Cryotherapy in extra-abdominal desmoid tumors: A systematic review and meta-analysis.

Bimal Mayur Kumar Vora,Nagavalli Somasundaram,Adnan Sheikh,Yet Yen Yan,Hanis Abdul Kadir,Peter L Munk,Hugue A Ouellette,Tien Jin Tan,Paul I Mallinson,Robert S Benjamin

doi:10.1371/journal.pone.0261657

Abstract

IntroductionDesmoid tumor is a locally-invasive neoplasm that causes significant morbidity. There is recent interest in cryotherapy for treatment of extra-abdominal desmoid tumors. This systematic review assesses evidence on safety and efficacy of cryotherapy in the treatment of extra-abdominal desmoid tumors.Materials and methodsThe systematic review was conducted with reference to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Literature search was performed using MEDLINE and the Cochrane Central Register of Controlled Trials. 9 full text papers were reviewed and meta-analysis was performed for measures of safety, efficacy and symptom relief.ResultsThe estimated pooled proportion of major and minor complications was 4.2% (95% CI, 1.8–9.6; I 2 = 0%) and 10.2% (95% CI, 5.7–17.8; I 2 = 0%) respectively. The estimated pooled proportion of non-progressive disease rate of all studies was 85.8% (95% CI, 73.4–93.0; I 2 = 32.9%). The estimated progression free survival rate at 1 year was 84.5% (95% CI:74.6–95.8) and 78.0% at 3 years (95% CI: 63.8–95.3). As for pain control, the estimated pooled proportion of patients with decrease in visual analogue scale (VAS) > = 3 for those with VAS > = 3 before treatment for 2 studies was 87.5% (95% CI, 0.06–100; I 2 = 71.5%) while 37.5% to 96.9% of patients were reported to have experienced partial or complete symptom relief in the other studies.ConclusionCryotherapy is a safe and effective treatment modality for extra-abdominal desmoid tumors with efficacy similar to those treated with traditional strategies in the short to medium term.

Highlights

Desmoid tumor is a locally-invasive neoplasm that causes significant morbidity
The estimated progression free survival rate at 1 year was 84.5% and 78.0% at 3 years
As for pain control, the estimated pooled proportion of patients with decrease in visual analogue scale (VAS) > = 3 for those with visual analog scale (VAS) > = 3 before treatment for 2 studies was 87.5% while 37.5% to 96.9% of patients were reported to have experienced partial or complete symptom relief in the other studies

Summary

Introduction

Desmoid tumor is a locally-invasive neoplasm that causes significant morbidity. There is recent interest in cryotherapy for treatment of extra-abdominal desmoid tumors. This systematic review assesses evidence on safety and efficacy of cryotherapy in the treatment of extra-abdominal desmoid tumors. The locally-invasive nature of these tumors can cause considerable morbidity. DT mostly occur sporadically, with β-catenin gene mutations found in approximately 85%–90% of tumors [3]. The National Comprehensive Cancer Network guidelines recommend initial active surveillance in the absence of progressive, morbid, or symptomatic disease and intervention in DT showing ongoing progression with potential morbidity and significant symptoms [5,6,7,8]. Response rates of chemotherapy are between 35 to 40%, and usually occur months after commencement of therapy [12].

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