Percutaneous Image-Guided Cryoablation of Head and Neck Tumors for Local Control, Preservation of Functional Status, and Pain Relief

Abstract

Objective: We report nine consecutive percutaneous image-guided cryoablation procedures of head and neck tumors in seven patients (four men and three women; mean age, 68 years; age range, 50-78 years). Ablation of the entire tumor for local control or ablation of a region of tumor for pain relief or preservation of function was achieved in eight of nine procedures. One patient experienced intraprocedural bradycardia, and another developed a neopharyngeal abscess. There were no deaths, permanent neurologic or functional deficits, vascular complications, or adverse cosmetic sequelae due to the procedures.

Conclusion: Percutaneous image-guided cryoablation offers a potentially less morbid minimally invasive treatment option than salvage head and neck surgery. The complications that we encountered may be avoidable with increased experience. Further work is needed to continue improving the safety and efficacy of cryoablation of head and neck tumors and to continue expanding the use of cryoablation in patients with head and neck tumors that cannot be treated surgically.

Keywords: cryoablation; cryosurgery; head and neck neoplasms; interventional oncology.

Figures

Figure 1

(a) 75 year-old male with recurrent squamous cell carcinoma of the neopharynx. Intraprocedural axial fused PET-CT image demonstrates cryoprobe (white arrow) within FDG-avid lesion (black arrow) with ice ball encompassing FDG-avid lesion (black arrows with white outlines) and the entire neopharynx. (b) 50 year-old male with adenoid cystic carcinoma metastases. Intraprocedural axial fused PET-CT image demonstrates cryoprobe (white arrow) within the hypermetabolic lesion (black arrow) with faintly visible ice ball (black arrows with white outlines) encompassing the lesion. A second cryoprobe is demonstrated in a right vertebral foramen metastasis, which was simultaneously ablated.

Figure 1

(a) 75 year-old male with recurrent squamous cell carcinoma of the neopharynx. Intraprocedural axial fused PET-CT image demonstrates cryoprobe (white arrow) within FDG-avid lesion (black arrow) with ice ball encompassing FDG-avid lesion (black arrows with white outlines) and the entire neopharynx. (b) 50 year-old male with adenoid cystic carcinoma metastases. Intraprocedural axial fused PET-CT image demonstrates cryoprobe (white arrow) within the hypermetabolic lesion (black arrow) with faintly visible ice ball (black arrows with white outlines) encompassing the lesion. A second cryoprobe is demonstrated in a right vertebral foramen metastasis, which was simultaneously ablated.

Figure 2

59 year-old male with squamous cell carcinoma metastases. (a) Preprocedure contrast-enhanced axial CT image demonstrates an ill-defined lesion (black arrows) involving the carotid and vertebral arteries (white arrows). (b) Intraprocedural axial TSE T2-weighted MR image demonstrates ice ball (black arrows with white outlines) adjacent to carotid and vertebral arteries (white arrows) with deformed ice ball contour due to flow-related heat sink effect and with preserved flow voids and mild surrounding edema; warm saline soaked gauze overlies the skin.

Figure 2

59 year-old male with squamous cell carcinoma metastases. (a) Preprocedure contrast-enhanced axial CT image demonstrates an ill-defined lesion (black arrows) involving the carotid and vertebral arteries (white arrows). (b) Intraprocedural axial TSE T2-weighted MR image demonstrates ice ball (black arrows with white outlines) adjacent to carotid and vertebral arteries (white arrows) with deformed ice ball contour due to flow-related heat sink effect and with preserved flow voids and mild surrounding edema; warm saline soaked gauze overlies the skin.

Figure 3

65 year-old female with metastatic adenoid cystic carcinoma metastasis causing severe right-sided facial pain. (a) Preprocedure and (b) intraprocedural coronal TSE T2-weighted MR images demonstrate a mass (white arrows) and a cryoprobe with ice ball (black arrows with white outlines) covering the entire mass and extending to the right temporal lobe. The ice ball was also adjacent to the right cavernous carotid artery several millimeters posterior to this plane.

Figure 3

65 year-old female with metastatic adenoid cystic carcinoma metastasis causing severe right-sided facial pain. (a) Preprocedure and (b) intraprocedural coronal TSE T2-weighted MR images demonstrate a mass (white arrows) and a cryoprobe with ice ball (black arrows with white outlines) covering the entire mass and extending to the right temporal lobe. The ice ball was also adjacent to the right cavernous carotid artery several millimeters posterior to this plane.