Diagnosis
Desmoid-type fibromatosis of the right infraclavicular region. Status post systemic therapy and radiation therapy.
Patient:
Male, 51 years old, Georgia
Physician:
Dr. Daniel Rau, Head of the Center for Tumor Orthopedics and Surgical Oncology, Charité – Universitätsmedizin Berlin
Clinical History and Prior Therapy
Primary Diagnosis: Mass in the right infraclavicular fossa (measuring approx. 10 × 4.5 × 4 cm) closely adhering to the subclavian vessels (vasa subclavia), with cortical destruction along the anterior contour of the clavicle (extending up to 2 cm). Core needle biopsy confirmed a desmoid tumor.
Systemic Therapy (Medical Treatment):
- Chemotherapy: 3 cycles of liposomal doxorubicin.
- Targeted Therapy (Pazopanib): Pazopanib treatment was temporarily interrupted and adjusted due to a transient elevation of liver enzymes (Grade 3 hepatotoxicity). Liver function tests have since stabilized. During pazopanib therapy, significant tumor regression was achieved, decreasing from 11.2 cm to approximately 7.0 cm.
- Radiation Therapy: Radiotherapy was administered concurrently with ongoing pazopanib treatment.
Current Status
The patient's overall condition is stable. Following the completion of radiotherapy, a follow-up MRI was performed on September 8, 2026. A multidisciplinary tumor board recommended a consultation with a surgical oncologist.
Surgical Oncology Recommendations by Dr. Daniel Rau
Based on the provided information, the patient presents with desmoid-type fibromatosis of the right infraclavicular region, which has already demonstrated significant regression under systemic therapy with pazopanib and underwent radiation therapy just a few weeks ago.
According to current international clinical practice guidelines for desmoid tumors, there is no clear indication for surgical resection of residual post-treatment masses visible on imaging after systemic or radiation therapy. Treatment decisions depend primarily on clinical course, documented disease progression, or impending functional impairment.
This principle is particularly critical in anatomically complex locations—such as the infraclavicular fossa or shoulder girdle—due to proximity to the subclavian artery, subclavian vein, and brachial plexus. Surgical intervention in these regions carries a high risk of severe functional loss and complex reconstructive complications, and should only be considered when clinically imperative.
Furthermore, radiation therapy was completed in mid-July 2026. For desmoid tumors, radiation-induced therapeutic response can evolve over many months. Consequently, imaging performed only 7 to 8 weeks post-radiation does not reflect the final local treatment efficacy. In this clinical context, radiotherapy serves as a definitive local therapy rather than neoadjuvant (preoperative) treatment.
Given this clinical course, surgical resection is currently not indicated. The recommended management plan is close clinical surveillance and serial MRI monitoring.
MRI review confirms this assessment. Surgical intervention is not recommended.
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