A preliminary study on ultrasound-guided percutaneous microwave ablation for palliative treatment of advanced head and neck malignancies

Abstract

Objective: To evaluate the safety and efficacy of ultrasound (US)-guided percutaneous microwave ablation (UgPMWA) for palliative treatment of advanced head and neck malignancies. Materials and methods: This study includes 18 consecutive patients with advanced head and neck malignancies (n ¼ 24), who have undergone UgPMWA for palliative treatment at our institution from December 2016 to April 2020. The maximum diameter and volume of the tumor were assessed by US, CT or MRI before microwave ablation (MWA), 1, 3 and 6 months after MWA and every 6 months thereafter. The quality of life was clinically assessed by the University of Washington Head and Neck Quality of Life questionnaire (UW-QOl). Results: The success rate of tumor-targeting microwave antenna placement was 100%. No nerve injury and serious complications or death occurred during the perioperative period. The follow-up duration varied from 1 month to 38 months (11.56 ± 10.23 months) among patients. By the last followup before submission, the value of maximum diameter (5.00 ± 2.90 vs 3.28 ± 2.11 cm. p < 0.05) and tumor volume decreased significantly(74.35 ± 46.88 vs 47.45 ± 24.08 cm 3. p < 0.05)respectively after palliative treatment with UgPMWA. UW-QOl of the patients was improved (59.24 ± 11.51 vs 69.84 ± 8.12, p < 0.05). Conclusion: UgPMWA is safe and effective for the palliative treatment of head and neck malignancies. Ultrasonic guidance can indicate an accurate location of the microwave antenna. It can also monitor the ablation area in real-time during the operation to avoid damage to surrounding normal tissues.

A Technical Guide to Palliative Ablation of Recurrent Cancers in the Deep Spaces of the Suprahyoid Neck

“…If the patient is not suitable for GA, these procedures can be done under conscious sedation with cervical plexus block. 22 Prophylactic antibiotics coverage for oral and skin organisms are recommended. 14…”

“…Recently, the use of US with intravenous contrast alone as a guidance and monitoring modality has been reported. 22…”

“…If the patient is not suitable for GA, these procedures can be done under conscious sedation with cervical plexus block. 22 Prophylactic antibiotics coverage for oral and skin organisms are recommended. 14 Preprocedural contrast-enhanced cross-sectional imaging should be performed within a month prior to and on the day of procedure to assess for feasibility.…”

“…Belfiore et al achieved a maximum temperature of 90 °C with a peak power of 170 to 190 W, an impedance of 60 to 80 ohms, and a peak current between 1,600 and 2,000 mA. 27 When using MWA, a lower power is used with a generator output of 30 to 45 W by Liao et al and Belfiore et al 22,27 When using cryoablation, Gangi et al used two to eight cryoprobes and freezing time ranged between 12 and 20 minutes using the double-freeze protocol, terminating the freezing cycle prematurely if adjacent neurovascular structures were at risk. 16 At our institution, we start at 30% freezing power, increasing by 10% every 2 minutes while monitoring the propagation of the ice-ball.…”

“…Cellulitis was also reported after heat-based RHNC ablation. 22,25,26 In our institution, prophylactic antibiotics coverage for oral and skin organisms is routinely given. Belfiore et al reported one case of cutaneous fistula which resolved with local therapy and one case of palate perforation that required a prosthetic replacement.…”