Large chest wall fibromatosis with challenging treatment plan

The primary mode of treatment for desmoid tumors is surgical excision. However, high recurrence rates (39-79%) have been reported when surgery is used alone. The role of adjuvant radiotherapy after surgical resection of primary disease is controversial and should be based on a balanced discussion of potential morbidity from radiotherapy and local recurrence. In this patient, the maximum dimension of tumor was 21 cm. This is a larger chest wall fibromatosis than has been reported thus far, to the best of our knowledge. In this case, post-operative margins were free, but in view of the large initial tumor size and potential morbidity in case of any future locoregional recurrence, post-operative adjuvant external beam radiation was delivered. An image guided intensity modulated radiotherapy technique was chosen to spare adjacent breast and lung parenchyma, and tolerance of these structures was well respected. This case provides insight into this treatment approach