Desmoid tumors are a type of benign sarcoma that can be locally aggressive and extremely morbid. Dr. Jack Jennings from Washington University in St. Louis discusses his experience in treating this condition.

Surgical resection is considered the gold standard for treatment; however, the aggressive nature of these tumors can make resection challenging. To address this, Dr. Jennings’ institution began offering ablation for non-surgical candidates, becoming a major referral center for these cancers.

Cryoablation has become the preferred option. It is particularly effective for uncomplicated desmoid tumors that are likely to have clean surgical margins. Ideal tumors for cryoablation are those that do not involve nerves and are located extra-abdominally or in the extremities. Cryoablation allows for visualization of a low attenuation ice ball and the ability to sculpt the ablation zone based on the tumor geometry, with a goal of achieving a 10mm or greater margin around the tumor.

Thermoprotective strategies are essential to protect nearby structures during cryoablation, such as nerves and bowel. Carbon dioxide gas can be used, along with hydrodissection and sometimes balloons. The bowel is particularly sensitive to ice, so careful planning is required to avoid complications. CT is typically used for intraprocedural imaging, with the addition of ultrasound to visualize  superficial targets or to avoid streak artifacts. Some facilities also employ MR guidance for this procedure.

TIMESTAMPS

00:00 - Evolution of Treatment for Desmoid Tumors

02:52 - Planning for Ablation

05:38 - Thermoprotective Strategies

07:30 - Carbon Dioxide Use

09:05 - Imaging Modalities for Ablation

CHECK OUT THE FULL EPISODE

BackTable MSK Ep. 7- Desmoid Tumors: IR’s Role in Diagnosis and Management

https://www.backtable.com/shows/msk/podcasts/22/genicular-nerve-ablation