Conclusions

Percutaneous image-guided ablation is now integral to desmoid tumor management, with prospective and meta-analytic data demonstrating local control comparable to surgery, high rates of symptom relief, and major complication rates below 5%. The inclusion of ablation and embolization in the NCCN Soft Tissue Sarcoma Guidelines Version 3.2026, with cryoablation identified as the most commonly utilized modality and DEB-TACE recognized when cryoablation is not technically feasible [13], represents a significant milestone for the field. Patient selection requires multidisciplinary evaluation weighing tumor characteristics, location, symptom burden, and reproductive considerations. The CRYODESMO-02 trial, together with prospective studies evaluating combination strategies such as embolization followed by cryoablation and nirogacestat combined with cryoablation, will refine optimal sequencing, patient selection, and the potential systemic-therapy-sparing role of local intervention.