Interpretation of the latest treatment guide for hard fibroma

Hello everyone, today we are going to share the latest guidelines for the treatment of hard fibroma. The guide was published in the European Cancer Magazine in January 2020. The author is an organization called the "Hard Fibroma Cooperation Group". Although this organization is to sayIt is a consensus made at a conference in Milan, Italy in 2018, but because it contains consensus reached by experts from North America, Europe, Japan and other countries, it can be understood as oneGlobal Treatment Guide.

1. Common sense of invasive fibroma

First of all, I want to give the patients popular science that "hard fibroma" and "" invasive fibroma "," "ligament -like fibroma" and "fibroma" are the same disease, but they are only different.

For this disease, according to epidemiological statistics, it is good to occur in women. According to international documents, the proportion of men and women is about 1: 3, but the data of men and women in our country is not so different.Reach the ratio of 1: 3.It can happen at any age. According to our experience, the youngest patients are less than one year old, and the oldest patients are even 82 years old, but the average and median age (the peak of the onset) is generally 30 years old at the age of 30about.

Regarding the treatment of this disease, it is traditionally divided into three major blocks of surgery, radiotherapy, and drug treatment.Among them, drug therapy is divided into chemotherapy and targeted therapy.In addition, as everyone’s understanding of this disease has further deepened, the general trend is to be more inclined to conservative observation and drug treatment.The status of surgery and radiotherapy has greatly reduced the treatment ratio of this disease. I will give you a detailed explanation later.

There is a very interesting data about surgical treatment of hard fibroma.Everyone knows that there are two situations: "cutting clean" and "not clean", which is the "negativeness of cutting edge" and "positive".It is now found that the recurrence rate is almost the same for patients with the first surgery or positive.However, if surgery is performed after recurrence, the negative effect of cutting edge will be more positive than cutting edge. This difference gives us two revelations: First, the first diagnosis of this disease is particularly important. Many patients may have found a local area.The mass is directly removed without any pathological puncture. After the surgery is performed, it is discovered that it is the disease. This will lose the opportunity to expand the resection for the first time.A better and satisfactory tumor control effect.

There is a guideline recognized by all oncologists in the world, called NCCN guidelines, which gives some drugs that can be used in the treatment of hard fibroma, including non -steroidal anti -inflammatory drugs and anti -estrogen treatment.Drugs such as Xifen, Torimen); in addition, chemotherapy drugs include methotrexate, Changchun Shin -alkali, Changchun Risbin, Doro Bico, Dorrio Star Liposuction, etc. can be used to treat this diseaseof.There are also some foreign scholars studying for small dose interferon; in addition, the targeting drugs that can be used in the guidelines include Emantinib, Sorafeni, etc. The reason for the recommendation isEvidence of some large -scale clinical trials is supported.

The above content is about some basic common sense of hard fibroma. The following content will officially start the interpretation of the latest tumor tumor in Europe. This guide has compared to our previous understanding of the treatment of hard fibroma, in some places to compareBig update.

2. Growth method, incidence and conservative observation

This disease shows a local aggressive growth trend. Because of this aggressive growth trend, patients are more likely to recur on.Even so, everyone must realize that the disease is not malignant, and it will not move.

However, the disgusting thing about this disease is that it often forms multiple lesions on the limbs and body. Some patients may have a deep understanding. They may only have a bag at first, but after repeated surgery, it may be on the upper end of the original mass.It grows new blocks, and we find that this mass has a tendency to grow along the blood vessel nerve beam.Some patients have grown on their feet. Later, they may slowly grow to the calf and thighs, and even to the hips. This way of growth grows itself -grow from the direction from the remote to the heart to the heart.EssenceHowever, there is also a way to grow far -hearted. Some patients may grow on their hips. After repeated surgery, they may grow to their thighs and then grow to calves.This is also a strange feature of this tumor, and it is also a very important way to grow different from other tumors.

In recent years, the incidence of this disease has increased. The data about ten years ago showed that the incidence was 2 to 4th, which was that there may be 2 to 4 new diseases each year among 1 million people, but now this is nowThe data is raised to 5 to 6, which means that 5 to 6 new patients may be newly patients each year.

This disease can occur in the abdominal wall, abdominal cavity, or other places outside the abdominal wall and abdominal cavity. There are about 5%-10%of patients. It may merge a disease called FAP. FAP is called family adenoma polyps.It is mainly manifested as a polyps of colon, which will evolve into colon cancer.If patients with this disease are combined with hard fibroma at the same time, they are called Gardner syndrome. Gardner syndrome is an ingredients of alternative chromosomal genetic diseases, and half of the probability is inherited to their offspring.

Any tumor must do a clear nature of a puncture biopsy before treatment.Some patients may feel that tumors increase after puncture.Is this really the case?Through some retrospective studies in this guide, a conclusion was obtained. This is that the tumor increased or painful after this puncture, which did not mean that the puncture stimulated the growth of the tumor.Terminal is too nervous to puncture.

We mentioned that the growth method of this tumor has changed a lot. Recent research also observes a situation. It may be stable for a long time or it may continue to grow, and it may even subscribe by itself.However, the greater the tumor, the greater the possibility of continuous growth, that is, the tumor with a large volume may be more difficult to treat. At the same time, it is not suitable for this conservative therapy for observation.

In addition, patients may be very concerned. When is it better to start treatment after diagnosis?Or in the past, I did not know that it was the disease, and now I have relapsed. When will it be better after recurrence?In this regard, the latest guide puts forward a suggestion that we can simply summarize it into a sentence, called "it is not long."That is to say, whether you are original or recurrence patients, first of all, observe first, and we recommend observing two consecutive times -to pass the two consecutive imaging examinations for review (ultrasound, CT or nuclear magnetic).When we all show that the tumor has a growing growth trend before, we need to actively intervene.

At present, this European guide puts forward clear suggestions on hard fibroma from diagnosis to the treatment of the entire process: First of all, suspecting this disease, you need to do a diagnosis, and obtain the pathological diagnosis through rough needle puncture; after diagnosis, first step, the first stepIt is active observation. It is just what I said that we may need to review the nuclear magnetic magnetic every three months. At least twice continued twice, observing the progress of the tumor before treatment is needed.If the tumor observes two consecutive observations (they are increasing), which treatment should be selected later depends on its occurrence.

3. Related principles for surgery

At present, this guide believes that only hard fibroma growing on the abdominal wall is the first choice.treat.Everyone note that this is the biggest different from the previous, that is, in the treatment of these parts, different treatment methods are selected according to different parts. Only the position of the abdominal wall is the first choice.Essence

Let’s talk about the principles of surgery below. As far as surgery is concerned, expanding resection to negative cutting is a goal of surgery, and it is also an ideal situation we need to reach.But the positive edge is also acceptable. When can it accept this situation?That is to say, when expanding resection will cause huge losses in body and organ function and appearance, then we can sacrifice the negativeness of the cutting edge in this case.The visible residual tumor cells are also acceptable.

The second principle of surgery is that if the pre -surgery has been predicted, the positive mirror cutting edge may occur. In this case, in addition to surgery, other conservative drug treatment should be considered.And even if there is a positive condition during surgery, we do not recommend postoperative radiotherapy, or to expand resection again.Many patients may remove this tumor as an ordinary tumor at the beginning, and the cutting edge may be positive.In this case, many, many patients may be puzzled. I don’t know if they want to do radiotherapy immediately or immediately expand resection.According to the current guide, you do n’t need to do this. You can keep observation first and confirm that it recurs, and it is necessary to continue to grow before you need to treat it.

4. Related principles for radiotherapy

Under what circumstances can you consider radiotherapy?The guide mentioned in some specific situations, such as the age of patients, unable to withstand surgery, tolerance of drug treatment, or patients with some complications, not suitable for surgery or drug treatment, or this lesion grows too fast too fast, It may threaten important organs, and radiotherapy can be considered in this case.It is worth mentioning is the side reaction of radiotherapy. Especially in young people, it may lead to physical developmental disorders, body joint contracture, and even severe if it is severe.Fibrous sarcoma has occurred in the future, and fibromaoma has become malignant sarcoma. Therefore, we now do not advocate radiotherapy for young patients.

5. About Gardner syndrome

Below, let’s talk about the previous mention of family adenoma polyp disease with hard fibroma called Gardner syndrome. There are several patients in our group.Compared to more aggressiveness, at the same time, the way of multi -lesion growth will often show.And most of this Gardner syndrome -related tumor grows behind the abdominal cavity and peritoneal. In this case, it may have a certain impact on life. Therefore, we will take more positive drug treatment methods.

6. Drug treatment

[Xilezheng]:

Xi Leyi is the representative of non -steroidal anti -inflammatory drugs recommended by the guide I mentioned earlier. The current clinical trial tips, Xilezhe combined with antibacterial drugs such as Monoffimen)It has a good effect, so it is not recommended for conventional drug therapy for hard fibroma.

[Targeting drugs]:

The sub -reactions of common targeting drugs for hard fibroma are fatigue, rash, hypertension, and gastrointestinal reactions.The earliest and most commonly used is Imarinib.The characteristic of Ima Diitinib is that there is a relatively high tumor control rate, which can have a probability of 60%-80%to allow the tumor to reach a stable condition.However, its tumor tumor rate (that is, the probability of narrowing tumors) is relatively low. Different studies have shown that the tumor reducing rate of Imarinib is about 6%-19%.

In addition, there are two new targeting drugs. In 2018, the research results were announced at a internationally renowned oncology conference called ASCO.

Solafini is a drug that can treat liver and kidney cancer. Now it is used for some research on hard fibroma. Regarding this medicine, their research plan is 400 mg/dailyThat is to say, about 1/3 of patients can be reduced after taking Sorafini.Although the dose recommended in the experiment is 400 mg per day, it is also found that if the dose is reduced to 200 mg (that is, half of the dose), the patient can also benefitYou can also receive a certain effect.

Borizani is approved by the FDA in the United States. The first targeted medicine for soft tissue sarcoma (soft tissue sarcoma is a malignant tumor, which is different from our hard fibroma), but now I also try to use thisMedicine is used to treat hard fibroma. The recommended dose is 800 mg per day, but in our clinical application, it is found that this dose may be relatively large for the Chinese physique.After some adjustments, many of our patients are taken at 600 mg/daily dose.The effective rate of this medicine is similar to Sorafini.

It is worth pointing out that, according to the current existing test evidence, these three targeting drugs that are effective for hard fibroma are these three -Emantinib, Sorafini, and Borizani.But I know many patients or some other doctors in other places recommend patients to eat Apatinib and Arotinib.Theoretically, Apatinib, Arotinib, Bacopini, Sorrafini, etc. are similar medicines, but medicine believes that as long as there is no evidence to prove that it is effective, it should not be abused casually.Since we have the tests that have been confirmed to have effective these three medicines, we should choose these three medicines when choosing. Although theoretically Aerotinib and Apatinib may be valid, but because there is no verification support support, there is no support for verification.Try not to use it as the first choice.

[Chemotherapy]:

Next, let’s talk about chemotherapy.Some chemotherapy for hard fibroma is now a small -dose chemotherapy for chemotheatprexide, Changchun Risbly, or Dorno.

Small chemotherapy: There are two main solutions we use. One is the small chemotherapy that patients are more familiar with. This solution mainly uses two medicines: methotrexate and Changchun Ruibin.Regarding methotrexate, it is generally used internationally internationally, and there are also useful use of intravenous infusion once a week, but the treatment effect is far worse than orally.Regarding Changchun Ruibin, it was mainly used in the method of infusion, once a week, but now it has oral capsule products, which is greatly convenient for patients.Patients should use simple oral methotrexate and Changchun Rinbin. Compared with the form of infusion, the efficiency should be similar.

The tumor reducing rate of small chemotherapy is between 35%-40%. Chemotherapy has a characteristic that the tumor rarely reduces the initial stage of treatment.Time can observe the narrowing of the tumor, and it is also observed that an interesting phenomenon is that once the tumor shrinks under the action of the drug, this tumor can continue to shrink after stopping the drug.

Some patients may feel that the tumor is still long, and the tumor is still long, and it is uncertain whether chemotherapy is effective.I often play such an analogy to patients. For example, you are driving east at a speed of 60 kilometers/hour. If you want to turn around, you must slow down first.This car is also driving forward, so we think that as long as you are using the first evaluation of the medication, the tumor increases by not more than 20%, and we still think it is effective.

Some patients are concerned about how long the drug treatment can be controlled. Regarding this issue, there is no particularly clear data. The result of the statistics of small doses of chemotherapy before, nearly 40%of patients with less than 50 years. After 5 years of stopping the drug, after 5 years of stopping the medicineThe tumor can also be continuously stable or even reduced.International research data also proves that 50%-70%of patients can reach a relatively long-term disease control.

It is worth noting that if the tumor is treated with drugs first and effectively controlled after a period of time, we can also try to use the previous plan.It is necessary to pay attention to its side reaction problem, especially methotrexate. If orally for a long time, a relatively serious side effect may occur called pulmonary fibrosis, and it also has a certain impact on the liver and reproduction.Therefore, the cycle we treat now is generally up to a year and a half. Many patients may use a year of methotrexate first, and feel that the effect is not bad.But it may be a period of time. After three or five years, I will grow up. I ask if I can use this solution anymore. At most, we will let the patient eat for half a year.However, some patients have eaten for two years, but because there are individual differences, it is best to control for one and a half years for safety.

At present, there is a new study abroad about chemotherapy, which is simply orally in Changchun Risbin, but the dose it uses is relatively large. Eat 80 to 90 mg a week. According to their reports, this treatment method will also have a good effect.But because this article was published at a meeting, and it was not officially published as a paper. Therefore, we are temporarily doubt about its reliability, so we do not recommend patients as a conventional choice.

Big Chemotherapy: Now let’s talk about the large chemotherapy. The large chemotherapy is a treatment solution based on the cycloid drugs.Drugs may have been used by patients. At present, the latest is Dorrio Bichen Liposuction. Compared with other drugs, this drug is mainly more than the previous drugs.The rate is relatively high, and the tumor will be shorter.Generally, we are used to grow quickly or in the abdominal cavity, and the thoracic threatening of life or important organs in the chest cavity.Regarding its medication cycle, we have a maximum of 12 cycles for patients, the effect is good, and the response is not great, but the internationally recommended internationally is generally six to eight cycles.

[Section of the choice of drug treatment plan]:

I just said so much drug treatment, including targeted therapy, small chemotherapy, and large chemotherapy. So which solution should be the first choice, which one is the second, the third?There is no consensus internationally internationally. Internationally, it is recommended to choose a gradient from low toxicity to high toxicity. It is to use low toxic drugs and then use high toxic drugs, but I think this view is more one -sided.I think the choice of the plan should be based on the following five aspects: the first is the level of evidence; the second is the tumor division rate, the third is the control rate of tumors, and the fourth is the convenience of our administration.It is more convenient than infusion, and the economy is also a manifestation of convenience. It is definitely easier to get cheap than expensive. The fifth is the degree of toxicity of the drug. I think it should be comprehensive and individualized judgment.Essence

7. Tumor efficacy assessment

If the conditions permit, be sure to do enhanced MRI. The MRI’s evaluation of the efficacy of tumor can provide the most information, including the judgment of the size of the tumor is the most accurate. In addition, through the changes in the degree of strengtheningChange the level of tumor metabolism.

8. About the pregnancy of female patients

It is now considered that pregnancy is not a taboo of a hard fibroma, but pregnancy needs to be performed by the secret monitoring of experienced obstetrics and gynecology doctors and hard fibroma experts.Everyone knows that this disease is related to estrogen. Due to the changes in hormones during pregnancy, there are many stimulating tumor growth.I generally recommend patients: if you are the first child, you can try to take risks, but if you are a second child, you should consider it carefully.

9. Some new progress in the treatment of hard fibroma

Recently, many patients are very concerned about a new drug. That medicine is called nirogacestat. This medicine is now conducted abroad to the third phase of the clinical trial stage. Its expected deadline should be in April 2023.A tumor control rate close to 100%, the effect is very good.This medicine is a orphan drug developed specifically for hard fibroma. Many patients may have seen this information and have high hopes for it.I am now actively contacting the United States. I hope that we can introduce the third phase of this medicine to China. In this case, our patients can use this medicine earlier.However, it may be affected by the epidemic and international political factors, and the progress will be relatively slow.After the explanation is over, I will not dissolve this group. I will change it to a recruitment group of clinical experiments of new hard fibroma new drugs. You can continue to pay attention to the information of this group.Once the clinical experiments of this medicine are carried out in China, I will publish information in this group.It was mentioned before that the principles of Arotinib are similar to Sorafini and Sobizoni, and there should be similar effects, but now there is no clinical experiment to support it can be used in clinical clinical, so I don’t have it.It is advocated that patients can buy this medicine by themselves, but in order to verify the efficacy of this medicine, I will soon conduct a clinical trial. At that time, everyone can come to the group. This clinical experiment will be in the early stage.For free, we will use two months to determine whether the medicine is effective. If it is valid, the patient will be purchased by themselves.

10. About the recovery of hard fibroma

Because many patients’ hard fibroma grows on the limbs, especially near the joints. In this case, after early surgery or the development of tumors, it will lead to a contracture of the limbs and may lead to limited joint activity. Now this kind ofIn the case, we also cooperated with professional rehabilitation doctors to cooperate with the rehabilitation treatment after the control of hard fibroma drug control. At that time, it will also give you some guidance for everyone.(Medical cards have been added here, please go to today’s headline client to view)

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