Radiofrequency ablation of malignant cervical lymph nodes: an unusual treatment for dysphagia

Radiofrequency ablation (RFA) has been used for the treatment of nonfunctional pancreatic neuroendocrine tumors (PNETs) < 2 cm [1], functional PNETs (insulinoma) [2], pancreatic metastasis of kidney cancer [3], and isolated cases of intraductal papillary mucinous neoplasm (IPMN) with worrisome features [4]. We describe the use of RFA to treat a compressive cervical lymph node causing dysphagia ([Video 1]).

Video 1 Radiofrequency ablation of malignant cervical lymph nodes.

A 64-year-old woman undergoing palliative care for metastatic cervical cancer was treated with several lines of chemotherapy (cisplatin-paclitaxel, capecitabine, vinorelbine, paclitaxel, carboplatin, topotecan). The patient presented rapid-onset, dysphagia progressing to grade IV due to a large cervical area lymph node metastasis. The patient had already undergone radiotherapy on the cervical area during the management of her disease. The stenosis was also too close to Killian’s triangle to place an esophageal stent. After discussion with the patient and because she could not swallow her own saliva without discomfort, we proposed the use of endoscopic ultrasound-guided RFA on the cervical area lymph nodes.

RFA was performed with a therapeutic linear echoendoscope under carbon dioxide insufflation using EUS-RFA (Starmed/TaeWoong Medical, Gimpo, South Korea). The procedure was performed with the patient sedated and intubated. Radiofrequency power was typically applied (50 W) until the appearance of hyperechoic bubbles.

The patient underwent one session of RFA, with two total RFA shots administered. Clinicians should be careful to not perform RFA too close to the esophageal wall to avoid potential fistula. The goal of the treatment was necrosis of the posterior part of the lymph node.

After 2 days, the dysphasia was reduced to grade I. After 4 months, the patient received only supportive care owing to disease progression.

RFA is a promising minimally invasive technique mainly described for PNETs, but additional applications are expected.

Endoscopy_UCTN_Code_TTT_1AS_2AC

Competing interests

The authors declare that they have no conflict of interest.

• References

• 1 Marx M, Godat S, Caillol F. et al. Management of non-functional pancreatic neuroendocrine tumors by endoscopic ultrasound-guided radiofrequency ablation: retrospective study in two tertiary centers. Dig Endosc 2022; 34: 1207-1213
• 2 Marx M, Trosic-Ivanisevic T, Caillol F. et al. EUS-guided radiofrequency ablation for pancreatic insulinoma: experience in 2 tertiary centers. Gastrointest Endosc 2022; 95: 1256-1263
• 3 Chanez B, Caillol F, Ratone JP. et al. Endoscopic ultrasound-guided radiofrequency ablation as an future alternative to pancreatectomy for pancreatic metastases from renal cell carcinoma: a prospective study. Cancers (Basel) 2021; 13: 5267
• 4 Barthet M, Giovannini M, Lesavre N. et al. Endoscopic ultrasound-guided radiofrequency ablation for pancreatic neuroendocrine tumors and pancreatic cystic neoplasms: a prospective multicenter study. Endoscopy 2019; 51: 836-842

Publikationsverlauf

Artikel online veröffentlicht:
11. November 2022