Percutaneous Intratumor Laser Ablation for Fetal Sacrococcygeal Teratoma

Abstract

<b><i>Objective:</i></b> To evaluate the efficiency of percutaneous intratumor laser ablation for fetal solid sacrococcygeal teratoma (SCT). <b><i>Subjects and Methods:</i></b> We carried out percutaneous ultrasound-guided intratumor laser ablation through a 17-gauge needle using an output of 40 W in 7 fetuses with large solid SCT and reviewed the literature for minimally invasive therapy for this condition. <b><i>Results:</i></b> Laser ablation was carried out at a median gestational age of 20 (range 19–23) weeks, and in all cases there was elimination of obvious vascularization within the tumor and improvement in cardiac function. Three (43%) babies survived and had surgical excision of the tumor within 2 days of birth, 3 liveborn babies died within 5 days of birth and before surgery, and 1 fetus died within 2 weeks after the procedure. In previous series of various percutaneous interventions for predominantly solid SCT the survival rate was 33% (2/6) (95% CI 9.7–70%) for endoscopic laser to superficial vessels, 57% (4/7) (95% CI 25–84%) for intratumor laser, 67% (8/12) (95% CI 39–86%) for intratumor radiofrequency ablation, and 20% (1/5) (95% CI 3.6–62%) for intratumor injection of alcohol. <b><i>Conclusions:</i></b> In solid SCT, the reported survival from intratumor laser or radiofrequency ablation is about 50%, but survival does not mean success, and it remains uncertain whether such interventions are beneficial or not because the number of fetuses is small and there were no controls that were managed expectantly.

Prenatal ultrasound and magnetic resonance evaluation and fetal outcome in high‐risk fetal tumors: A retrospective single‐center cohort study over 20 years

“…We aimed in this study to evaluate morbidity and mortality in fetuses SCTs are the most common fetal tumors, carrying a variable prognosis. 4,6,7,9,21 Tumor-fetal ratio and hydrops have been advocated to predict outcome 2,3,18 but were not useful predictors for outcome in our series. Early delivery and fetal surgery have been suggested to improve prognosis.…”

“…2,3 Fetuses may be considered unstable and therefore at risk of premature delivery at an unfavorable birthweight, or referred to a center that offers prenatal surgical intervention. [4][5][6][7][8][9] Delivery at a center with nearby neonatal oncology services may or may not improve outcome of fetuses with rare malignancies, 10,11 but only a few centers worldwide take an overview of large series of similar intrauterine patients to establish protocols for perinatal treatment. 1,5,8,12 Currently, there is little data available on the prenatal multimodal and multiparametric imaging as well as the clinical course of fetal tumors.…”

A Clinical Analysis of the Diagnosis and Treatment of Fetal Sacrococcygeal Teratomas

“…8 Large, rapidly growing SCTs with abundant blood vessels were found to have a higher incidence of perinatal mortality and complications than small SCTs with only a few blood vessels. 6,9 The rapid growth rates of more than 150 cubic centimeters per week 10 are associated with perinatal mortality. In the present study, in the case with rapid tumor growth, the risk of an increased fetal heart to chest ratio was higher than in the other cases.…”

“…Studies reveal a good prognosis for cystic tumors and a poor prognosis for solid ones. 9 In the case of solid tumors, several studies have demonstrated the prognostic value of the solid tumor volume index (tumor volume/estimated fetal body mass). There is a 17-fold higher risk of fetal edema when the value is >0.16.…”

“…Fetal intrauterine therapy might be considered when the fetus has cardiac abnormalities and signs of fetal edema before reaching the viable gestational age. The aim of intrauterine therapy, such as vascular embolization, radio-frequency ablation, alcohol sclerosis, and open fetal surgery, 9,18 is to prevent arterialvenous shunting and reduce the tumor size or remove the tumor completely. However, it can result in complications such as preterm delivery, intrauterine stillbirth, and maternal injury.…”