E5116. Desmoid Tumor Cryoablation: An Effective Technique for a Management Conundrum
Authors
Fereshteh Yazdanpanah;
University of Pennsylvania
Stephen Hunt;
University of Pennsylvania
Background
Aggressive fibromatosis with low potential for distant metastasis may present on any part of the body; it is locally aggressive and can cause pain. Peak incidence is at age 35–40 years; 85–90% are sporadic and 10–15% are genetic (APC). Sporadic: associated with prior trauma or surgery; associated with mutations in CTNNB1. Genetic: hereditary APC mutations. This exhibit reviews the presentation, epidemiology, and imaging features of desmoid tumors, featuring two case reports of cryoablation-treated desmoid tumors. The exhibit presents current treatment methods with an emphasis on cryoablation.
Educational Goals / Teaching Points
Review relevant pathophysiology of desmoid tumors. Describe indications for desmoid tumor cryoablation. Describe risks of desmoid tumor ablation. Highlight tips and tricks for risk mitigation. Cryoablation is a promising treatment modality, found to result in low rates of recurrence.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Desmoid tumors may present as a mass in any part of the body. They may be treated with cryoablation, which is destruction of tumor using extreme cold. Cryoablation probes are placed under CT guidance; subdermal nerve block; hydro/pneumodissection to separate tumor from dermis; insertion of multiple cryoprobes under CT guidance; two 10-minute freeze cycles separated by 5-minute active thaw cycles. Intermittent monitoring of cryoablation zone under CT. Follow-up MRI at 1 month, 6 months, and 1 year.
Conclusion
Treatment of desmoid tumors based on patient and disease factors: location, comorbidities, and age. Surgical resection results in a 29% risk of recurrence. Chemotherapy regimens have shown 12-month progression-free survival ranging from 67–90%. Multiple retrospective articles have shown cryoablation to be an effective modality for treatment of desmoid tumors. A recent meta-analysis demonstrated progression-free survival ranging from 62–100% with major complication rates of under 6%. Cryoablation is a safe and effective modality for treatment of extra-peritoneal desmoid tumors.
