The Desmoid Tumor Research Foundation

June 2026

Cryoablation as a downsizing strategy enabling R0 resection in a giant mediastinal desmoid tumor: a case report

Author Information

Ibtissem Ben Bayer 1, Ana Maria Santos Portela 1, Dana Mihaela Radu 1 2, Arthur Petit 3, Olivier Seror 3 4, Marine Peretti 1, Antoine Martin 5, Kader Chouahnia 6, Emmanuel Martinod 1 2, Ilaria Onorati 1 2

1Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Chirurgie Thoracique et Vasculaire, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, France. 2Inserm UMR1272, Hypoxie et Poumon, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, France. 3Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Interventional Radiology Unit, Bobigny, France. 4Research Team AIMOKA, Inria, Assistance Publique-Hôpitaux de Paris, Université Sorbonne Paris, Nord, Inria Research Centre at Rennes University, Rennes, France. 5Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Anatomie Pathologique, Bobigny, France. 6Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Oncologie, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, France.

Publication

Mediastinum

Summary

Background: Endothoracic desmoid tumors are rare, locally aggressive soft-tissue neoplasms whose intrathoracic location often precludes safe surgical resection. The historical paradigm of upfront radical surgery has shifted toward a more conservative and stepwise approach, prioritizing active surveillance and non-surgical treatments whenever feasible. Surgical resection is now typically reserved for selected cases. Percutaneous cryoablation (PCA) has emerged as a promising minimally invasive treatment and valid therapeutic alternative for selected patients, although its role as a tumor downsizing strategy remains poorly defined. Case description: We report the case of a 64-year-old woman presenting with a giant anterior mediastinal desmoid tumor causing progressive respiratory symptoms and pain. Initial systemic therapies were associated with disease progression, and despite second-line treatment, tumor control was not achieved, leading to surgical contraindication. Within the framework of the prospective CRYODESMO-O1 trial, the multidisciplinary team proposed PCA, resulting in a significant reduction in tumor size and improved anatomical relationships. This evolution allowed reconsideration of surgical resection, which was subsequently performed via a left sternothoracotomy approach. Final pathological examination demonstrated less than 10% residual desmoid tissue with complete (R0) resection. At the last follow-up at 8 months after surgery the patient was well and without recurrence. Conclusions: In this case, cryoablation was associated with marked tumor downsizing and a major pathological response, facilitating reconsideration of surgical resection in a tumor initially deemed unresectable. This approach may represent a potential component of multimodal management in carefully selected patients, although further evidence is needed to confirm its role.

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