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

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.