Aims and objectives
Desmoid tumors are locally infiltrative,
non-malignant soft tissue tumors.
Based on location,
desmoids are divided into extra-abdominal (trunk and extremities) and intra-abdominal tumors.
Risk factors are prior surgery or trauma and pregnancy.
Due to the chronic and highly variable nature of disease course and multiple different treatment options,
a multidisciplinary treatment approach including surgeons,
oncologists and interventional radiologists is required to achieve optimal outcome.
Treatment should be pursued in patients with progressive disease,
risk of adjacent structures or cosmetic concerns.
Methods and materials
Five patients with relapsing,
pathologically proven desmoid tumors (three males,
two females; age range 40–79 years) were treated with MR-HIFU.
Two patients had desmoids located in the rectus abdominis muscle,
one in the deltoid muscle,
one in the intercostal muscles and one in the popliteal fossa.
If applicable the whole tumor was targeted.
Treatments were performed under regional anesthesia or a combination of local anesthesia and analgosedation,
based on tumor location and patient preference.
An MR-HIFU system with an in-table 1,2-MHz transducer was used with...
MR-HIFU was technically successful in all patients without severe side effects.
In one patient with desmoid in the popliteal fossa,
the deeper parts of the tumor could not be targeted because of proximity to nerve and vessel structures.
Follow-up periods range from 2 to 60 months.
Initial targeted median tumor volume was 23 ml (range 3 – 70 ml),
volumes decreased significantly in all patients (Table 1).
Two patients required more than one treatment session due to insufficient sonication during the first session (patient nr....
MR-HIFU is an effective,
outpatient treatment for patients with desmoid tumors that has minimal side effects and that can be combined with other treatment modalities.
Given that desmoids are non-malignant tumors,
the main treatment approach should be local tumor control while minimizing side effects.
Small lesions have a high probability of complete ablation (Fig.
In cases of incomplete ablation,
MR-HIFU can be repeated until desired therapeutic effect is achieved.
It is important to realize that symptom relief does not require total tumor ablation.
Canton Hospital Winterthur,Institute of Radiology and Nuclear Medicine,
Brennan MF (1999) Extremity and trunk desmoid tumors: a multifactorial analysis of outcome.
Lo Vullo S,
Rosai J (2003) Quality of surgery and outcome in extra-abdominal aggressive fibromatosis: a series of patients surgically treated at a single institution.
J Clin Oncol 2003;21(7):1390-7