European Conference on Interventional Oncology

April 28 - May 1 | Palma de Mallorca, ES

April 28 - May 1 | Palma de Mallorca, ES

April 28 - May 1 | Palma de Mallorca, ES

April 28 - May 1 | Palma de Mallorca, ES

April 28 - May 1 | Palma de Mallorca, ES

ProgrammeHead and neck tumour ablation

Head and neck tumour ablation


Three reasons why you cannot miss my lecture

  • You will develop a systemic technical approach in ablation in the deep spaces of the head and neck
  • You will understand pertinent issues unique to ablation in the head and neck region
  • You will be able to expand your ablation practice to fulfil a treatment gap

Dr. Uei Pua
Speaker bio

Click here to watch this lecture via the ECIO 2023 congress platform.

A new local treatment option in recurring tumours

Recurrent head and neck cancers (HNC) occur in 50-60% of patients within 2 years of initial successful treatment of the index head and neck cancer. It can also occur as a secondary primary malignancy (SPM) histological and geographically distinct from the index HNC, due to “field cancerization”. [1,2] In both scenarios, management of these cancers can be challenging, as standard of care treatments such as repeat surgery and/or radiation may not be possible due to the prior surgery with altered anatomy or radiation dose limits. As such, many patients will receive systemic treatment for a localized disease due to lack of suitable loco-regional treatment options. Consequently, these patients portend a poor prognosis, as they tend to be biologically less favourable given the recurrent or secondary nature of the tumour. Therefore, ablation with curative intent, which is commonplace elsewhere in the body such as the liver and kidney, is seldom possible, and a palliative intent is an acceptable treatment endpoint, e.g. aiming for local control, palliation of mass effect, pain management, and delay of oro-aero-bypasses (e.g. PEG/tracheostomies).

Using the “big five” to face challenging anatomy

The body of literature describing local ablation of HNC remains limited, consisting of mainly case series. [3] However, physicians have been apprehensive to widely adopt this technique, partly due to the complex anatomy inherent to the HN region, especially in the post-surgical neck. To this end, a standardized approach to reach the different deep spaces of the HN region has been recently described to overcome this technical hurdle. [4] To summarise, five different relatively avascular trajectories allowing for safe access to the deep spaces have been described based on the appearance of bony and soft-tissue landmarks on axial CT. These are: sub-zygomatic, retro-maxillary, retro-molar trigone, trans-glandular, and trans-flap. In addition, a hybrid approach has also been undertaken in areas that could be reached under direct vision and ablation guided using endoscopy and intra-operative ultrasound, such as tumours in the oropharynx and nasopharynx.

What to watch out for

In both the percutaneous or hybrid approach, protection of organ-at-risk (OAR) is crucial. Relevant OAR would include the carotid artery which beyond haemorrhage/blow-out and stroke risk if inadvertently injured, could also cause intra-operative autonomic instability due to neural pathway thermal disturbance. Destruction of cranial nerves in the vicinity of the tumour are typically acceptable during ablation, as loss of function is expected with disease progression (without treatment) or would be destroyed with other local treatment (e.g. enbloc resection or radiation). Other OAR would include the glossus, orbital contents, and brain which would either require physical displacement (e.g. hydrodissection) or real-time monitoring of the ablation zone.

To conclude, ablation can potentially fulfil a treatment gap in patients with recurrent HNC tumours who often have limited treatment options. A systemic technical approach and awareness of relevant issues can allow for a safe procedure with minimal anxiety.

Image 1: Transflap approach for ablation of submandibular recurrence of squamous cell carcinoma

Image 2: Hybrid direct access and IOUS guided ablation of oropharyngeal recurrence of squamous cell carcinoma

Image 3: Retro-molar trigone under CT guidance for cryoablation of nasaopharyngeal carcinoma in the fossa of Rosenmuller


Pua Uei

Tan Tock Seng Hospital, Singapore/SG

Dr. Pua Uei is a senior consultant and Head of Interventional Radiology service at Tan Tock Seng Hospital (TTSH) in Singapore. He is active in medical education and is an Associate Professor of Radiology at the National University of Singapore. He has a penchant for novel IO treatments in areas of ablation, embolotherapy, and bone intervention. He has published more than 180 peer-reviewed publications and has delivered more than 200 lectures at regional and international conferences, as well as in his capacity as visiting professor at leading universities. Dr. Pua has been inducted as a fellow in several societies including CIRSE, the Society of Interventional Radiology (SIR), the Royal College of Radiologists (RCR), the Academy of Medicine, Singapore, and the Society of Cardiovascular Angiography and Intervention (SCAI). He is a founding and board member of the Society of Interventional Oncology (SIO), the inaugural chairperson of the Chapter of Interventional Radiologists in the Academy of Medicine Singapore, and is a Past President of the Singapore Radiological Society.



  1. Gregoire V, Lefebvre JL, Licitra L, Felip E, Group E-E-EGW. Squamous cell carcinoma of the head and neck: EHNS-ESMO-ESTRO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2010;21 Suppl 5:v184-186.
  2. Denaro N, Merlano MC, Russi EG. Follow-up in Head and Neck Cancer: Do More Does It Mean Do Better? A Systematic Review and Our Proposal Based on Our Experience. Clin Exp Otorhinolaryngol. 2016;9(4):287-297.
  3. Schwartz J, Auloge P, Koch G, Robinson JM, Garnon J, Cazzato RL, Perruisseau-Carrier J, Debry C, Gangi A. Percutaneous Cryoablation for Recurrent Head and Neck Tumors. Cardiovasc Intervent Radiol. 2022 Jun;45(6):791-799. doi: 10.1007/s00270-022-03120-3. Epub 2022 Apr 4. PMID: 35378612.
  4. Hui TCH, Lim MY, Karandikar AA, Loke SC, Pua U. A Technical Guide to Palliative Ablation of Recurrent Cancers in the Deep Spaces of the Suprahyoid Neck. Semin Intervent Radiol. 2022 Jun 30;39(2):184-191. doi: 10.1055/s-0042-1745764. PMID: 35782002; PMCID: PMC9246491.