EUS-Guided Radiofrequency Ablation for Recurrent Lymph Node Metastasis

Abstract

Radiofrequency ablation causes tissue destruction through the application of a high-frequency alternating current, generating local temperatures above 60 °C and leading to coagulative necrosis [1, 2]. The technique has been widely used in many solid organ tumours and has been shown to result in 5-year survival rates comparable to surgery. The application of EUS-guided RFA was first described in the pancreas in 1999 [3]. Since then, there have been significant improvements in the device and EUS-guided RFA is currently under evaluation in humans. In an initial report, EUS-guided RFA was shown to be technically feasible in 6 patients with unresectable pancreatic adenocarcinoma [4]. Two patients suffered from mild abdominal pain but no serious adverse events were reported. Thereafter, the technique has been described in patients suffering from pancreatic neuroendocrine tumour (NET), pancreatic cystic neoplasms, hepatocellular carcinoma, and adrenal metastasis [5–7]. In pancreatic cancer, EUS-guided RFA was able to induce tumour ablation. In pancreatic NET, up to 86% of the patients had complete resolution of the tumour. In pancreatic cystic neoplasms, 64.7% had complete response. However, whether the procedure is associated with improved outcomes as compared to conventional treatment requires further evaluation. In our centre, a research protocol is in place to evaluate the role of EUS-guided RFA in isolated metastatic lymph nodes. The current case is used to illustrate the potential role of EUS-guided RFA in this clinical scenario.