Emerging Indications for Interventional Oncology: A Comprehensive Systematic Review of Image-Guided Thermal Ablation for Metastatic Non-cervical Lymph Node Disease

Introduction Lymphatic node metastatic disease encompasses a distinct oncological entity which has been associated with poor prognosis. Image-guided thermal ablation has recently been proposed as a safe and alternative treatment for these lesions. The aim of this systematic review is to evaluate the pooled safety and efficacy of thermal ablation techniques for the treatment of oligometastatic non-cervical lymph nodal disease. Recent Findings A systematic search of the three major databases (MEDLINE, EMBASE, and CENTRAL) from inception to 30 December 2023 was conducted according to the PRISMA Guidelines. Observational studies reporting technical success, complications and oncologic outcomes were included. Meta- analysis was performed by estimating the pooled incidence rates and risk ratios by fitting random-effect models. Overall, 8 studies were included, comprising of 225 patients and 305 ablated LNMs and a median follow-up of 12 months. The combined data analysis showed that technical success after thermal ablation was 98% (CI: 95%–99%), major complication rate was 1% (CI: 95%–99%), pooled overall response rate was 72% (CI: 54%–87%), local tumor progression rate was 18% (CI: 8%–33%) and disease-free survival rate was 68% (CI: 51%–81%). No difference between radiofrequency ablation and cryoablation was found for every outcome during subgroup analysis. Summary Image-guided percutaneous thermal ablation (with either radiofrequency ablation or cryoablation) is safe and effective for the treatment of oligometastatic LMN disease, however further studies to confirm these findings are still needed.