Cryoablation Offers Local Control for Extra-Abdominal Desmoid Tumors

For patients with extra-abdominal desmoid tumors, local treatment involves a familiar trade-off: controlling painful or enlarging lesions without compromising nearby nerves, vessels, or function. In a retrospective study published in the Journal of Vascular and Interventional Radiology, image-guided cryoablation was associated with symptom improvement and radiologic response in most treated patients. The findings also highlight an important practical distinction: achieving disease control may take more than one procedure.

Researchers in Alberta, Canada reviewed provincial records from 2020 through 2024, identifying 208 patients with desmoid tumors, 44 of whom underwent cryoablation. Follow-up data were available for 38 patients, who received 92 ablation sessions altogether. Median tumor diameter was 6.9 cm, and median clinical follow-up was 28.9 months. Treatment decisions were reviewed by a multidisciplinary tumor board.

Disease Control Didn’t Always Mean a Single Treatment

The study's primary endpoint, clinical success, was achieved in 81.1% of 37 evaluable patients. Success required absence of radiologic progression at the last assessment, no subsequent nonablative treatment, and improvement or resolution of symptoms. Crucially, repeat cryoablation did not count as failure, reflecting a strategy of treating residual or recurrent disease over time.

Only 16 of 38 patients underwent a single ablation session. Another 12 received multiple planned sessions within one treatment course, while 10 (26.3%) needed additional courses, 8 for radiologic progression and 2 for persistent enhancing disease. This matters when counseling patients: the reported success rate represents control achieved through the overall ablation strategy, not necessarily the effect of a single procedure.

Symptoms improved or resolved in 83.8% of 37 patients with documentation. At the last MRI assessment attributable to cryoablation, conducted at a median of 16.3 months, 24.3% had a complete radiologic response and 54.1% had a partial response, yielding a combined response rate of 78.4%. These outcomes suggest potential benefit beyond imaging alone, although symptom changes were assessed retrospectively from clinical notes rather than validated patient-reported measures.

Progression-Free Survival Tells a Different Story

The estimated progression-free survival (PFS) rate was 76.5% at 1 year (95% CI, 58.2%–87.6%) and 67.4% at 2 years (95% CI, 46.5%–81.7%). Unlike the clinical success endpoint, PFS captured the first documented progression even when subsequent cryoablation restored control. This difference helps explain why the final clinical success rate was higher than the 2-year PFS estimate.

Patients who experienced a PFS event had larger baseline tumors than those who did not (median volume, 131.2 vs 48.0 cc; P = .027). The association was exploratory, however, and the small number of events limits its value for selecting treatment candidates.

Imaging Agreement was Strong, but Safety Still Matters

Volumetric MRI response categories showed near-perfect agreement with modified Response Evaluation Criteria in Solid Tumors classifications in 26 assessable patients (quadratic weighted κ = 0.895). Yet volumetric thresholds were borrowed from research in hepatic metastases and have not been validated specifically for desmoid tumors.

Procedure-related adverse events affected 21.1% of patients. Two patients (5.3%) had major complications: hemorrhagic shock requiring arterial embolization and skin necrosis requiring grafting. Nerve injuries and pain were among the other reported events; no treatment-related deaths occurred.

With no untreated or alternative-treatment comparison group, the study cannot separate cryoablation effects from the variable natural history of desmoid tumors, including spontaneous stabilization or regression. Its retrospective design, modest sample, qualitative symptom assessments, and limited longer-term surveillance also temper conclusions about durability.

Still, the findings support considering cryoablation within multidisciplinary care when intervention is warranted, particularly where surgery carries meaningful morbidity. Prospective studies with standardized symptom measures could better define who benefits most and how often retreatment should be expected.

Reference

Arseneault-Monette E, Luo T, Mack L, et al. Cryoablation for extra-abdominal desmoid tumors: a retrospective study of clinical and radiological outcomes. J Vasc Interv Radiol. Published online September 12, 2026. doi:10.1016/j.jvir.2026.109083