CardioVascular and Interventional Radiology

, Volume 43, Issue 2, pp 264–272 | Cite as

Salvage Lymph-Node Percutaneous Cryoablation: Safety Profile and Oncologic Outcomes

  • Georgia TsoumakidouEmail author
  • Katerina Mandralis
  • Arnaud Hocquelet
  • Rafael Duran
  • Alban Denys
Clinical Investigation Interventional Oncology
Part of the following topical collections:
  1. Interventional Oncology


Purpose To evaluate the technical feasibility and safety of percutaneous cryoablation (CA) for the treatment of single/oligometastatic lymph-node (LN) relapse in different anatomic regions.

Materials and Methods

This is a retrospective study of all patients who underwent percutaneous CA of LN metastases (May 2014–April 2019).


Eighteen patients with a total of 27 LNs were treated with CT-guided CA (Galil Medical, Israel). One patient was excluded since no follow-up was available. The mean LN diameter was 11 mm (range 4–28 mm). Thirteen patients had a history of previous treatment for locoregional lymphadenopathy. In 21 LNs, a supplementary thermal insulation-displacement technique was used (hydrodissection = 12; carbodissection = 6; both = 3). According to the RECIST criteria, 8 LNs had a complete response, 8 stable disease, 8 partial response and 1 progressive disease. In the subgroup of patients with prostate cancer relapse, the mean PSA level before treatment was 5.5 ngr/ml (range 0.6–36 ngr/ml) and reduced to 0.32 (range 0–1.1 ngr/ml) and 0.3 (range 0–0.6 ngr/ml) at 3- and 6-month follow-up, respectively. Six patients presented distant tumor deposits on follow-up that were further treated with systemic (5 patients: hormone/chemo/immunotherapy) and local therapies (1 patient: CA of bone oligometastatic disease). No major complication was noted. Two patients with obturator LN presented transient obturator nerve paresis. Mean follow-up was 15 months (range 1–56 months).


In this series of patients, we have shown that metastatic LNs can be safely treated with image-guided CA. Caution should be paid, and additional measures should be taken when treating LNs near thermal-sensible structures.


Lymphadenopathy Lymph node relapse Cryoablation Prostate cancer relapse 



This study was not supported by any funding.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Moulding FJ, Roach SC, Carrington BM. Unusual sites of lymph node metastases and pitfalls in their detection. Clin Radiol. 2004;59(7):558–72.CrossRefGoogle Scholar
  2. 2.
    Sleeman JP. The lymph node pre-metastatic niche. J Mol Med (Berl). 2015;93(11):1173–84.CrossRefGoogle Scholar
  3. 3.
    Suardi N, Gandaglia G, Gallina A, et al. Long-term outcomes of salvage lymph node dissection for clinically recurrent prostate cancer: results of a single-institution series with a minimum follow-up of 5 years. Eur Urol. 2015;67(2):299–309.CrossRefGoogle Scholar
  4. 4.
    Suardi N, Briganti A, Gandaglia G, et al. Salvage lymph node dissection for node-only recurrence of prostate cancer: ready for prime time? Eur Urol. 2017;71(5):693–4.CrossRefGoogle Scholar
  5. 5.
    Ploussard G, Almeras C, Briganti A, et al. Management of node only recurrence after primary local treatment for prostate cancer: a systematic review of the literature. J Urol. 2015;194:983–8.CrossRefGoogle Scholar
  6. 6.
    Salah S, Watanabe K, Welter S, et al. Colorectal cancer pulmonary oligometastses: pooled analysis and construction of a clinical lung metastatectomy model. Ann Oncol. 2012;23(10):2649–55.CrossRefGoogle Scholar
  7. 7.
    Taked A, Sanuki N, Kunieda E. Role of stereotactic body radiotherapy for oligometastatis from colorectal cancer. World J Gastroenterol. 2014;20:4220–9.CrossRefGoogle Scholar
  8. 8.
    Onal C, Guler OC, Yildrim BA. Treatment outcomes of breast cancer liver metastasis treated with stereotactic body radiotherapy. Breast. 2018;42:150–6.CrossRefGoogle Scholar
  9. 9.
    Zhang Y, Schoenhals J, Christie A, et al. Stereotactic ablative radiotherapy (SAbR) used to defer systemic therapy in oligometastatic renal cell cancer. Int J Radiat Oncol Biol Phys. 2019. ahead of print).CrossRefPubMedGoogle Scholar
  10. 10.
    Luo X, He W, Long X, et al. Cryoablation of cardiophrenic angle lymph node metastases: a case report. J Med Case Rep. 2017;11(1):223.CrossRefGoogle Scholar
  11. 11.
    Adam LC, Raja J, Ludwig JM, et al. Cryotherapy for nodal metastasis in NSCLC with acquired resistance to immunotherapy. J Immunother Cancer. 2018;6(1):147.CrossRefGoogle Scholar
  12. 12.
    Cornelis F, Paty PB, Sofocleous CT, et al. Percutaneous cryoablation for local control of metachronous inguinal lymph node metastases. Cardiovasc Interv Radiol. 2015;38(5):1369–72.CrossRefGoogle Scholar
  13. 13.
    Koch G, Garnon J, Edalat F, Cazzato RL, Gangi A. Revealing mediastinal anatomy through hydrodissection. J Vasc Interv Radiol. 2016;27(11):1761–3.CrossRefGoogle Scholar
  14. 14.
    Kilcoyne A, Frenk NE, Arallano RS. Percutaneous cryoablation of a metastatic right external iliac lymph node with associated injury of the femoral nerve. J Vasc Interv Radiol. 2016;27(4):611–2.CrossRefGoogle Scholar
  15. 15.
    Cazzato RL, Garnon J, Ramamurthy N, et al. Tansdiscal hydrodissection of the retrocrural space to optimize percutaneous image-guided cryoablation of a nodal metastasis: case report of a novel technique. J Vasc Interv Radiol. 2016;27(9):1463–4.CrossRefGoogle Scholar
  16. 16.
    Shah T, Arbel U, Foss S, et al. Modeling cryotherapy ice ball dimensions and isotherms in a novel gel based model to determine optimal cryo-needle configurations and settings for potential use in clinical practice. Urology. 2016;91:234–40.CrossRefGoogle Scholar
  17. 17.
    Filippiadis D, Binkert C, Pellerin O, et al. Cirse quality assurance document and standards for classification of complications: the cirse classification system. Cardiovasc Interv Radiol. 2017;40:1141–6.CrossRefGoogle Scholar
  18. 18.
    Pound CR, Partin AW, Epstein JI, Walsh PC. Prostate-specific antigen after anatomic radical retropubic prostatectomy: patterns of recurrence and cancer control. Urol Clin N Am. 1997;24(2):395–406.CrossRefGoogle Scholar
  19. 19.
    Shaha AR, Loree TR, Shah JP. Prognostic factors and risk group analysis in follicular carcinoma of the thyroid. Surgery. 1995;118:1131–6 (discussion 1136–8).CrossRefGoogle Scholar
  20. 20.
    Yuan Z, Xing A, Zheng J, Li W. Safety and technical feasibility of percutaneous ablation for lymph node metastases of hepatocellular carcinoma. Int J Hyperth. 2019;36:160–8.CrossRefGoogle Scholar
  21. 21.
    Chen SC, Chang HK, Lin YC, et al. Prognosis of breast cancer after supraclavicular lymph node metastasis: not a distant metastasis. Ann Surg Oncol. 2006;13(11):1457–65.CrossRefGoogle Scholar
  22. 22.
    Karnes RJ, Murphy CR, Bergstralh EJ, et al. Salvage lymph node dissection for prostate cancer nodal recurrence detected by 11C-choline positron emission tomography/computerized tomography. J Urol. 2015;193(1):111–6.CrossRefGoogle Scholar
  23. 23.
    Samaan NA, Schultz PN, Hickey RC, et al. The results of various modalities of treatment of well differentiated thyroid carcinomas: a retrospective review of 1599 patients. J Clin Endocrinol Metab. 1992;75:714–20.PubMedGoogle Scholar
  24. 24.
    Stewart FA. Re-treatment after full-course radiotherapy: is it a viable option. Acta Oncol. 1999;38(7):855–62.CrossRefGoogle Scholar
  25. 25.
    Wang W, Larson SM, Tuttle RM, et al. Resistance of [18f]-fluo- rodeoxyglucose-avid metastatic thyroid cancer lesions to treatment with high-dose radioactive iodine. Thyroid. 2001;11:1169–75.CrossRefGoogle Scholar
  26. 26.
    Hoffman NE, Bischof JC. The cryobiology of cryosurgical injury. Urology. 2002;60(Suppl 2A):40–9.CrossRefGoogle Scholar
  27. 27.
    Ahmed M, Brace CL, Lee FT Jr, Goldberg SN. Principles of and advances in percutaneous ablation. Radiology. 2011;253(2):351–69.CrossRefGoogle Scholar
  28. 28.
    Robinson D, Halperin N, Nevo Z. Two freezing cycles ensure interface sterilization by cryosurgery during bone tumor resection. Cryobiology. 2001;43(1):4–10.CrossRefGoogle Scholar
  29. 29.
    Kurup AN, Morris JM, Schmit GD, et al. Neuroanatomic considerations in percutaneous tumor ablation. Radiographics. 2013;33(4):1195–215.CrossRefGoogle Scholar
  30. 30.
    Garnon J, Cazzato RL, Caudrelier J, Nouri-Neuville M, Rao P, Boatta E, Ramamurthy N, Koch G, Gangi A. Adjunctive thermoprotection during percutaneous thermal ablation procedures: review of current techniques. Cardiovasc Interv Radiol. 2019;42(3):344–57. 2018 Oct 11).CrossRefGoogle Scholar
  31. 31.
    Dupuy DE, Monchik JM, Decrea C, Pisharodi L. Radiofrequency ablation of regional recurrence from well-differentiated thyroid malignancy. Surgery. 2001;130:971–7.CrossRefGoogle Scholar
  32. 32.
    Tsoumakidou G, Garnon J, Ramamurthy N, Buy X, Gangi A. Interest of electrostimulation of peripheral motor nerves during percutaneous thermal ablation. Cardiovasc Interv Radiol. 2013;36(6):1624–8.CrossRefGoogle Scholar
  33. 33.
    Hiraki T, Yasui K, Mimura H, et al. Radiofrequency ablation of metastatic mediastinal lymph nodes during cooling and temperature monitoring of the tracheal mucosa to prevent thermal tracheal damage: initial experience. Radiology. 2005;237(3):1068–74.CrossRefGoogle Scholar
  34. 34.
    Samadi K, Arellano RS. Ureteral protection during microwave ablation of renal cell carcinoma: combined use of pyeloperfusion and hydrodissection. Diagn Interv Radiol. 2018;24(6):388–91.CrossRefGoogle Scholar
  35. 35.
    Sabel MS. Cryo-immunology: a review of the literature and proposed mechanisms for stimulatory versus suppressive immune responses. Cryobiology. 2009;58:1–11.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2019

Authors and Affiliations

  1. 1.Centre Hospitalier Universitaire VaudoisLausanneSwitzerland

Personalised recommendations