Desmoid tumors are rare benign but aggressive lesions. They are characterized by bland-appearing fibroblasts, indistinct margins, and the ability of local invasion and recurrence. Though they are not cancer they may metastasize and can cause significant morbidity. Treatment is primarily surgical, although radiation or systemic therapy can be beneficial if surgery is not feasible. We retrospectively reviewed our patients since 1980 in respect to treatment modalities and outcome.

Between 1980 and 2008 26 patients (16 m, 10 f) with desmoid tumours had been surgically treated. The mean age with diagnosis was 37 years (7 – 69 years). The mean age at surgery was 46 years (10 – 81 years). 17 of the patients had only one resection. In 6 patients two resections, in 2 three resections and in one patient four resections had to be performed. Only 7 patients achieved a R0-situation. In 9 patients adjuvant radiotherapy was used. Two patients had several courses of Vinblastine or MTX based chemotherapy, three patients had Sulindac or Tamoxifen, several other patients combinations of different NSARs. All patients were still alive, one patient developed metastatic disease from the initial lesion in the groin to the foot. After an average of 17 months (7 – 42 months) 11 patients showed recurrent disease. 13 patients are without recurrence after an average of more than 9 years. In 4 patient stable disease is seen without progression in 42 to 156 months (Ø 95 months).

In conclusion desmoid tumours did show an inpredictable course of disease. Due to many alterations in treatment in the 28 years since the first patient of this study and the rareness of this disease no clear predicitve factor could be established. Remarkably no patient did need an amputation. A more detailed analysis regarding the dose effect of irradiated patients is intented.

There is little information about the effects of extracorporeal shock-wave about application the effects (ESWA) of on normal bone physiology. We have therefore investigated the effects of ESWA on intact distal rabbit femora in vivo. The animals received 1500 shock-wave pulses each of different energy flux densities (EFD) on either the left or right femur or remained untreated. The effects were studied by bone scintigraphy, MRI and histopathological examination.

Ten days after ESWA (0.5 mJ/mm² and 0.9 mJ/mm² EFD), local blood flow and bone metabolism were decreased, but were increased 28 days after ESWA (0.9 mJ/mm²). One day after ESWA with 0.9 mJ/mm² EFD but not with 0.5 mJ/mm², there were signs of soft-tissue oedema, epiperiosteal fluid and bone-marrow oedema on MRI. In addition, deposits of haemosiderin were found epiperiosteally and within the marrow cavity ten days after ESWA.

We conclude that ESWA with both 0.5 mJ/mm² and 0.9 mJ/mm² EFD affected the normal bone physiology in the distal rabbit femur. Considerable damaging side-effects were observed with 0.9 mJ/mm² EFD on periosteal soft tissue and tissue within the bone-marrow cavity.