Percutaneous cryoablation for the treatment of extra‐abdominal desmoid tumors

• Published in: Journal of surgical oncology Vol. 120; no. 3; pp. 366 - 375
• Main Authors: Redifer Tremblay, Kaila, Lea, William B., Neilson, John C., King, David M., Tutton, Sean M.
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01-09-2019; John Wiley and Sons Inc
• Subjects: Abdominal Wall - diagnostic imaging; Abdominal Wall - pathology; Abdominal Wall - surgery; ablation; Adolescent; Adult; Aged; aggressive fibromatosis; Cancer surgery; cryoablation; Cryosurgery - methods; desmoid; Extremities - diagnostic imaging; Extremities - pathology; Extremities - surgery; Female; Fibromatosis, Aggressive - diagnostic imaging; Fibromatosis, Aggressive - pathology; Fibromatosis, Aggressive - surgery; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies; Sarcoma; Thoracic Wall - diagnostic imaging; Thoracic Wall - pathology; Thoracic Wall - surgery; Tomography, X-Ray Computed; Tumors; Young Adult; sarcoma; cryoablation; aggressive fibromatosis; ablation; desmoid
• ISSN: 0022-4790; 1096-9098
• DOI: 10.1002/jso.25597

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.