Doxorubicin Eluting Embolization (DEE), a type of trans-arterial chemoembolization (TACE), is a method to treat desmoid tumors by exposing the tumor to a high concentration of doxorubicin while minimizing the doxorubicin exposure to the rest of the body. In DEE a pharmacist will first mix doxorubicin with drig-eluting microparticles designed to soak up the drug in the bottle but release it in the body. The treatment is then performed by an Interventional Radiologist who will will make a tiny incision to allow the navigatation of a catheter into the arterial blood supply of the Desmoid tumor. Once in position, the doxorubicin loaded micro-beads are released into the tumor tissue and there they slowly elute the chemotherapy. The procedure is usually performed using local anesthesia and sedation, and takes a 2-3 hours. Patients typically undergone two to three procedures to treat the entire desmoid. Large and rapidly growing tumors may require more. DEE is usually offered after failure of at least one systemic therapy. Generally, DEE is performed for larger tumors (>5cm diameter) or smaller tumors if Cryoablation risks Neuro vascular injury.
DEE for Desmoid tumors was first described in 2018 (https://pubmed.ncbi.nlm.nih.gov/30075974/), with additional reports published in 2022 (https://pubmed.ncbi.nlm.nih.gov/36291829/ and https://pubmed.ncbi.nlm.nih.gov/35441242/). Following the promising results seen in these preliminary studies, a dedicated multi center prospective trial is in the works with sites at the Royal Marsden in London, LMU in Munich, University of Heidelberg, Italian National Cancer Institute in Milan and at Share Zedek Medical Center in Jerusalem. Other sites with experience in DEE include Hong Kong Childrens Hospital; Kids Cancer Center in Sydney and Memorial Sloan Kettering Cancer Center in NY.
