Salvage Lymph-Node Percutaneous Cryoablation: Safety Profile and Oncologic Outcomes

Purpose To evaluate the technical feasibility and safety of percutaneous cryoablation (CA) for the treatment of single/oligometastatic lymph-node (LN) relapse in different anatomic regions.

This is a retrospective study of all patients who underwent percutaneous CA of LN metastases (May 2014-April 2019).

Eighteen patients with a total of 27 LNs were treated with CT-guided CA (Galil Medical, Israel). One patient was excluded since no follow-up was available. The mean LN diameter was 11 mm (range 4-28 mm). Thirteen patients had a history of previous treatment for locoregional lymphadenopathy. In 21 LNs, a supplementary thermal insulation-displacement technique was used (hydrodissection = 12; carbodissection = 6; both = 3). According to the RECIST criteria, 8 LNs had a complete response, 8 stable disease, 8 partial response and 1 progressive disease. In the subgroup of patients with prostate cancer relapse, the mean PSA level before treatment was 5.5 ngr/ml (range 0.6-36 ngr/ml) and reduced to 0.32 (range 0-1.1 ngr/ml) and 0.3 (range 0-0.6 ngr/ml) at 3- and 6-month follow-up, respectively. Six patients presented distant tumor deposits on follow-up that were further treated with systemic (5 patients: hormone/chemo/immunotherapy) and local therapies (1 patient: CA of bone oligometastatic disease). No major complication was noted. Two patients with obturator LN presented transient obturator nerve paresis. Mean follow-up was 15 months (range 1-56 months).

In this series of patients, we have shown that metastatic LNs can be safely treated with image-guided CA. Caution should be paid, and additional measures should be taken when treating LNs near thermal-sensible structures.