Percutaneous cryoablation in soft tissue tumor management: an educational review

BACKGROUND: Percutaneous cryoablation (PCA), having shown effectiveness in treating liver, lung, prostate, breast, and kidney tumors, is now gaining attention for the treatment of soft tissue tumors. PCA functions by freezing tissue, which induces ice crystal formation and cell death without damaging collagen structures. Technical considerations include the selection and handling of cryoprobes and cryogenic agents, procedural duration, and choice of image guidance for precision. This review aims to synthesize the mechanisms, applications, and technical aspects of PCA in the treatment of soft tissue tumors. METHODS: Adhering to PRISMA 2020 guidelines, a review was conducted of studies published prior to March 2024 that investigated PCA of soft tissue tumors. The review focused on technical and procedural aspects of cryoablation, cryobiological principles, cellular and tissue responses to extreme cold, intra- and post-procedure physiological mechanisms during and post-procedure, and main clinical applications. RESULTS: PCA is efficient in treating soft tissue tumors, including desmoid tumors, vascular malformations, and abdominal wall endometriosis. Several cryobiological mechanisms are involved, notably ice crystal formation, cellular dehydration, osmotic effects, and the inflammatory response, all of which contribute to its efficacy. Key technical aspects include the choice of cryoprobes, cryogenic agents (argon gas or liquid nitrogen), and the duration and control of freezing/thawing cycles. PCA also frequently outperformed traditional treatments like surgery and radiotherapy in terms of pain reduction, tumor size reduction, and patient outcomes. Moreover, its nerve sideration properties make it effective under local anesthesia. CONCLUSION: Demonstrating substantial pain reduction, tumor size decrease, and high technical success rates, PCA offers a promising and minimally invasive alternative for soft tissue tumor treatment. CRITICAL RELEVANCE STATEMENT: Percutaneous cryoablation provides a minimally invasive, precise alternative for soft tissue tumor management, advancing clinical radiology by offering effective treatment with reduced patient risk and enhanced outcomes through image-guided procedures. KEY POINTS: Percutaneous cryoablation (PCA) offers a promising, minimally invasive alternative for managing soft tissue tumors. PCA employs image-guided techniques to accurately target and treat tumors, ensuring high precision and control. PCA preserves structures like collagen, reduces pain, decreases tumor size, and generally enhances patient outcomes.

The implementation of DL models including radiomics under the wide umbrella of AI in healthcare can enhance the clinical and survival outcomes in cancer patients. In DF patients, these improved models can serve as tools to support the physicians in the early phase of the diagnostic process and predict the risk of relapse in patients undergoing active therapy. As we are only experiencing the “tip of the iceberg” in the AI revolution, these rare tumors must be prioritized to optimize their therapeutic plan and avoid unnecessary invasive procedures or toxic anti-cancer drugs. Ongoing trials should prospectively evaluate the clinical utility of radiomics, focusing not only on its ability to predict treatment response and disease progression but also on its potential to enhance personalized treatment strategies.

Desmoid tumors or aggressive fibromatosis are locally aggressive benign tumors. These arise anywhere in the body but are commonly seen in the anterior abdominal wall. The main treatment choices are continuous surveillance, adjuvant chemotherapy, surgery, and postoperative chemotherapy. However, where needs arise, surgery may be done, specifically wide local excision with adequate clearance. In our case report we show a case of a male patient presenting with umbilical hernia and an incidental discovery of a desmoid tumor that was closely proximate to the herniated sac. The plan of action planned were sac excision followed by tumor excision and then anatomical repair, that is, umbilical herniorrhaphy and postoperative chemotherapy.

Desmoid fibromatosis (DF) is a rare, non-metastasizing but locally aggressive mesenchymal tumor arising from fibroblasts or myofibroblasts. We report a solitary case of DF involving the retropharyngeal and danger spaces, a location rarely documented. The patient, a woman in her 70s, presented with progressive pharyngeal discomfort over six months. Imaging studies revealed a soft-tissue mass consistent with DF, and the diagnosis was confirmed pathologically. The tumor demonstrated unique imaging findings, including band-like hypointense areas on T2-weighted imaging on magnetic resonance imaging and moderate 2-deoxy-2-[18F]fluoro-D-glucose uptake on positron emission tomography/computed tomography (PET/CT), which may aid in differentiating DF from malignant tumors in atypical locations. Furthermore, this case highlights the effectiveness of radiotherapy in achieving significant tumor reduction, offering insights into the management of DF in rare and challenging locations. These findings not only aid in refining the differential diagnosis but also provide evidence supporting radiotherapy as a viable treatment option in cases where surgical resection is unfeasible.

Background: Fibromatosis of the breast, also known as desmoid-type fibromatosis (DTF), is a rare tumor marked by the development of non-metastatic, locally aggressive tumors in breast tissue. It represents only 0.2% of all breast tumors. It is a nonmalignant tumor that often resembles cancer in both its clinical presentation and radiologic imaging characteristics, posing unique diagnostic and management challenges. Case Description: This is a case report of a 34-year-old female with a history of bilateral silicone implant placement who presented with bilateral breast masses. She reported a 6-month history of a 1-cm firm, palpable mass in the right breast without associated pain or growth. She had a family history of breast, pancreatic, and prostate cancer but no significant past medical history. Ultrasound-guided biopsy of the right breast and magnetic resonance imaging (MRI)-guided biopsy of the left breast both revealed fibromatoses. She underwent bilateral excisional biopsies and surgical pathology confirmed breast fibromatosis in the background of benign breast tissue with fibrocystic changes. The patient had an uncomplicated post-operative course. Conclusions: This case report of a patient with prior breast augmentation surgery highlights the clinical presentation, diagnosis, and management of breast fibromatosis. The intricate relationship between desmoid tumors and factors such as tissue injury, surgical trauma, exogenous hormone exposure, and genetics is discussed. Ultimately, comprehensive diagnostic and therapeutic approaches with individualized treatment strategies are essential for managing fibromatosis effectively.

BACKGROUND: In 2023 and 2024, a wide variety of new studies have been published in the field of soft tissue sarcomas, representing the enormous heterogeneity of sarcoma histotypes, anatomical location, treatment variability, and biological behavior. PATIENTS AND METHODS: This article summarizes the, in our view, seven most important publications in the field that will have an impact on the surgical practice and future treatment strategies of our patients. RESULTS: In the last year, we gained more insight in the genetic background of patients with sarcoma from a large Australian study, which will have an impact on future counseling and screening of our patients. Also, the role of radiotherapy in retroperitoneal liposarcoma became clearer in the combined STRASS-STREXIT study. Radiotherapy for extremity sarcomas can now also be done in a 3-week, hypofractioned manner, which is a major improvement for our patients. Furthermore, more evidence has been presented regarding the improved outcome of patients with retroperitoneal sarcoma when treated in high volume centers. Landmark studies with systemic treatment include the positive trial with nirogacestat in desmoid tumors, which have finally shifted the paradigm of desmoid treatment from surgery to systemic treatment. Also, the results of 2 phase 3 randomized controlled trials recently showed 1) that the combination of doxorubicin with trabectedin significantly improved progression free survival for patients with leiomyosarcoma when compared with doxorubicin alone and 2) that the combination of neoadjuvant pembrolizumab and radiotherapy followed by 1-yr adjuvant pembrolizumab significantly improved disease free survival for patients with primary localized undifferentiated pleomorphic sarcoma/myxofibrosarcoma or dedifferentiated/pleomorphic liposarcoma of the extremities or girdles. CONCLUSIONS: Key papers from the last year informs us that management of soft tissues sarcoma is constantly improving, since more data became available to guide us in defining the best treatment strategies.