NODAL RECURRENCE TREATED WITH ENDOSCOPIC ULTRASOUND-GUIDED RADIOFREQUENCY ABLATION

Aims EUS-guided ablation procedures are emerging as a minimally invasive therapeutic alternative for locally advanced pancreatic cancer, pancreatic neuroendocrine tumors and pancreatic cystic lesions. This is a safe and technically easy procedure with few complications. In an animal model also demonstrated successful ablation of lymphatic nodes.

Methods Description of two cases of EUS-guided ablation of solid gastrointestinal tumors performed in our hospital between 2017–2019.

Results Case 1:65-year-old patient diagnosed with stenosing colon adenocarcinoma T3N1M0,treated by surgery and adjuvant-QT. Four years later, a nodal recurrence (4x5 cm) that infiltrates the upper mesenteric vein was observed.Chemotherapy and radiofrequency ablation were subsequently proposed. Two ablation sessions (Dec-17, Apr-19) were held for which a EUSRA RF catheter 1 Fr (EMcision, London, UK) with 19 G needle(9–10 passes for 10–20 seconds at 50 W) was used. We had one intraprocedure complication (gastric wall hematoma). In the following month there was an increase of the lesion size and subsequently metastatic liver was observed.

Case 2: 66-year-old patient diagnosed with gastric fundus adenocarcinoma T4aN3, treated with perioperative chemotherapy and surgery. One year later, the patient experienced a single nodal relapse (20 mm) above the celiac axis. QT chemotherapy was initiated and radiofrequency ablation was subsequently proposed, for which a EUSRA RF electrode with 19 G needle (STARmed, Koyang, Korea) was used (two 10 second ablations at 50 W). The absence of the lesion and no signs of recurrence at other levels were observed in a follow-up CT performed 3 months later.

Conclusions A patient is currently kept free of recurrence and the other, despite presenting disease progression, we think of an increase in survival in relation to the technique.We can conclude that radiofrequency ablation of a local nodal recurrence of solid gastrointestinal tumors is a simple technique that might improve the results of chemotherapy and increase survival in selected cases.