Clinical study
CT-guided Radiofrequency Ablation in the Palliative Treatment of Recurrent Advanced Head and Neck Malignancies

https://doi.org/10.1016/j.jvir.2007.12.439Get rights and content

Purpose

To evaluate the safety and effectiveness of computed tomography (CT)-guided radiofrequency (RF) ablation in the palliative treatment of recurrent advanced head and neck cancers.

Materials and Methods

From November 2002 to January 2005, the authors identified 14 patients (median age, 61 years) with 14 recurrent advanced primary head and neck malignancies who underwent 27 CT-guided RF ablation applications during 20 sessions at their institution. RF ablation was performed in all patients with the intent of palliative therapy. Radiologic tumor response was assessed by using Response Evaluation Criteria in Solid Tumors. Patients were assessed clinically by means of University of Washington Head and Neck Quality of Life questionnaires.

Results

Technical success in tumor targeting and electrode deployment was 100%. University of Washington quality of life surveys completed by six of 14 patients (43%) showed an index increase by a median of 3.1 percentage points, with four of six patients (67%) demonstrating improvement. Three major complications (in 27 applications, 11%) occurred 7 days to 2 weeks after the procedure. These included stroke, carotid blowout leading to death, and threatened carotid blowout with subsequent stroke. Retrospective analysis of intraprocedural CT scans revealed that the retractable electrodes were within 1 cm of the carotid artery during ablation in these cases.

Conclusions

RF ablation in patients with advanced head and neck malignancies is feasible and effective for palliation. CT-guidance provides accurate probe placement and electrode deployment. The energy level used and proximity of the ablation sphere to the carotid artery may predispose to vascular complications.

Section snippets

Patients and Tumor Characteristics

From November 2002 to January 2005, we identified 14 patients from our quality assurance database who underwent 27 CT-guided RF ablation applications during 20 sessions for the treatment of 14 primary head and neck malignancies. The patient population included nine men and five women. The median age of the cohort was 61 years (range, 36–81 years). All patients had previously undergone surgery, radiation therapy, and chemotherapy for the treatment of a primary head and neck malignancy and had

RF Ablation Procedure

Complete results according to tumor characteristics are given in Table 1. Successful placement of the RF ablation probe was achieved in all sessions. Owing to the wide disparity in lesion geometry and size, ablation times per session varied greatly (range, 8.0–70.0 minutes; median, 12.5 minutes). If we exclude the patient treated with the XLi probe, the number of RF applications per tumor was one for each of six tumors (mean maximal diameter, 5.0 cm ± 1.2), two for each of two tumors (7.3 cm ±

Discussion

Recurrent head and neck malignancies are rarely curable (7). Although both surgery and radiation therapy play an important role in the treatment of these patients, the general approach has been palliative, given the poor long-term results and toxic nature of standard treatment modalities (6, 7). In addition, many such patients have compromised cardiopulmonary status or other coexistent medical problems, which leads to substantial postoperative mortality. The substantial morbidity that plagues

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    None of the authors have identified a conflict of interest.

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