A modified radiofrequency ablation approach for treating distant lymph node metastasis in two patients with late-stage cancer
A 57-year-old woman presented with metastasis of esophageal carcinoma after chemoradiotherapy. She was previously diagnosed with stage T3N1M0 esophageal carcinoma (UICC 2009) in 2010 and underwent radical radiotherapy (60 Gy in 30 fractions, 5 fractions per week) with 4 courses of synchronous chemotherapy (5-fluorouracil plus cisplatin). Positron emission tomography/computed tomography (PET/CT) scan showed signs of primary local advance and solitary metastasis in the right supraclavicular lymph node in April 2011. Ultrasound revealed the lymph node was 2.6 cm × 1.4 cm × 1.2 cm ().\nThe patient refused to undergo radiotherapy for the right supraclavicular lymph node because of the severe adverse effects of previous radiotherapy. Subsequently, the patient underwent systemic chemotherapy (5-fluorouracil plus cisplatin) for local esophageal carcinoma and radiofrequency ablation for the right supraclavicular lymph node. This patient underwent a radiofrequency ablation treatment to destruct the right supraclavicular lymph node. The follow-up protocol was the same as that for case 1. After 1 month of radiofrequency, the right supraclavicular lymph node was not enhanced on contrast-enhanced CT scans, but the local lesion had advanced. Hence, gemcitabine was added to control the local progressive primary disease. At the last follow-up in February 2012, the patient was in good condition, and there was no evidence that distant lymph node metastasis had recurred.