A modified radiofrequency ablation approach for treating distant lymph node metastasis in two patients with late-stage cancer
A 58-year-old man was admitted in August 2011 with a 2-month history of progressive pain of the right lower limb. One year prior, he was diagnosed with stage T3N1M0 nasopharyngeal carcinoma (NPC) according to the Union for International Cancer Control (UICC, 2009) classification and treated with radical radiotherapy (70 Gy in 35 fractions, 5 fractions per week) combined with 3 courses of concurrent cisplatin chemotherapy. During physical examination, a tender, unfixed lymph node measuring 1.0 cm × 1.0 cm × 0.9 cm could be palpated in level III of the right cervicum, and this finding was confirmed by ultrasonography (). The skin of the cervical region was normal in appearance, and no lesions were found in the oral cavity. No facial nerve palsy was present. During the course of the disease, there were no reports of headache, diplopia, abnormal deglutition, nasal occlusion, or blood-stained nasal discharge. Emission computed tomography (ECT) and magnetic resonance imaging (MRI) scans revealed metastasis from NPC to the lumbar vertebra 2/3 and a single lymph node in level III of the right cervical region. Laboratory studies, which included full blood cell count, electrolytes, urinalysis, and liver function tests, showed results within normal limits.\nAccording to the presentation, physical examination, and laboratory examination, this patient was diagnosed, after radio-therapy, with NPC with metastasis to the lumbar vertebra and a single lymph node in level III of the right cervical region. The patient was unwilling to undergo radiotherapy again and instead was treated with palliative radiotherapy for metastasis in the lumbar vertebra and radiofrequency ablation for lymph node metastasis in the right cervical region. This patient did not undergo radiotherapy for the right cervical lymph node because of local radiation-induced injury from the treatment of primary NPC. Thus, this patient underwent a radiofrequency ablation treatment to destruct the right cervical lymph node.\nThe patient achieved clinical complete response after 1 month of treatment. The follow-up protocol included clinical and laboratory examinations every 3 months in the first year after therapy and every 6 months thereafter. The patient was in good condition at the last follow-up in February 2012 and was living a normal life.