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MR-guided focused ultrasound therapy of extra-abdominal desmoid tumors: a multicenter retrospective study of 105 patients

  • Interventional
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objective

To assess the safety and efficacy of magnetic resonance-guided focused ultrasound (MRgFUS) for the treatment extra-abdominal desmoids.

Methods

A total of 105 patients with desmoid fibromatosis (79 females, 26 males; 35 ± 14 years) were treated with MRgFUS between 2011 and 2021 in three centers. Total and viable tumors were evaluated per patient at last follow-up after treatment. Response and progression-free survival (PFS) were assessed with (modified) response evaluation criteria in solid tumors (RECIST v.1.1 and mRECIST). Change in Numerical Rating Scale (NRS) pain and 36-item Short Form Health Survey (SF-36) scores were compared. Treatment-related adverse events were recorded.

Results

The median initial tumor volume was 114 mL (IQR 314 mL). After MRgFUS, median total and viable tumor volume decreased to 51 mL (95% CI: 30–71 mL, n = 101, p < 0.0001) and 29 mL (95% CI: 17–57 mL, n = 88, p < 0.0001), respectively, at last follow-up (median: 15 months, 95% CI: 11–20 months). Based on total tumor measurements (RECIST), 86% (95% CI: 75–93%) had at least stable disease or better at last follow-up, but 50% (95% CI: 38–62%) of remaining viable nodules (mRECIST) progressed within the tumor. Median PFS was reached at 17 and 13 months for total and viable tumors, respectively. NRS decreased from 6 (IQR 3) to 3 (IQR 4) (p < 0.001). SF-36 scores improved (physical health (41 (IQR 15) to 46 (IQR 12); p = 0.05, and mental health (49 (IQR 17) to 53 (IQR 9); p = 0.02)). Complications occurred in 36%, most commonly 1st/2nd degree skin burns.

Conclusion

MRgFUS reduced tumor volume, reduced pain, and improved quality of life in this series of 105 patients with extra-abdominal desmoid fibromatosis.

Clinical relevance statement

Imaging-guided ablation is being increasingly used as an alternative to surgery, radiation, and medical therapy for the treatment of desmoid fibromatosis. MR-guided high-intensity focused ultrasound is an incisionless ablation technique that can be used to reduce tumor burden effectively and safely.

Key Points

• Desmoid fibromatosis was treated with MR-guided high-intensity focused ultrasound in 105 patients.

• MR-guided focused ultrasound ablation reduced tumor volume and pain and improved quality of life.

• MR-guided focused ultrasound is a treatment option for patients with extra-abdominal desmoid tumors.

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Abbreviations

Avg.:

Average

CI:

Confidence interval

CR:

Complete response

CT:

Computed tomography

GE:

General Electric

HIFU:

High-intensity focused ultrasound

IQR:

Interquartile range

Max. :

Maximum

mRECIST:

Modified response evaluation criteria in solid tumors

MRgFUS:

MR-guided high-intensity focused ultrasound

MRI:

Magnetic resonance imaging

NRS:

Numeric rating scale

NSAID:

Non-steroidal anti-inflammatory drugs

PD:

Progressive disease

PFS:

Progression-free survival

PR:

Partial response

RECIST:

Response evaluation criteria in solid tumors

RFS:

Recurrence-free survival

SD:

Stable disease

SD:

Standard deviation

SF-36:

RAND 36-Item Short Form Health Survey

TTV:

Total tumor volume

USA:

United States of America

VTV:

Viable tumor volume

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Acknowledgements

Daniel Düx would like to thank the Focused Ultrasound Foundation for their generous support of a Focused Ultrasound Fellowship.

Funding

The primary author Daniel Düx has received funding by the Focused Ultrasound Foundation

Author information

Authors and Affiliations

  1. Department of Radiology, Stanford University, Stanford, CA, USA

    Daniel M. Düx, Rachelle Bitton, Ryan L. Brunsing, Vipul R. Sheth, Jarrett Rosenberg & Pejman Ghanouni

  2. UCSF Department of Radiology & Biomedical Imaging, San Francisco, USA

    Joe Darryl Baal, Kisoo Kim, Eugene Ozhinsky & Matthew Bucknor

  3. UCSF School of Medicine, San Francisco, USA

    Joshua Chen

  4. Department of Orthopaedic Surgery, Stanford Medicine Outpatient Center, Redwood City, CA, USA

    Raffi Avedian

  5. Department of Medicine (Med/Oncology), Stanford Health Care, Stanford, CA, USA

    Kristen Ganjoo

  6. MR Focused Ultrasound Center, Future Medical Imaging Group, Victoria, Australia

    Andrew Dobrotwir

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  1. Daniel M. Düx
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Corresponding author

Correspondence to Daniel M. Düx.

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Guarantor

The scientific guarantor of this publication is Pejman Ghanouni, MD, PhD.

Conflict of interest

The authors of this manuscript declare relationships with the following companies:

Pejman Ghanouni, MD, PhD: Funding from INSIGHTEC. Advisory board for SonALAsense, Profound and INSIGHTEC. Shareholder in SonALAsense. Consulted for HistoSonics.

Raffi Avedian, MD: Paid speaker for Springworks

Kirsten Ganjoo, MD: Advisory Board for Daiichi Sankyo, Foundation Medicine, Deciphera

The other co-authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

Jarrett Rosenberg, PhD, kindly provided statistical advice for this manuscript, who is one of the co-authors.

Informed consent

Written informed consent was obtained from all subjects (patients) or their legal representatives in this study.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

Some study subjects or cohorts have been previously reported in Ghanouni P, Dobrotwir A, Bazzocchi A, et al (2017) Magnetic resonance-guided focused ultrasound treatment of extra-abdominal desmoid tumors: a retrospective multicenter study. Eur Radiol. https://doi.org/10.1007/s00330-016-4376-5.

Methodology

  • Retrospective

  • observational

  • multicenter

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Düx, D.M., Baal, J.D., Bitton, R. et al. MR-guided focused ultrasound therapy of extra-abdominal desmoid tumors: a multicenter retrospective study of 105 patients. Eur Radiol 34, 1137–1145 (2024). https://doi.org/10.1007/s00330-023-10073-9

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