Advertisement

Skeletal Radiology

, Volume 39, Issue 2, pp 175–182 | Cite as

Early experience with percutaneous cryoablation of extra-abdominal desmoid tumors

  • Jennifer L. Kujak
  • Patrick T. LiuEmail author
  • Geoffrey B. Johnson
  • Matthew R. Callstrom
Technical Report

Abstract

Objective

Surgical resection, radiation therapy and chemotherapy are all accepted as standard treatments for extra-abdominal desmoid (EAD) tumors, but their effectiveness has been limited by frequent local recurrence. The purpose of this article is to describe our early experiences with using percutaneous cryoablation for local control of extra-abdominal desmoid tumors in five patients whose tumors had failed to respond to standard therapy.

Material and methods

In a retrospective search of our institution’s radiology database for patients who had undergone percutaneous cryoablation for treatment of EAD tumors between June 2004 and July 2007, we identified five patients (three female and two male). No patients were excluded from this review. Three of these patients had been referred for cryoablation for local tumor control, and two had been referred for palliation of inoperable tumors. The age range of the patients at the time of cryoablation was 9–41 years. The treated EAD tumors were located in the neck, shoulders and trunk and ranged in size from 3.0 cm to 10.0 cm. Medical records were reviewed for short-term and long-term follow-up, and patients were contacted for additional follow-up. Patients were asked to rate their pain as absent, mild, moderate or severe, and to compare it with their levels before cryoablation, describing it as improved, unchanged or worsened. Radiology records were reviewed to follow the size of the EAD tumors before and after cryotherapy.

Results

For the three patients referred for local control of EAD tumors, complete tumor coverage with the ablation zones was achieved. Two of these patients, with masses 3.0 cm and 4.9 cm in diameter, reported complete absence of pain at both short-term and long-term follow-up at 13 months and 49 months. Their tumors had completely resolved on long-term imaging follow-up at 19 months and 43 months. The third patient, with a 6.1 cm mass, reported improved mild pain at 6 months, and imaging showed a moderate decrease of tumor size. For the two patients referred for palliative therapy, initial partial pain relief was felt 2 weeks after the procedure, At long-term (58 months) follow-up of one patient with a 9.1 cm mass, the tumor was still present although reduced in size, and local pain had returned to its former moderate level. In the other patient who underwent only partial treatment of a 10.0 cm mass, at long-term follow-up (36 months) the mass had enlarged and pain had returned to the pretreatment, moderate level.

Conclusion

Cryoablation appears to be an effective alternative treatment for the achievement of local control of small and moderately sized EAD tumors, but it is likely of limited use in patients with larger tumors that have untreatable regions due to involvement of vital structures. Continued research evaluating cryoablation for the treatment of EAD tumors is needed.

Keywords

Cryotherapy Fibromatosis Desmoid 

References

  1. 1.
    Azizi L, Balu M, Belkacem A, Lewin M, Tubiana JM, Arrive L. MRI features of mesenteric desmoid tumors in familial adenomatous polyposis. AJR Am J Roentgenol. 2005;184:1128–35.CrossRefGoogle Scholar
  2. 2.
    Kransdorf MJ, Murphey MD. Imaging of soft tissue tumors. 2nd ed. Lippincott Williams & Wilkins 2006.Google Scholar
  3. 3.
    Dafford K, Kim D, Nelson A, Kline D. Extraabdominal desmoid tumors. Neurosurg Focus. 2007;22:E21.PubMedGoogle Scholar
  4. 4.
    Okuno S. The enigma of desmoid tumors. Curr Treat Options Oncol. 2006;7:438–43.CrossRefGoogle Scholar
  5. 5.
    Dinauer PA, Brixey CJ, Moncur JT, Fanburg-Smith JC, Murphey MD. Pathologic and MR imaging features of benign fibrous soft-tissue tumors in adults. Radiographics. 2007;27:173–87.CrossRefGoogle Scholar
  6. 6.
    Higaki S, Tateishi A, Ohno T, et al. Surgical treatment of extra-abdominal desmoid tumours (aggressive fibromatoses). Int Orthop. 1995;19:383–9.CrossRefGoogle Scholar
  7. 7.
    Leithner A, Gapp M, Leithner K, et al. Margins in extra-abdominal desmoid tumors: a comparative analysis. J Surg Oncol. 2004;86:152–6.CrossRefGoogle Scholar
  8. 8.
    Sorensen A, Keller J, Nielsen OS, Jensen OM. Treatment of aggressive fibromatosis: a retrospective study of 72 patients followed for 1–27 years. Acta Orthop Scand. 2002;73:213–9.CrossRefGoogle Scholar
  9. 9.
    Hansmann A, Adolph C, Vogel T, Unger A, Moeslein G. High-dose tamoxifen and sulindac as first-line treatment for desmoid tumors. Cancer. 2004;100:612–20.CrossRefGoogle Scholar
  10. 10.
    Fontanesi J, Mott MP, Kraut MJ, Lucas DP, Miller PR. The role of postoperative irradiation in the treatment of locally recurrent incompletely resected extra-abdominal desmoid tumors. Sarcoma. 2004;8:83–6.CrossRefGoogle Scholar
  11. 11.
    Gega M, Yanagi H, Yoshikawa R, et al. Successful chemotherapeutic modality of doxorubicin plus dacarbazine for the treatment of desmoid tumors in association with familial adenomatous polyposis. J Clin Oncol. 2006;24:102–5.CrossRefGoogle Scholar
  12. 12.
    Melis M, Zager JS, Sondak VK. Multimodality management of desmoid tumors: how important is a negative surgical margin? J Surg Oncol. 2008;98:594–602.CrossRefGoogle Scholar
  13. 13.
    Xu KC, Niu LZ, He WB, Hu YZ, Zuo JS. Percutaneous cryosurgery for the treatment of hepatic colorectal metastases. World J Gastroenterol. 2008;14:1430–6.CrossRefGoogle Scholar
  14. 14.
    Bageacu S, Kaczmarek D, Lacroix M, Dubois J, Forest J, Porcheron J. Cryosurgery for resectable and unresectable hepatic metastases from colorectal cancer. Eur J Surg Oncol. 2007;33:590–6.CrossRefGoogle Scholar
  15. 15.
    Atwell TD, Farrell MA, Leibovich BC, et al. Percutaneous renal cryoablation: experience treating 115 tumors. J Urol. 2008;179:2136–40; discussion 40-1.CrossRefGoogle Scholar
  16. 16.
    Hinshaw JL, Shadid AM, Nakada SY, Hedican SP, Winter TC 3rd, Lee FT Jr. Comparison of percutaneous and laparoscopic cryoablation for the treatment of solid renal masses. AJR Am J Roentgenol. 2008;191:1159–68.CrossRefGoogle Scholar
  17. 17.
    Littrup PJ, Freeman-Gibb L, Andea A, et al. Cryotherapy for breast fibroadenomas. Radiology. 2005;234:63–72.CrossRefGoogle Scholar
  18. 18.
    Kawamura M, Izumi Y, Tsukada N, et al. Percutaneous cryoablation of small pulmonary malignant tumors under computed tomographic guidance with local anesthesia for nonsurgical candidates. J Thorac Cardiovasc Surg. 2006;131:1007–13.CrossRefGoogle Scholar
  19. 19.
    Onik G, Vaughan D, Lotenfoe R, Dineen M, Brady J. The “male lumpectomy”: focal therapy for prostate cancer using cryoablation results in 48 patients with at least 2-year follow-up. Urol Oncol. 2008;26:500–5.CrossRefGoogle Scholar
  20. 20.
    Wang H, Littrup PJ, Duan Y, Zhang Y, Feng H, Nie Z. Thoracic masses treated with percutaneous cryotherapy: initial experience with more than 200 procedures. Radiology. 2005;235:289–98.CrossRefGoogle Scholar
  21. 21.
    Beland MD, Dupuy DE, Mayo-Smith WW. Percutaneous cryoablation of symptomatic extraabdominal metastatic disease: preliminary results. AJR Am J Roentgenol. 2005;184:926–30.CrossRefGoogle Scholar
  22. 22.
    Callstrom MR, Atwell TD, Charboneau JW, et al. Painful metastases involving bone: percutaneous image-guided cryoablation—prospective trial interim analysis. Radiology. 2006;241:572–80.CrossRefGoogle Scholar
  23. 23.
    Allaf ME, Varkarakis IM, Bhayani SB, Inagaki T, Kavoussi LR, Solomon SB. Pain control requirements for percutaneous ablation of renal tumors: cryoablation versus radiofrequency ablation—initial observations. Radiology. 2005;237:366–70.CrossRefGoogle Scholar
  24. 24.
    Evonich RF 3rd, Nori DM, Haines DE. A randomized trial comparing effects of radiofrequency and cryoablation on the structural integrity of esophageal tissue. J Interv Card Electrophysiol. 2007;19:77–83.CrossRefGoogle Scholar
  25. 25.
    Hinshaw JL, Lee FT Jr. Cryoablation for liver cancer. Tech Vasc Interv Radiol. 2007;10:47–57.CrossRefGoogle Scholar
  26. 26.
    Janzen NK, Perry KT, Han KR, et al. The effects of intentional cryoablation and radio frequency ablation of renal tissue involving the collecting system in a porcine model. J Urol. 2005;173:1368–74.CrossRefGoogle Scholar
  27. 27.
    Robbin MR, Murphey MD, Temple HT, Kransdorf MJ, Choi JJ. Imaging of musculoskeletal fibromatosis. Radiographics. 2001;21:585–600.CrossRefGoogle Scholar
  28. 28.
    Yacoe ME, Bergman AG, Ladd AL, Hellman BH. Dupuytren’s contracture: MR imaging findings and correlation between MR signal intensity and cellularity of lesions. AJR Am J Roentgenol. 1993;160:813–7.CrossRefGoogle Scholar
  29. 29.
    McCarville MB, Hoffer FA, Adelman CS, Khoury JD, Li C, Skapek SX. MRI and biologic behavior of desmoid tumors in children. AJR Am J Roentgenol. 2007;189:633–40.CrossRefGoogle Scholar

Copyright information

© ISS 2009

Authors and Affiliations

  • Jennifer L. Kujak
    • 1
  • Patrick T. Liu
    • 1
    Email author
  • Geoffrey B. Johnson
    • 2
  • Matthew R. Callstrom
    • 2
  1. 1.Department of RadiologyMayo Clinic ArizonaPhoenixUSA
  2. 2.Department of RadiologyMayo Clinic RochesterRochesterUSA

Personalised recommendations