trials

Treatments are being studied for desmoid tumors. Talk to your doctor to see if you may be a good candidate for a clinical trial.

For anybody who’s diagnosed now: please research all of your treatment options.

DeAnn, patient with a desmoid tumor

DeAnn on a medical exam table

  1. Riedel RF. Agulnik M. Evolving strategies for management of desmoid tumor. Cancer. 2022;128(16):3027-3040.
  2. Cancer.Net. Desmoid tumor: types of treatment. Accessed April 16, 2022. https://www.cancer.net/cancer-types/desmoid-tumor/types-treatment.
  3. Penel N, Chibon F, Salas S. Adult desmoid tumors: biology, management and ongoing trials. Curr Opin Oncol. 2017;29(4):268-274.
  4. The Desmoid Tumor Working Group. The management of desmoid tumors: a joint global evidence-based consensus guideline approach for adult and pediatric patients. Accessed April 10, 2022. https://dtrf.org/wp- content/uploads/2020/02/Desmoid_Paper_2018_A4_RL_Web300-1.pdf.
  5. Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Soft Tissue Sarcoma V.2.2022. © National Comprehensive Cancer Network, Inc. 2022. All rights reserved. Accessed June 6, 2022. To view the most recent and complete version of the guideline, go online to NCCN.org. NCCN makes no warranties of any kind whatsoever regarding their content, use, or application, and disclaims any responsibility for their application or use in any way.
  6. Kasper B, Baumgarten C, Bonvalot S, et al. Desmoid Working Group. Management of sporadic desmoid-type fibromatosis: a European consensus approach based on patients’ and professionals’ expertise—a sarcoma patients EuroNet and European Organisation for Research and Treatment of Cancer/Soft Tissue and Bone Sarcoma Group initiative. Eur J Cancer. 2015;51(2):127-136.
  7. Kasper B, Baumgarten C, Garcia J, et al. Desmoid Working Group. 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(10):2399-2408.
  8. Penel N, Cesne AL, Bonvalot S, et al. Surgical versus non-surgical approach in primary desmoid-type fibromatosis patients: a nationwide prospective cohort from the French Sarcoma Group. Eur J Cancer. 2017;83:125-131.
  9. Ballo MT, Zagars GK, Pollack A, Pisters PWT, Pollock RA. Desmoid tumor: prognostic factors and outcome after surgery, radiation therapy, or combined surgery and radiation therapy. J Clin Oncol. 1999;17(1):158-167.
  10. Easter DW, Halasz NA. Recent trends in the management of desmoid tumors. Summary of 19 cases and review of the literature. Ann Surg. 1989;210(6)765-769.
  11. Skubitz KM. Biology and treatment of aggressive fibromatosis or desmoid tumor. Mayo Clin Proc. 2017;92)6):947-964.
  12. Crago AM, Denton B, Salas S, et al. A prognostic nomogram for prediction of recurrence in desmoid fibromatosis. Ann Surg. 2013;258(2):347-353.
  13. Referenced with permission from the NCCN Guidelines for Patients® for Soft Tissue Sarcoma V.1.2020. © National Comprehensive Cancer Network, Inc. 2020. All rights reserved. Accessed August 4, 2022. To view the most recent and complete version of the guideline, go online to NCCN.org. NCCN makes no warranties of any kind whatsoever regarding their content, use, or application, and disclaims any responsibility for their application or use in any way.
  14. Mayo Clinic. Cryoablation for cancer. Accessed April 29, 2022. https://www.mayoclinic.org/tests-procedures/cryoablation-for-cancer/about/pac-20385216.