Function-sparing surgery for desmoid tumors and other low-grade fibrosarcomas involving the brachial plexus Journal Article

Authors: Gaposchkin, C. G.; Bilsky, M. H.; Ginsberg, R.; Brennan, M. F.
Article Title: Function-sparing surgery for desmoid tumors and other low-grade fibrosarcomas involving the brachial plexus
Abstract: OBJECTIVE: Low-grade fibrosarcomas and desmoid tumors present a surgical challenge in that they have a strong tendency for local invasion, surgical margins are poorly delineated, and complete resections are difficult. Nowhere is this more evident than in those lesions involving the brachial plexus. We review our experience with these difficult lesions. METHODS: From a prospective database of 2900 patients admitted for treatment of sarcoma between 1982 and 1996, we identified 15 patients with involvement of the brachial plexus by a low-grade fibrosarcoma or desmoid tumor. All patients underwent resection, with 13 of 15 receiving adjuvant radiotherapy. The 15 patients had a mean age at initial operation of 47 years. The male-to-female ratio was 8:7. The mean follow-up period was 65 months (median, 53 mo). RESULTS: Gross total resection was achieved in 12 patients (80%), although 11 of these patients had positive surgical margins. Overall, 64% of the tumors have recurred locally. There were no distant metastases, and no patients died as a result of their disease. One patient died as a result of unrelated cancer. An assessment of the functional outcomes revealed seven patients with normal function or mild neurological deficits and eight who were suffering from significant weakness, debilitation, or chronic pain. One patient required forequarter amputation. CONCLUSION: Surgical resection plus postoperative radiotherapy is the treatment of choice for low-grade fibrosarcomas and desmoid tumors involving the brachial plexus. However, aggressive surgical management with the goal of achieving a gross total resection with negative histological margins can produce unnecessary morbidity. Preserving function should be a primary goal of the operations, although this will be associated with residual disease and will risk local recurrence but rarely death resulting from the disease.
Keywords: adolescent; adult; clinical article; treatment outcome; aged; aged, 80 and over; middle aged; postoperative period; cancer radiotherapy; follow up; follow-up studies; neoplasm recurrence, local; fibrosarcoma; tumor recurrence; desmoid tumor; nervous system; fibromatosis, aggressive; nervous system neoplasms; brachial plexus; nerve surgery; arm amputation; humans; human; male; female; priority journal; article; low-grade fibrosarcoma
Journal Title: Neurosurgery
Volume: 42
Issue: 6
ISSN: 0148-396X
Publisher: Oxford University Press  
Date Published: 1998-06-01
Start Page: 1297
End Page: 1303
Language: English
DOI: 10.1097/00006123-199806000-00058
PUBMED: 9632188
PROVIDER: scopus
Notes: Article -- Export Date: 12 December 2016 -- Source: Scopus
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MSK Authors
  1. Murray F Brennan
    823 Brennan
  2. Robert J Ginsberg
    156 Ginsberg
  3. Mark H Bilsky
    230 Bilsky