Desmoid tumors

Desmoid tumors are rare tumors also called aggressive fibromatosis. They originate from the cells called fibroblast in the connective tissue. They do not make distant metastasis unlike classical cancers, but have an aggressive course (locally aggressive). Therefore, they have both benign and malignant tumor characteristics.

Desmoid tumors can be seen at any age, but are most commonly seen in young and middle-aged women. Desmoid tumors located in the abdomen are usually seen with Gardner Syndrome, which is characterized by polyps in the large intestine. Desmoid tumors located outside the abdomen (extraabdominal) are most frequently seen under the skin in the anterior wall of the abdomen with the arms and legs. Such desmoids are more common in pregnancy, after local surgery or trauma and in patients who use estrogen drugs.

Classical treatment in desmoid tumors is the extensive removal of the tumor. However, after the surgical operation, up to 70% of the tumors reappear at the same site (local recurrence). In such cases and patients who are not suitable for surgery, radiotherapy can be performed. However, the tumor may frequently recur despite recurrent operation and radiotherapy. A recurrent tumor can damage organs in that area and may even cause death in some cases. In some studies, chemotherapy drugs used in liver cancer have been reported to have good results, but in general, desmoid tumors do not benefit from chemotherapy.

Percutaneous ablation is a common treatment modality in desmoid tumors. Especially successful results were obtained with cryoablation. In a recent 10-year study, it was shown that approximately 95% of patients had local tumor control and pain related to the tumor was eliminated. At our own centers, we have been using cryoablation in all kind of desmoid tumors for more than 15 years.

How do we do desmoid cryoablation?

Desmoid tumors are usually located close to the skin and they are seen easily with ultrasound. For this reason, cryoablation is usually performed under ultrasound guidance and sometimes under ultrasound + CT guidance. Because cryoablation is painless, local anesthesia and mild sedation are sufficient for the procedure. First, skin entry point to the tumor is determined by ultrasound and CT, then this area is numbed with local anesthesia. Then, cryoablation needles are placed into the tumor by using ultrasound or CT. The number of needles to be used depends on the size of the tumor; the larger the tumor, the more needles need to be placed. Once the needles have been placed, the device is switched on and the freezing is started. The iceball formed during the procedure can be easily seen on ultrasound and CT. Thus, it is easier to destroy the entire tumor and protect the surrounding tissues in cryoablation. After two freezing cycles that last about half an hour, the needles are pulled out and the process is terminated. Most patients may return home on the same day.

Video: freezing desmoid tumors with cryoablation

Why do we prefer cryoablation in desmoid tumors?

Cryoablation has been applied more and more frequently in recent years for desmoid tumors due to its following advantages:

It is performed under local anesthesia, is painless, has no incisions, stitches or scars. The patient can go home after being observed for a while.
Since the ablation area (iceball) can be seen on ultrasound and tomography during the procedure, surrounding tissues can be protected more easily.
Because cryoablation kills the nerves in and around the tumor, tumor-related pain usually disappears afterwards.
After cryoablation, the tumor loses its viability and becomes smaller and smaller. If the tumor grows again, the second and third surgery is more difficult, and radiotherapy cannot be given a second time to the same region. However, cryoablation can be repeated as many times as necessary in the same area.
There is a risk of future cancer formation in the area where radiotherapy is given, whereas there is no such risk in cryoablation.