Standardization of selection criteria for percutaneous image-guided cryoablation of recurrent soft-tissue sarcomas

PurposePercutaneous image-guided cryoablation has not been validated for local management of recurrence of soft tissue sarcoma (STS) of the trunk or limbs. This study aims to identify selection criteria for cryoablation in order to standardize indications of this treatment.Patients and methodsBetween 2000 and 2010, 46 patients (57 tumors) presenting local recurrences of STS of the trunk or limbs and treated following standards of care were selected from our institutional database. Eligibility for cryoablation was assessed by two radiologists according to predefined criteria: maximal diameter size of the tumor ≤ 10 cm, distance to skin >5 mm, distance to neurovascular structures 3 mm at least, absence of articular involvement and planned cryoablation covering the entire lesion volume. Characteristics and outcomes were compared.ResultsThere was nearly perfect agreement for all criteria (k coefficient ranging from 0.83 to 0.98) between both readers. A subgroup of 13 patients was identified as eligible for cryoablation. Locations to the trunk, pelvic girdle or shoulder were significantly more present in the cryoablation group (P = 0.002). In this group, tumors were mainly located deeply (P = 0.002) with great axes ≤ 5 cm (P = 0.044). High local tumor aggressiveness (P = 0.016) and differentiated myxoid liposarcoma or myxofibrosarcoma (P = 0.007) were more frequent in the eligible group.ConclusionBased on these criteria, two groups of patients with local relapse of STS can be identified. These results may improve the standardization of selection of patients who could be candidates for cryoablation.