📖 What is a desmoid tumour?
Desmoid tumours (aggressive fibromatosis) are rare mesenchymal tumours, locally aggressive but non-metastatic, developing in the muscles, aponeurosis or mesentery. They can be sporadic or associated with familial adenomatous polyposis (FAP/GAP). Leur traitement est complexe et nécessite une approche multidisciplinaire.
Percutaneous chemoembolization of desmoid tumours involves locally injecting a chemotherapy agent via the tumour's feeding artery, combined with arterial embolization. It is reserved for symptomatic desmoid tumours that are progressing or resistant to traitement médical (imatinib, sulindac, tamoxifène). Alternative à la chirurgie souvent mutilante.
🎯 Principe
Chemoembolization of desmoid tumours is an interventional radiology technique that selectively injects a chemotherapy agent (doxorubicin) combined with embolizing microspheres into the feeding artery of the desmoid tumour. The dual cytotoxic and ischaemique induit une nécrose tumorale et un ralentissement de la croissance.
Cochin Hospital AP-HP is a national reference centre for desmoid tumours. Chemoembolization is offered within a dedicated multidisciplinary team meeting, in liaison with oncology and surgery.
📋 Indications
- Symptomatic desmoid tumours progressing under medical treatment (anti-hormonal drugs, NSAIDs)
- Unresectable desmoid tumours or those at high surgical risk
- Relapse after surgery
- Rapidly growing or painful desmoid tumours
- Neoadjuvant treatment before surgical resection
🔧 Procedure
Pre-procedure work-up: baseline imaging (MRI or CT), blood tests, discussion at the desmoid tumour board.
Selective arteriography: catheterisation of the tumour's feeding artery via femoral or radial access.
Treatment injection: doxorubicin-loaded microspheres (DC Beads) injected hyperselectively into the tumour artery.
Hospital stay: 1 to 2 nights to monitor post-embolization syndrome (fever, pain, nausea).
Assessment at 3 months: MRI or CT to evaluate the tumour response (modified RECIST criteria).
📊 Results
Chemoembolization of desmoid tumours is a technique under prospective evaluation in our centre (DESMO-EMBO trial). Preliminary results show control of tumour growth in the majority of cases, with a significant improvement in pain.
🔬 DESMO-EMBO clinical trial open to patients meeting the inclusion criteria. Contact us at ri.cch@aphp.fr for more information.
✅ What are the expected benefits?
- Control of tumour growth in the majority of cases (preliminary results of the DESMO-EMBO trial)
- Significant improvement in pain related to the tumour
- Alternative to often mutilating surgery for difficult locations (mesentery, abdominal wall)
- Can serve as neoadjuvant treatment before surgical resection, making the operation easier
- Repeatable depending on the response
🩹 Quelles sont les suites et complications possibles ?
Effets attendus et transitoires :
- Post-embolization syndrome: fever, pain, nausea for 24 to 72h, monitored in hospital for 1 to 2 nights
Les complications sont les suivantes :
| Complication | Description | Frequency |
|---|---|---|
| Post-embolization syndrome | Fever, pain, nausea — managed in hospitalisation | Common |
| Haematoma at the puncture site | Spontaneous resolution | 2–5 % |
| Thermal/chemical injury to adjacent tissues | Prevented by hyperselective catheterisation; rare | < 3 % |
| Insufficient response | A repeat session or a change of strategy may be discussed | Variable |
📐 Quelles sont les limites du traitement ?
- Technique under prospective evaluation (DESMO-EMBO trial) — the level of evidence is still being built
- The tumour response is assessed at 3 months by imaging; several sessions may be needed
- For very large or multifocal tumours, efficacy may be partial
In all cases, surgery and medical treatments remain possible.
🔀 Quelles sont les autres techniques et alternatives possibles ?
💊 Medical treatment
Anti-hormonal drugs (tamoxifen), NSAIDs (sulindac), or targeted therapies (imatinib, sorafenib) — first-line treatment in many cases.
🏥 Surgery
Surgical resection, sometimes mutilating depending on the location, with a high risk of recurrence.
☢️ Radiotherapy
An option for certain locations, with a risk of long-term complications to be discussed.
👁️ Surveillance active
For stable, asymptomatic desmoid tumours, imaging surveillance is often preferred as first-line (spontaneous regression is possible).
❔ Que se passe-t-il si je refuse finalement le traitement ?
You remain entirely free in your decision. Your case will be discussed at a dedicated tumour board to consider the alternatives: medical treatment, surgery, radiotherapy, or active surveillance depending on your situation.
📄 Patient information sheet to download
✅ Procedure covered by French national health insurance · No extra fees · Cochin Hospital AP-HP