Percutaneous cryoablation for the treatment of extra‐abdominal desmoid tumors

Abstract

Background Desmoid tumors are rare locally invasive, benign neoplasms that develop along aponeurotic structures. Current treatment is complicated by associated morbidity and high recurrence rates. Methods A retrospective, single‐institution review identified 23 patients (age: 16‐77) with extra‐abdominal desmoid tumors who received CT‐guided percutaneous cryoablation as either a first‐line (61%) or salvage (39%) treatment in 30 sessions between 2014 and 2018. Median maximal lesion diameter was 69 mm (range: 11‐209). Intent was curative in 52% and palliative in 48%. Contrast‐enhanced cross‐sectional imaging was obtained before and after treatment in addition to routine clinical follow‐up. Results Technical success was achieved in all patients. The median follow‐up was 15.4 months (3.5‐43.4). Symptomatic improvement was demonstrated in 89% of patients. At 12 months, the average change in viable volume was −80% (range −100% to + 10%) and response by modified response evaluation criteria in solid tumors (mRECIST) was CR 36%, PR 36%, and SD 28% No rapid postablation growth or track seeding was observed. Four patients underwent repeat cryoablation for either residual or recurrent disease. Two patients sustained a major procedural complication consisting of significant neuropraxia. Conclusion Cryoablation for desmoid tumors demonstrates a high degree of symptom improvement and local tumor control on early follow‐up imaging with relatively low morbidity.

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

“…The study met its primary endpoint with 86% of patients having non-progressive disease at the 12-month follow-up, reduced pain, and better functional status. We found an additional five retrospective case series including up to 34 patients, one prospective case series, and three case reports ( Table 4 ) [ 11 , 12 , 13 , 14 , 24 , 25 , 26 , 27 , 28 ]. Most of these studies evaluated the safety and efficacy of CA as a second- or third-line treatment in symptomatic or progressive EAD tumors.…”

Management of aggressive fibromatosis (Review)

“…Simultaneously, the boundaries of the tumors are hard to distinguish intraoperatively from scars and connective tissue, causing difficulty in R0 resection ( 32 ). Recurrence after surgery not only occurs in situ but also in adjacent areas, as it is unable to preserve connective tissues well ( 33 ). Under these conditions, repeated recurrent desmoid tumors would tend to invade surrounding tissues in a concentric way if treated with surgery, which would gradually invade more tissues and important organs or major vessels.…”

“…According to Kurup and Callstrom ( 101 ), percutaneous cryoablation is a less-invasive treatment potential to cure desmoid tumors. A study ( 33 ) was performed to evaluate the efficacy, safety and advantages of cryoablation for both first-line treatment and remedial treatment of extra-abdominal desmoid tumors. A total of 89% of patients reported improvement and the average change in viable volume was −80% (range, −100 to +10%) with complete response of 36%, partial response of 36% and stable disease of 28% after a 1-year follow-up.…”

“…Similar results affirmed the efficacy of cryoablation for its high rate of local control ( 102 , 103 ). In addition, cryoablation has been investigated as both first-line and salvage treatment modality ( 33 ) and an ideal outcome has affirmed its reliability.…”

“…However, recurrence sites after surgery are located in adjacent tissue, complicating further therapy by causing neurovascular injury. This is due to connective tissues or compartments being well-preserved in cryoablation, unlike in surgery ( 33 ). Cryoablation has better local control which may substitute surgery or radiotherapy, neither of which alone could attain an ideal local control ( 47 ).…”