Percutaneous Management of Desmoid Tumors

To provide a comprehensive review of percutaneous image-guided techniques in the management of desmoid tumors including evolving thermal and non-thermal ablation options, as well as trans-arterial catheter options. Beyond each treatment modality, we aim to highlight considerations related to patient selection, technical components, and the growing interplay between percutaneous therapies and emerging systemic therapies.

Percutaneous ablation, particularly cryoablation, has emerged as a safe and effective treatment for extra-abdominal desmoid tumors, with prospective data demonstrating durable disease control and significant improvements in pain and functional status. A meta-analysis of 694 desmoid tumors treated with thermal ablation reported pooled local control of 88%, symptom relief in 90% of patients, and major complication rates below 5%. Transarterial doxorubicin-eluting embolization has shown promise in both adult and pediatric settings, while bland particle and radioembolic approaches remain under investigation. Irreversible electroporation is emerging as a non-thermal alternative near critical structures. The National Comprehensive Cancer Network (NCCN) Soft Tissue Sarcoma Guidelines now formally incorporate cryoablation along with embolization into the treatment algorithm for progressive, morbid, or symptomatic extra-abdominal desmoid tumors, marking a significant milestone in the recognition of percutaneous techniques as standard-of-care options. Percutaneous image-guided techniques now offer local tumor control with rates similar to surgical resection and a favorable safety profile. Some of these percutaneous techniques are endorsed alongside systemic therapy and radiation as primary options for progressive or symptomatic extra-abdominal desmoid tumors per various guidelines. An important consideration involves the level of data, comprised predominantly of retrospective data, without direct comparative date. The ongoing prospective CRYODESMO-02 trial will help define optimal sequencing and strengthen the evidence base underpinning guideline recommendations.