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Tyrosine kinase inhibitors versus radiation therapy in unresectable dermatofibrosarcoma protuberans (DFSP): A narrative systematic review

Published:September 25, 2022DOI:https://doi.org/10.1016/j.amjsurg.2022.09.040

      Highlights

      • Literature regarding TKI and radiotherapy for unresectable DFSP are reviewed in detail.
      • TKI may be employed against all DFSP histology types, with 70–95% clinical benefit.
      • Radiotherapy alone may be limited to low-grade classic DFSP, with 90% clinical benefit.
      • Patient selection is paramount and adverse effect profiles must be considered.

      Abstract

      Background

      In unresectable dermatofibrosarcoma protuberans (DFSP), no clear guideline exists regarding the use of tyrosine kinase inhibitors (TKI) versus radiotherapy. This study reviews current literature regarding TKI and radiotherapy in unresectable DFSP.

      Methods

      Following PROSPERO registration (CRD42021232508), a systematic literature search was performed including all studies reporting clinical results of TKI and/or radiotherapy in the treatment of unresectable DFSP. A narrative synthesis was used to compare patient characteristics, outcomes, and adverse effects.

      Results

      Of 1345 screened studies, 14 were included for review. Patient age ranged 18–77 years and 55% were male. Radiotherapy patients exhibited lower grade disease than TKI patients. Overall clinical benefit following TKI ranged from 70% to 96%. Radiotherapy patients exhibited control or resolution on last follow-up in 90% of cases. Radiotherapy adverse effects were mild, while TKI adverse effects were more severe and managed with dose reduction.

      Conclusion

      TKI may be employed in unresectable DFSP of all histology types whereas radiation alone may be limited to low-grade and classic-type DFSP. TKI may cause more severe adverse effects compared to radiation alone.

      Keywords

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