Auloge Pierre, Garnon Julien, Robinson Joey Marie, Thenint Marie-Aude, Koch Guillaume, Caudrelier Jean, Weiss Julia, Cazzato Roberto Luigi, Kurtz Jean Emmanuel, Gangi Afshin
Service d'Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, 3 rue des Alisiers, 67100, Strasbourg, France.
Service de Radiologie, Centre François Baclesse, Caen, France.
Int J Clin Oncol. 2021 Jun;26(6):1147-1158. doi: 10.1007/s10147-021-01887-y. Epub 2021 Mar 11.
To assess efficacy and safety of percutaneous cryoablation (CA) for advanced and refractory extra-abdominal desmoid tumors.
This retrospective study reviewed 30 consecutive patients with symptomatic desmoid tumors evolving after "wait and watch" periods, and despite medical treatment, treated by CA between 2007 and 2019. Progression free survival (PFS), objective response rate, pain reduction (decreased of visual analogic scale pain (VAS)[Formula: see text] 3 or disappearance of pain), total volume lesion (TVL) and complications were documented. Kaplan Meier method was used to outline PFS. Paired sample t test was used to compare volume of tumors before treatment and at 1 and 3 year.
With a median follow-up of 18.5 months (range 6-93 months, interquartile range (IQR): 12-55), the PFS was 85.1% at 1 year and 77.3% at 3 years. Objective response was obtained for 80% of patients with a complete response for 43% patients. Pain reduction was obtained for 96.7% (95% confidence interval (95% CI): 90.3, 100) of patients. Median volume of desmoid tumor before treatment was 124.1cm (range 2-1727cm, IQR: 54-338cm). Median change of TLV after ablation was 66.6% (95% CI: 37.2, 72.3; p = 0.002) at 1 year and 76.4% (95% CI: 59.1, 89.8; p = 0.002) at 3 year. Adverse events rate was 36.6%, the most common was edema and temporary increase of pain in the days following CA. Four patients experienced a major complication (13.3%): 2 skin necrosis, 1 infection and 1 brachial plexopathy.
CA is an effective treatment for advanced and refractory extra-abdominal desmoid tumor, that induces durable responses.
评估经皮冷冻消融术（CA）治疗晚期及难治性腹外硬纤维瘤的疗效和安全性。
本回顾性研究纳入了30例连续的有症状硬纤维瘤患者，这些患者在“观察等待”期后病情进展，尽管接受了药物治疗，但在2007年至2019年间接受了CA治疗。记录无进展生存期（PFS）、客观缓解率、疼痛减轻情况（视觉模拟评分法疼痛（VAS）降低[公式：见正文]3或疼痛消失）、肿瘤总体积（TVL）和并发症。采用Kaplan-Meier方法描绘PFS。使用配对样本t检验比较治疗前、治疗后1年和3年时肿瘤的体积。
中位随访时间为18.5个月（范围6 - 93个月，四分位数间距（IQR）：12 - 55），1年时PFS为85.1%，3年时为77.3%。80%的患者获得客观缓解，43%的患者完全缓解。96.7%（95%置信区间（95%CI）：90.3，100）的患者疼痛减轻。治疗前硬纤维瘤的中位体积为124.1cm（范围2 - 1727cm，IQR：54 - 338cm）。消融后1年TVL的中位变化为66.6%（95%CI：37.2，72.3；p = 0.002），3年时为76.4%（95%CI：59.1，89.8；p = 0.002）。不良事件发生率为36.6%，最常见的是水肿和CA后数天内疼痛暂时加重。4例患者发生严重并发症（13.3%）：2例皮肤坏死、1例感染和1例臂丛神经病变。
CA是治疗晚期及难治性腹外硬纤维瘤的有效方法，可诱导持久缓解。
