目的:评估磁共振引导聚焦超声(MRgFUS)治疗腹外纤维瘤的安全性和有效性。
方法:共105例纤维瘤病患者(79例女性,26名男性;35±14岁)在2011年至2021年之间在三个中心接受了MRgFUS治疗。在治疗后的最后一次随访中评估每位患者的总肿瘤和存活肿瘤。响应和无进展生存期(PFS)在实体瘤中用(修改的)响应评估标准(RECIST第1版和mRECIST)评估。比较了数字评定量表(NRS)疼痛的变化和36项简短形式健康调查(SF-36)得分。记录治疗相关的不良事件。
结果:初始肿瘤体积中位数为114mL(IQR314mL)。在MRgFUS之后,中位总肿瘤体积和存活肿瘤体积降至51毫升(95%CI:30-71毫升,n=101,p<0.0001)和29mL(95%CI:17-57mL,n=88,p<0.0001),分别,最后一次随访(中位数:15个月,95%CI:11-20个月)。基于总肿瘤测量(RECIST),86%(95%CI:75-93%)在最后一次随访时疾病至少稳定或更好,但50%(95%CI:38-62%)的剩余活结节(mRECIST)在肿瘤内进展。总肿瘤和存活肿瘤在17个月和13个月时达到中位PFS,分别。NRS从6(IQR3)降至3(IQR4)(p<0.001)。SF-36得分改善(身体健康(41(IQR15)至46(IQR12);p=0.05,心理健康(49(IQR17)至53(IQR9);p=0.02))。并发症发生率为36%,最常见的1/2度皮肤烧伤。
结论:MRgFUS减少肿瘤体积,减轻疼痛,并改善了105例腹外纤维瘤病患者的生活质量。
结论:成像引导消融术越来越多地用作手术的替代方法,辐射,和治疗纤维瘤病的药物治疗。MR引导的高强度聚焦超声是一种无切口消融技术,可有效、安全地降低肿瘤负荷。
结论:•MR引导下高强度聚焦超声治疗纤维瘤病105例。•MR引导聚焦超声消融减少了肿瘤体积和疼痛,提高了生活质量。•MR引导聚焦超声是腹外硬纤维瘤患者的治疗选择。
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.
CONCLUSIONS: MRgFUS reduced tumor volume, reduced pain, and improved quality of life in this series of 105 patients with extra-abdominal desmoid fibromatosis.
CONCLUSIONS: 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.
CONCLUSIONS: • 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.