The safety and ablation efficacy of ultrasound-guided high-intensity focused ultrasound ablation for desmoid tumors

Figures & data

Table 1. The characteristics of the patients and tumors.

Variable	Value
Gender
Male	32 (28.8%)
Female	79 (71.2%)
Age of onset (years)	24.7 ± 1.0 (1–61)
Age of HIFU ablation (years)	29.5 ± 1.0 (3–63)
Number of tumors
Single tumor	75 (67.6%)
≥2 tumors	36 (32.4%)
Situation
Primary	27 (18.6%)
Recurrent	118 (81.4%)
Tumor type
Extra-abdominal	118 (81.4%)
Abdominal wall	16 (11.0%)
Intra-abdominal	11 (7.6%)
Tumor size (cm)
<5	12 (8.3%)
5–10	72 (49.7%)
>10	61 (42.0%)

Figure 1. Contrast-enhanced MRI of three types of desmoid tumors (DTs). Before HIFU ablation, the areas of significant enhancement (white arrow) were shown in extra-abdominal DT (A), abdominal wall DT (B) and intra-abdominal DT (C). One week after HIFU ablation, non-perfused areas (red arrow) were observed within the extra-abdominal DT (A₁), abdominal wall DT (B₁) and intra-abdominal DT (C₁), and the areas of peripheral enhancement representing residual tumors (blue arrow) were observed in the extra-abdominal DT (A₁) and intra-abdominal DT (C₁).

Table 2. The treatment parameters and HIFU ablation results.

Variable	Value
Anesthesia
Sedation and analgesia	177 (95.2%)
General anesthesia	9 (4.8%)
Power (W)	223 (60–400)
Extra-abdominal (W)	200 (60–400)
Abdominal wall (W)	280 (220–340)
Intra-abdominal (W)	320 (260–400)
Sonication time (s)	1112.5 (93–3296)
Overall treatment time (min)	110 (20–330)
Energy (J)	254635.5 (13,620–1,198,700)
NPVR (%)	84.9 (1.9–100)
Extra-abdominal (%)	85.0 (6.1–100)
Abdominal wall (%)	100 (47.6–100)
Intra-abdominal (%)	26.2 (1.9–56.4)
Tumor volume reduction at 3 months after HIFU (%)	36.1 ± 4.2

Table 3. The types and incidences of adverse events in 188 sessions of HIFU ablation.

Adverse events	n (%)	CTCAE grade, n
		Grade 1	Grade 2	Grade 3	Grade 4–5
Hypothermia	1 (0.5)	0	1	0	0
Hypertension	2 (1.0)	1	1	0	0
Pain	26 (13.8)	20	6	0	0
Skin burn	7 (3.7)	5	2	0	0
Nerve stimulation	3 (1.6)	3	0	0	0
Nerve injury	1 (0.5)	0	0	1	0
Hematuria	2 (1.0)	0	2	0	0
Fever	1 (0.5)	1	0	0	0
Intratumoral hemorrhage	1 (0.5)	0	1	0	0
Secondary infection	2 (1.0)	0	0	2	0
Bone reaction	18 (9.6)	18	0	0	0
Total (%)	64	48 (75)	13 (20.3)	3 (4.7)

Table 4. Comparison of the incidences of adverse events between patients with a single session of HIFU ablation and those with multiple sessions of HIFU ablation.

HIFU ablation	No. of patients	No. of treatments	Adverse events		Incidence of adverse events (%)	χ^2	p
			No	Yes
Single session	64	64	46	18	28.1
Multiple sessions	47	124	84	40	32.3	0.338	.561

Figure 2. Contrast-enhanced axial MRI obtained from a 26-year-old woman with recurrent DT in the popliteal fossa before and after HIFU ablation. (A) Before HIFU ablation, the DT showed significant enhancement (white arrow), and the tibia showed no abnormal signal. (B) Three months after HIFU ablation, the DT without enhancement shrank (white arrow), and the tibia adjacent to the DT showed banded hyperintensity (blue arrow). (C) Fifteen months after HIFU ablation, the DT disappeared (white arrow), and the area of hyperintensity in the tibia (blue arrow) shrank.