Successful Low-Dose Chemotherapy Using Vinblastine and Methotrexate for the Treatment of an Ileoanal Pouch Mesenteric Desmoid Tumor: Report of a Case

Abstract

The purpose of this report was to describe the first known case of ileoanal pouch salvage by a low-dose regimen of vinblastine and methotrexate chemotherapy for the treatment of desmoid tumor arising from the mesentery of the ileoanal pouch in a patient who had undergone ileal pouch-anal anastomosis for familial adenomatous polyposis. Mesenteric desmoid tumor involving the ileoanal pouch in a 28-year-old female was treated with vinblastine and methotrexate biweekly for 12 months and monthly for 12 months in an outpatient unit. The desmoid tumor response to the treatment was assessed at routine intervals by physical examination and magnetic resonance imaging. Desmoid tumor was successfully treated with a low-dose regimen of vinblastine and methotrexate chemotherapy without significant side effects, and function of the ileoanal pouch was fully preserved. Magnetic resonance imaging showed a decrease in desmoid tumor size and cellularity, and changes consistent with fibrosis. This is a unique case highlighting the possibility of ileoanal pouch salvage by low-dose combination chemotherapy using vinblastine and methotrexate in a familial adenomatous polyposis patient with mesenteric desmoid tumor.

A Multimodality Approach to Successful Ileal Pouch Desmoid Excision with Pouch Salvage: Report of a Case

“…[8][9][10] Chemotherapy, utilizing combinations of vinblastine (3 mg/m 2 ), methotrexate (15 mg/m 2 ), doxorubicin (dose range, 60-90 mg/m 2 ), dacarbazine (dose range, 750-1000 mg/m 2 ), or carboplatin (400 mg/m 2 ), have been successful in resolving desmoid tumors unresponsive to standard conservative therapy. 8,9 Although chemotherapy can result in significant adverse reactions, it provides an important treatment option for inoperable DTs. 10 Surgery is generally reserved for symptomatic or refractory desmoid-related disease.…”

Low-dose dacarbazine-doxorubicin therapy against intra-abdominal desmoid tumors

“…Dacarbazine-doxorubicin (DTIC-DOX) therapy achieved better results against desmoid tumors (8-12) than other potential treatments such as prednisolone, interferon γ, vinorelbine, vinblastine and methotrexate (16)(17)(18)(19)(20). We previously reported the case of a patient who repeatedly had aggressive intraabdominal mesenteric desmoids after proctocolectomy due to FAP.…”

Successful combined treatment for giant mesenteric desmoid tumor: case report and review of the literature

“…To our knowledge, similar activity and less toxicity have been demonstrated with low-dose chemotherapy using VBL and MTX. We reviewed the published cases treated with VBL and MTX [1,6,13,17,18,[27][28][29][30] in the Table. Reviewing all series, we attempted to categorize the response to the therapy of available patients (n = 79) in 4 groups: complete response as the absence of residual tumor on imaging studies; partial response as tumor reduction greater than 50%; minor response as tumor reduction 25% to 50%; stable disease as tumor size reduction less than 25%; progressive disease as progression of the tumor during treatment; and disease recurrence within 1 months after the end of the therapy or absent response. The overall results of the low-dose chemotherapy (median of duration, 1-35 months) was complete response in 8 (10.1%) of 79, partial response in 23 (29.1%) of 79, minor response in 5 (6.3%) of 79, stable disease in 34 (43%) of 79 patients, progressive disease in 8 (10.1%) of 79, and 1 mixed response (patient with 2 lesions, partial response in one lesion and minor response in the other) after a period of 1 to 127 months of follow-up.…”