Abstract
Forty of 416 patients with familial adenomatous polyposis were noted to have intra-abdominal desmoid tumors, and a subgroup of 16 were treated with noncytotoxic drug therapy. Drugs used were sulindac (14 patients), sulindac plus tamoxifen (3 patients), indomethacin (4 patients), tamoxifen (4 patients), progesterone (DEPO-PROVERA®; Upjohn Co., Kalamazoo, MI) (2 patients), and testolactone (1 patient). Therapy with these drugs for continuous periods of six months or more resulted in three complete and seven partial remissions. When treated patients were compared with untreated patients (n=12), there were significant benefits for the treated group, both in reduction of desmoid size and in improvement of symptoms, despite the inherent selection bias against this. Sulindac was the only drug used in enough patients to permit independent evaluation of its effect, with one complete and seven partial reductions of tumor size. Some patients had a delayed response to sulindac, with tumor shrinkage occurring after an initial period of tumor enlargement. When using sulindac for the treatment of desmoid tumors, this phenomenon should be considered.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Gardner EJ, Richards RC. Multiple cutaneous and subcutaneous lesions occurring simultaneously with hereditary polyposis and osteomatosis. Am J Hum Genet 1953;5;139–47.
Sener SF, Miller HH, DeCosse JJ. The spectrum of polyposis. Surg Gynecol Obstet 1984;159:525–32.
Jarvinen HJ, Peltokallio P, Landtman M, Wolf J. Gardner's stigmas in patients with familial adenomatosis coli. Br J Surg 1982;69:718–21.
McAdam WA, Goligher JC. The occurrence of desmoids in patients with familial polyposis coli. Br J Surg 1970;57:618–31.
Jones IT, Fazio VW, Weakley FL, Jagelman DG, Lavery IC, McGannon E. Desmoid tumors in familial polyposis coli. Ann Surg 1986;204:94–7.
Arvanitis ML, Jagelman DJ, Fazio VW, Lavery IC, McGannon E. Mortality in patients with familial adenomatous polyposis. Dis Colon Rectum 1990;33:639–42.
Jarvinen HJ. Desmoid disease as a part of familial adenomatous polyposis coli. Acta Chir Scand 1987;153:379–83.
Klemmer S, Pascoe L, DeCosse J. Occurrence of desmoids in patients with familial adenomatous polyposis of the colon. Am J Med Genet 1987;28:385–92.
Dozois RR, Berk T, Buelow S,et al. Surgical aspects of familial adenomatous polyposis. Int J Colorectal Dis 1988;3:1–16.
Lofti AM, Dozois RR, Gordon H,et al. Mesenteric fibromatosis complicating familial adenomatous polyposis: predisposing factors and results of treatment. Int J Colorectal Dis 1989;4:30–6.
Kinzbrunner B, Ritter S, Domingo J, Rosenthal J. Remission of rapidly growing desmoid tumors after tamoxifen therapy. Cancer 1983;52:2201–4.
Waddell WR, Gerner RE. Indomethacin and ascorbate inhibit desmoid tumors. J Surg Oncol 1980;15:85–90.
Waddell WR, Gerner RE, Reich MP. Nonsteroid antiinflammatory drugs and tamoxifen for desmoid tumors and carcinoma of the stomach. J Surg Oncol 1983;22:197–211.
Reitamo JJ, Scheinin TM, Haeyry P. The desmoid syndrome: new aspects in the cause, pathogenesis, and treatment of the desmoid tumor. Am J Surg 1986;151:230–7.
Klein WA, Miller HH, Anderson M, DeCosse JJ. The use of indomethacin, sulindac, and tamoxifen for the treatment of desmoid tumors associated with familial polyposis. Cancer 1986;60:2863–8.
Jenkins NH, Freedman LS, McKibbin B. Spontaneous regression of a desmoid tumor. J Bone Joint Surg 1986;68-B:780–1.
Reitamo JJ. The desmoid tumor, IV: choice of treatment results, and complications. Arch Surg 1983;118:1318–22.
Tsukada K, Church JM, Jagelman DG, Fazio VW, Lavery IC. Systemic cytotoxic chemotherapy and radiation therapy for desmoid in familial adenomatous polyposis. Dis Colon Rectum 1991;34:1090–1092.
Flower RJ. Drugs which inhibit prostaglandin biosynthesis. Pharmacol Rev 1974;26:33–67.
Plescia OJ, Smith AH, Grinwich K. Subversion of immune system by tumor cells and role of prostaglandins. Proc Natl Acad Sci USA 1975;72:1848–51.
Ellis L, Copeland EM III, Bland KI,et al. Role of prostaglandins in surgically induced enhancement of tumor growth. Surg Forum 1989;75:433–5.
Miller-Graziano CL, Fink M, Wu JY, Szabo G, Kodys K. Mechanisms of altered monocyte prostaglandin E2 production in severely injured patients. Arch Surg 1988;123:293–9.
Kim D-H, Goldsmith HS, Quan SH, Huvos AG. Intraabdominal desmoid tumor. Cancer 1971;27:1041–5.
Waddel WR. Treatment of intra-abdominal and abdominal wall desmoid tumors with drugs that affect the metabolism of cyclic 3′,5′-adenosine monophosphate. Ann Surg 1975;181:299–302.
Verma AK, Ashendel CL, Boutwell RK. Inhibition by prostaglandin synthesis inhibitors of the induction of epidermal ornithine decarboxylase activity, the accumulation of prostaglandins, and tumor promotion caused by 12-O-Tetradecanoylphorbol-13-acetate. Cancer Res 1980;40:308–15.
Lim CL, Walker MJ, Mehta RR, Dasgupta TK. Estrogen and anti-estrogen binding sites in desmoid tumors. Eur J Cancer Clin Oncol 1986;22:583–7.
McCann J. Spectacular remissions seen in desmoid tumors. Article on Michael Baum's research. Oncol Biotechnol News 1990;4(5):11.
Ferriera SH, Vane JR. New aspects of the mode of action of nonsteroid anti-inflammatory drugs. Annu Rev Pharmacol Toxicol 1974;14:57–73.
Author information
Authors and Affiliations
Additional information
Read at the meeting of The American Society of Colon and Rectal Surgeons, St. Louis, Missouri, April 29 to May 4, 1990.
This work was supported by the International Center for Specialty Studies of Cleveland Clinic Foundation.
About this article
Cite this article
Tsukada, K., Church, J.M., Jagelman, D.G. et al. Noncytotoxic drug therapy for intra-abdominal desmoid tumor in patients with familial adenomatous polyposis. Dis Colon Rectum 35, 29–33 (1992). https://doi.org/10.1007/BF02053335
Issue Date:
DOI: https://doi.org/10.1007/BF02053335