Interventional Oncology

Session: Educational Exhibit Presentations - Station 7: Imaging and Interventional Oncology

Cryoablation of subcutaneous desmoid neoplasms

Monday, March 6, 2023

5:05 PM – 5:10 PM

Location: Phoenix Convention Center, North Ballroom 120ABC, Poster Hall

Abstract Presenter(s)

IX

Ianto L. Xi, MD (he/him/his)

IR/DR Resident
Hospital Of the University Of Pennsylvania

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

TG

Terence P. Gade, MD PhD

Assistant Professor of Radiology
Penn Image-Guided Interventions (PIGI) Lab, Hospital of the University of Pennsylvania
Gregory J. Nadolski, MD

Attending Physician
Penn Image-Guided Interventions (PIGI) Lab, Hospital of the University of Pennsylvania, Division of Interventional Radiology
Stephen Hunt, MD, PhD, FSIR (he/him/his)

Assistant Professor of Radiology
Penn Image-Guided Interventions (PIGI) Lab, Hospital of the University of Pennsylvania

Disclosure(s):

Ianto L. Xi, MD: No financial relationships to disclose

Terence P. Gade, MD PhD: Astra Zeneca: Advisory Committee or Review Panel Member (Terminated); Instylla, Inc.: Research Grant Recipient (Ongoing); Trisalus Life Sciences: Advisory Committee or Review Panel Member (Ongoing)

Stephen Hunt, MD, PhD, FSIR: Boston Scientific: Consultant (Ongoing), Speaking and Teaching (Ongoing); Guerbet: Research Grant Recipient (Ongoing); Instylla, Inc.: Research Grant Recipient (Ongoing)

Learning Objectives:

To review cryoablation techniques for treatment of extra-abdominal desmoid tumors.

Background:

Desmoid tumors are uncommon neoplasms originating from mesenchymal stem cell progenitors with a low potential for distal metastasis {1}. They typically present as a palpable firm mass in the soft tissues when extraperitoneal. They are locally aggressive and often well embedded in muscle and fascia. Symptoms and complications typically arise from local compression and invasion of adjacent structures. They are insensitive to chemotherapy and have a high incidence of recurrence after surgical resection. In addition, local invasion of vital structures often makes wide surgical resection infeasible. More recently, less invasive therapies such as percutaneous cryoablation have been employed with promising results {2-4}.

Clinical Findings/Procedure Details:

We present a small series of patients with symptomatic extra-peritoneal soft tissue desmoid tumors who were treated with cryoablation at our center. Under CT-guidance and general anesthesia, subdermal nerve block followed by hydro or pneumo-dissection was used to separate the tumor from the overlying dermis. Next, multiple cryoprobes were inserted percutaneously into the tumor under CT guidance. Cryoablation was performed with two 10 minute freeze cycles separated by 5 minute active thaw cycles in each ablation zone. Intermittent monitoring of the hypoattenuating cryoablation zone was performed under CT. Warm compresses were employed intra-procedurally to protect the overlying dermis. Patients were discharged the day of the ablation. Follow-up MR imaging was employed at one month for response assessment, followed by 6 month surveillance imaging. All patients demonstrated significant regression in tumor bulk and permanent relief of reported symptoms by 6 month follow-up. No major adverse events occurred. Minor complications included temporary treatment area skin sloughing, blistering, skin discoloration and numbness or paresthesia. All minor complications had resolved by 6 month follow-up.

Conclusion and/or Teaching Points:

Desmoid tumors are an uncommon clinical entity with limited therapeutic options and high rates of local recurrence after surgical resection. Cryoablation is a promising treatment for symptomatic extraperitoneal desmoid tumors that can offer substantial volume reduction and symptomatic relief.