Percutaneous cryoablation of extra-abdominal desmoid tumors as first-line and salvage therapy

Summary

We performed a retrospective analysis of 22 patients who underwent percutaneous cryoablation of extra-abdominal desmoid tumors between December 2008 and March 2017. Patients were treated with first-line cryoablation (treatment-naïve; n = 11) or salvage cryoablation (disease progression after surgical resection, radiation therapy, and/or systemic therapy; n = 11). Primary endpoints were progression-free survival (PFS) after the first cryoablation and PFS after one or more sessions of cryoablation. PFS was calculated using the Kaplan-Meier method. Predictors of disease progression after the first cryoablation were determined using the log rank test and the Cox proportional hazards model. Tumor sites included abdominal wall (n = 10), back (n = 4), chest wall (n = 6), and upper extremity (n = 2). Disease control was obtained in 15 of 22 patients (68%) after the first cryoablation. Univariate analysis identified age younger than 25 years old (HR: 5.74, P = 0.010), salvage therapy (HR: 8.64, P = 0.017), transaxial diameter >5 cm (HR: 11.37, P = 0.006), and hydrodissection (HR: 0.11, P = 0.041) as predictors of disease progression after the first cryoablation. Univariate analysis found no significant difference in PFS after the first cryoablation based on gender, prior pregnancy, gravidity, or tumor site. Multivariate analysis identified salvage therapy as the only independent predictor of disease progression after the first cryoablation (HR: 13.85, P = 0.05). Five-year PFS rate for all patients after one or more sessions of cryoablation was 88.9% (95% CI 71-100). Disease was ultimately controlled in 21 of 22 patients after one or more sessions of cryoablation (95.5%). A single session of cryoablation appears to provide better control of extra-abdominal desmoid tumors when used as first-line therapy compared to salvage therapy. Given that long-term disease control can be achieved with first-line cryoablation, cryoablation is an appropriate treatment consideration for select treatment-naïve patients with extra-abdominal desmoid tumors.