Cryoablation of Extra-Abdominal Desmoid Tumors: A Single-Center Experience with Literature Review

Abstract

Cryoablation (CA) has gained popularity in the treatment of benign and malignant musculoskeletal tumors. While extra-abdominal desmoid (EAD) tumors are not malignant, they remain challenging to treat because of their high local recurrence rate. We reviewed all EAD tumors treated with CA at our institution between November 2012 and March 2020. Fourteen procedures were performed on nine females and one male (mean age, 33 ± 18 years) as either first-line (n = 4) or salvage therapy (n = 6) with curative intent (n = 8) or tumor debulking (n = 2). Mean tumor size was 63.6 cm3 (range, 3.4–169 cm3). Contrast-enhanced MRI was performed before treatment and at 3-, 6-, and 12-month follow-up. Treatment outcome was based on the change in enhanced tumor volume (ET-V). For curatively treated patients, the mean ET-V change was −97 ± 7%, −44 ± 143%, and +103 ± 312% at 3, 6, and 12 months, respectively. For debulking patients, the mean ET-V change was −98 ± 4%, +149 ± 364%, and +192 ± 353% at 3, 6, and 12 months, respectively. During a mean follow-up of 53.7 months (range, 12–83 months), one grade III and one grade IV complication were noted. We found CA to be safe and well tolerated in patients with EAD.

Cryotherapy in extra-abdominal desmoid tumors: A systematic review and meta-analysis

“…7 studies recorded both the pre-ablation mean tumor diameter and volume [ 20 , 22 – 25 , 27 , 28 ], while 1 study recorded only the pre-ablation tumor volume [ 26 ] and 1 study only recorded pre-ablation tumor diameter [ 21 ]. Volume was assessed in different ways, either by an ellipsoid formula, a modified ellipsoid formula (½ x (length x width x height)), manual segmentation or automated software measurement.…”

“…Volume was assessed in different ways, either by an ellipsoid formula, a modified ellipsoid formula (½ x (length x width x height)), manual segmentation or automated software measurement. 2 studies utilised the ½ x (length x width x height) formula [ 20 , 27 ], 1 study utilised the ellipsoid formula [ 22 ], 3 studies utilised manual segmentation [ 23 , 25 , 28 ] and 1 study used IntelliSpace Discovery software platform (Philips Healthcare) semi-automatic 3D segmentation tool [ 26 ]. 1 study did not mention the method of volume measurement [ 24 ].…”

“…Patient selection criteria for cryoablation was heterogeneous among studies with palliative or curative intent. From the applicable studies, 79 and 61 patients were treated for curative and palliative intent respectively [ 20 , 22 , 23 , 25 , 27 , 28 ]. 38 patients underwent cryoablation as 1st line therapy and 191 patients underwent cryoablation as >1st line therapy.…”

“…For pre-ablation tumor volume and diameter, generic inverse variance method was used. Estimation of variation in 2 studies [ 23 , 25 ] was performed based on Wan et al [ 33 ]. For complications and non-progressive disease rates, logit-transform proportions with generalized linear mixed-effects model were applied.…”

Cryo‐surgery for symptomatic extra‐abdominal desmoids. A proof of concept study

“…Tremblay et al 22 described a rate of 6.7% for major complication and a rate of 13.3% for mild complications. Saltiel et al 33 reported 2 major complications out of 14 ablation procedures. We contend that the low levels of complications and the absence of any major complications in the current study may be attributed to the advanced preoperative planning and intraoperative monitoring that were implemented.…”