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.

Keywords: ablation; aggressive fibromatosis; cryoablation; desmoid; sarcoma.

© 2019 Wiley Periodicals, Inc.

Figures

Figure 1

(A) Pre‐ablation axial T1 postcontrast MRI and (B) procedural images obtained for a patient undergoing cryoablation of an upper extremity desmoid tumor. Sequential axial noncontrast CT images obtained intermittently throughout the procedure reveal a progressive increase in the ablation zone that ultimately encompasses the mass. (C) First follow‐up axial T1 (fat sat.) postcontrast MRI revealing a small area of residual enhancing tumor at the posterior ablation margin, which was treated with a second cryoablation procedure, with extensive heterogenous enhancement anteriorly consistent with expected posttreatment change. MRI, magnetic resonance imaging

Figure 2

A, Representative pretreatment axial, coronal, and sagittal plane T2‐weighted fat‐suppressed MR images in a patient with a desmoid tumor involving the rectus abdominus. B, Axial T1‐weighted MR images five minutes postcontrast administration at preprocedural evaluation and at 2, 8, 20, and 31 months postablation demonstrating an A0 ablation. MR, magnetic resonance

Figure 3

Tumor response following cryoablation by (A) viable tumor volume, (B) mRECIST criteria, and (C) total lesion volume. Given the irregular shape and tumor margins, evaluation on the basis of the single longest cross‐sectional dimension often underestimates response. mRECIST, modified response evaluation criteria in solid tumors [Color figure can be viewed at wileyonlinelibrary.com]