The Desmoid Tumor Research Foundation

September 2023

MR-guided focused ultrasound therapy of extra-abdominal desmoid tumors: a multicenter retrospective study of 105 patients

Author Information

Daniel M Düx 1, Joe Darryl Baal 2, Rachelle Bitton 3, Joshua Chen 4, Ryan L Brunsing 3, Vipul R Sheth 3, Jarrett Rosenberg 3, Kisoo Kim 2, Eugene Ozhinsky 2, Raffi Avedian 5, Kristen Ganjoo 6, Matthew Bucknor 2, Andrew Dobrotwir 7, Pejman Ghanouni 3

1Department of Radiology, Stanford University, Stanford, CA, USA. d.duex@outlook.com. 2UCSF Department of Radiology & Biomedical Imaging, San Francisco, USA. 3Department of Radiology, Stanford University, Stanford, CA, USA. 4UCSF School of Medicine, San Francisco, USA. 5Department of Orthopaedic Surgery, Stanford Medicine Outpatient Center, Redwood City, CA, USA. 6Department of Medicine (Med/Oncology), Stanford Health Care, Stanford, CA, USA. 7MR Focused Ultrasound Center, Future Medical Imaging Group, Victoria, Australia.

Publication

Eur Radiol.

Summary

Objective: To assess the safety and efficacy of magnetic resonance-guided focused ultrasound (MRgFUS) for the treatment extra-abdominal desmoids. Methods: A total of 105 patients with desmoid fibromatosis (79 females, 26 males; 35 ± 14 years) were treated with MRgFUS between 2011 and 2021 in three centers. Total and viable tumors were evaluated per patient at last follow-up after treatment. Response and progression-free survival (PFS) were assessed with (modified) response evaluation criteria in solid tumors (RECIST v.1.1 and mRECIST). Change in Numerical Rating Scale (NRS) pain and 36-item Short Form Health Survey (SF-36) scores were compared. Treatment-related adverse events were recorded. Results: The median initial tumor volume was 114 mL (IQR 314 mL). After MRgFUS, median total and viable tumor volume decreased to 51 mL (95% CI: 30-71 mL, n = 101, p < 0.0001) and 29 mL (95% CI: 17-57 mL, n = 88, p < 0.0001), respectively, at last follow-up (median: 15 months, 95% CI: 11-20 months). Based on total tumor measurements (RECIST), 86% (95% CI: 75-93%) had at least stable disease or better at last follow-up, but 50% (95% CI: 38-62%) of remaining viable nodules (mRECIST) progressed within the tumor. Median PFS was reached at 17 and 13 months for total and viable tumors, respectively. NRS decreased from 6 (IQR 3) to 3 (IQR 4) (p < 0.001). SF-36 scores improved (physical health (41 (IQR 15) to 46 (IQR 12); p = 0.05, and mental health (49 (IQR 17) to 53 (IQR 9); p = 0.02)). Complications occurred in 36%, most commonly 1st/2nd degree skin burns. Conclusion: MRgFUS reduced tumor volume, reduced pain, and improved quality of life in this series of 105 patients with extra-abdominal desmoid fibromatosis. Clinical relevance statement: Imaging-guided ablation is being increasingly used as an alternative to surgery, radiation, and medical therapy for the treatment of desmoid fibromatosis. MR-guided high-intensity focused ultrasound is an incisionless ablation technique that can be used to reduce tumor burden effectively and safely. Key points: • Desmoid fibromatosis was treated with MR-guided high-intensity focused ultrasound in 105 patients. • MR-guided focused ultrasound ablation reduced tumor volume and pain and improved quality of life. • MR-guided focused ultrasound is a treatment option for patients with extra-abdominal desmoid tumors.

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