Safe and Effective RF Ablation for Thyroid Tumors

Safe and Effective RF Ablation for Thyroid Tumors

Dutch researchers analyzed published reports of the use of radiofrequency ablation in patients with papillary thyroid microcarcinomas (PTMC) and found that the procedure resulted in complete disappearance of tumors in 79% of cases, with few complications.

“Radiofrequency ablation could be considered as an adjunctive therapy after local tumor growth under active surveillance or as initial therapy in patients anxious about active surveillance and wishing to avoid surgery,” the corresponding author wrote. , Dr. Tessa van Ginhoven, PhD, of Erasmus MC Cancer Institute in Rotterdam, The Netherlands.

Papillary thyroid carcinoma is the most common type of thyroid cancer, with microcarcinomas less than 10 mm in diameter (PTMC) accounting for an increasing proportion of cases, according to the World Health Organization.

PTMCs are diagnosed during high-frequency ultrasound examinations and ultrasound-guided biopsies, with most guidelines recommending surgical removal of tumors as first-line treatment. However, the surgery entails significant costs and potential damage to the laryngeal nerve. RF ablation has been studied as a less aggressive alternative, but its safety and effectiveness remain to be determined, the authors wrote.

In this systematic review and meta-analysis, the Dutch group combed through published studies on RF ablation for PTMC and found 1,045 papers up to May 2021. After careful selection, they included 15 studies for their analysis. All of the studies were from China (n=11) or Korea (n=4) and were published after 2016, the researchers noted.

The studies included a total of 1,770 patients (1,379 women and 391 men) between the ages of 42 and 66 who underwent the procedure. All patients had PTMC confirmed by ultrasound or core biopsy without evidence of lymph node metastasis before undergoing RF ablation.

The group found evidence of complete disappearance of tumor tissue after RF ablation in 12 of the studies, with an average patient follow-up of 34 months. All 15 studies reported the possibility of tumor progression after RF ablation, with a combined proportion of tumor progression of 1%, the authors wrote.

Additionally, the team assessed complications in the 15 studies and found a total of three cases of major complications: two patients experienced voice changes, which resolved spontaneously after two months, and one patient experienced temporary cardiac arrhythmias during the RFA procedure. Minor complications, including postoperative pain, transient voice changes and skin burns, occurred in 45 patients (2.5%).

“The results of this systematic review and meta-analysis suggest that RFA is a safe and effective method for treating PTMC, with complete disappearance rates of 79% of tumor tissue,” the authors said.

The researchers noted several limitations, namely that there were 11 studies with potentially overlapping patient cohorts based on authors’ names, inclusion periods and affiliations. Additionally, because RF ablation for patients with PTMC is relatively new, the follow-up periods for the patients included in the analyzed studies were short, they wrote.

“To properly assess and compare oncologic outcomes with surgery and/or active surveillance in populations with restrictive diagnostic workup strategies, prospective trials or registration studies with long-term follow-up should be conducted,” they wrote. concluded van Ginhoven and his colleagues.

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