Desmoplastic small round cell tumour: characteristics and prognostic factors of 41 patients and review of the literature

Abstract

Background: Desmoplastic small round cell tumour (DSRCT) is a rare but frequently fatal sarcoma, and many of its characteristics still require further clarification.

Methods: We retrospectively analysed 41 patients treated at or referred to two regional referral centres in the UK between 1991 and 2012. A review of the current literature was also performed.

Results: The median age of presentation was 27 years (range 16 to 45 years), with a male-to-female ratio of 3:1. Ninety percent of patients had disease in the abdomen. The median size of the presenting tumour was 13 cm (range 3.5 to 23 cm), and 80% had metastatic disease at diagnosis, mainly in the liver (33%) and lungs (21%). Time-to-progression (TTP) was 3.9, 2.3 and 1.1 months after first-, second- and third-line chemotherapy, respectively. First-line treatment with VIDE chemotherapy appeared to confer the longest TTP (median 14.6 months). Ifosfamide and doxorubicin resulted in TTP of >3.8 months when used in any-line setting. Eleven patients received targeted agents as part of a clinical trial. After a median follow-up of 14 months, the overall median survival (MS) was 16 months. There was no difference in MS with regards to age, gender, or size of the presenting tumour. Patients with extra-abdominal disease survived longer compared to those with tumours in the abdomen (all still alive vs MS of 15 months; P = 0.0246). Patients with non-metastatic intra-abdominal disease who underwent surgery had an MS of 47 months (16 months for those who did not have surgery; P = 0.0235). Radiotherapy for locoregional control in patients with metastatic intra-abdominal DSRCT was associated with longer survival (MS of 47 vs 14 months; P = 0.0147).

Conclusions: DSRCT is a rare but often fatal disease that mainly affects younger male patients. Those with intra-abdominal DSRCT have a poorer prognosis, although surgical resection for localised disease and radiotherapy in the metastatic setting are associated with improved survival. A patient's age, gender and size of presenting tumour do not have prognostic significance.

Figure 1

Kaplan-Meier plot of overall survival for the entire cohort (n = 41).

Figure 2

Factors not associated with prognostic significance. Kaplan-Meier plots of overall survival stratified according to patient’s (a) age, (b) gender and (c) size of the primary tumour.

Figure 3

Factors associated with prognostic significance. Kaplan-Meier plots of overall survival stratified according to (a) site of disease (abdomen/pelvis (n = 37) or other sites (n = 4)), (b) whether patients had undergone surgical resection (n = 6) or not (n = 11) for localised intra-abdominal disease and (c) whether patients with intra-abdominal metastatic disease had radiotherapy (n = 4) or not (n = 29) for locoregional control.