INTRODUCTION

Surgical resection remains the main therapeutic option for abdominal metastases. However, a considerable number of patients are not suitable candidates for surgery due to high operative risk, advanced age, comorbidities, or unresectable disease. In recent years, minimally invasive alternatives have been introduced, with endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) emerging as a valuable option for local tumor control. This technique enables targeted ablation of adrenal lesions while reducing morbidity, shortening hospital stay, and improving tolerance compared with conventional surgery. Although its use has been more extensively evaluated in pancreatic or peripancreatic lesions, evidence regarding adrenal gland metastases is still limited. Therefore, EUS-RFA may represent a particularly relevant approach in selected patients when curative or consolidative intent is pursued.

CASE REPORT

A 77-year-old man was diagnosed with oropharyngeal squamous cell carcinoma in 2019 and initially managed with chemoradiotherapy. Due to cervical oligoprogression during follow-up, salvage surgery was performed, and treatment continued with immunotherapy (nivolumab). In late 2024, surveillance PET-CT revealed a hypermetabolic lesion in the left adrenal gland (Figure 1), raising suspicion of metastatic disease. Endoscopic ultrasound revealed a solid adrenal mass, and fine-needle biopsy confirmed metastatic squamous cell carcinoma. Considering the patient’s characteristics and underlying comorbidities, EUS-RFA was selected as a local therapeutic alternative. The procedure was performed in April 2025 without intra- or post-procedural complications. Subsequent imaging demonstrated complete resolution of the adrenal lesion. Immunotherapy was discontinued thereafter, and the patient has remained clinically stable without radiological evidence of recurrence to date.

CONCLUSION

EUS-RFA represents a promising therapeutic alternative for patients with adrenal metastases who are not suitable for surgery. It offers a safe, effective, and well-tolerated option that allows satisfactory short- and mid-term oncologic control with low complication rates. However, existing evidence remains limited, and further prospective studies with larger sample sizes are required to better define standardized indications and confirm long-term outcomes.