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

Area of Science:

• Oncology
• Interventional Radiology
• Minimally Invasive Procedures

Background:

• Metastatic lymph node (LN) relapse presents a challenge in cancer management.
• Oligometastatic disease requires precise and effective treatment strategies.
• Percutaneous cryoablation (CA) offers a minimally invasive approach for tumor ablation.

Purpose of the Study:

• To evaluate the technical feasibility of percutaneous cryoablation (CA) for single/oligometastatic lymph node (LN) relapse.
• To assess the safety and efficacy of image-guided CA in treating metastatic LNs across different anatomical regions.
• To analyze treatment outcomes and complications associated with CA of LN metastases.

Main Methods:

• Retrospective analysis of patients undergoing percutaneous CA for LN metastases from May 2014 to April 2019.
• Utilized CT-guided CA, with supplementary thermal insulation-displacement techniques (hydrodissection, carbodissection) in select cases.
• Evaluated treatment response using RECIST criteria and monitored prostate-specific antigen (PSA) levels in relevant subgroups.

Main Results:

• Twenty-seven lymph nodes (LNs) in 18 patients were treated with CT-guided CA.
• Tumor response included 8 complete responses, 8 stable disease, and 8 partial responses.
• Mean PSA levels significantly reduced post-treatment in prostate cancer relapse patients; no major complications reported, with transient nerve paresis in two cases.

Conclusions:

• Image-guided percutaneous cryoablation (CA) is a safe and technically feasible option for treating metastatic lymph nodes (LNs).
• The procedure demonstrated favorable oncological outcomes, including significant PSA reduction in prostate cancer relapse.
• Caution and specific measures are advised when performing CA on LNs adjacent to thermal-sensitive structures.