Thyroid No Surgery: Ablation of Micro-Cancers with Radiofrequency RFA Coming Soon
Comment: The arrival of FDA approved RFA systems with small probe designed for the delicate neck environment of the thyroid and lymph nodes, by StarMed Korea will allow us to do studies on the use of RFA for micro-cancers and recurrent lymph node metastatic disease after original neck dissection. DR Kim’s paper on this topic is summarized for the lay person.
Richard B. Guttler MD,FACE,ECNU
Of 27 patients with 36 tumors, 24 patients (88.9%) with 31 tumors (one tumor in 17 patients and two tumors in seven patients) underwent one session of RFA. For the remaining three patients (11.1%) with five tumors (one tumor in two patients and three tumors in one patient), two sessions of RFA were performed because of the difficulty in accessing the tumors or tumor multiplicity. Although two of 27 patients (7.4%) complained of severe pain during the ablation, the pain could be controlled by a reduction of RFA power or by stopping the ablation for several seconds. The ablation time per session was 5.5 minutes ± 1.5 (range, 3–8 minutes).
In the reoperation group, at least one tumor was confirmed as recurrent by using fine-needle aspiration before the operation, and the other lesions with high probability of recurrence at preoperative US imaging were resected and evaluated with pathologic examination. All of the repeat surgeries were performed while the patient underwent general anesthesia (K.H.K., Y.K.Y., M.W.S., and K.E.L., with 33, 30, 23, and 8 years of experience in thyroid surgery, respectively). By using a 3.5- to fivefold magnification loupe, comprehensive neck dissection was performed to include all of the compartments.
In our study, we demonstrated that RFA might be an effective and safe treatment for locally recurrent thyroid cancers that were less than 2 cm. These results suggest that RFA may be considered an alternative treatment for local recurrent thyroid cancer.
RFA may be a good alternative to surgery because it can be performed in outpatient clinics without general anesthesia. In the event that recurrence develops repeatedly, RFA may be applied relatively easily and effectively in most cases; we applied RFA successfully in four cases of recurrence after RFA or repeat surgery.
Another important factor in treatment choice is the development of potential complications. In general, the more aggressive surgery is more likely to cause complications (6,27,28). The management of recurrent thyroid cancers, RFA may be a safe alternative to repeat surgery.
In conclusion, based on the comparable recurrence-free survival and complication rates between RFA and reoperation groups, RFA may be performed as an effective and safe alternative to repeat surgery in patients with localized small recurrent thyroid cancers.
The 1- and 3-year recurrence-free survival rates were comparable with surgery.
■ The posttreatment hoarseness rate did not differ RFA. But posttreatment hypocalcemia occurred exclusively in the reoperation group.
■ RFA may be an effective and safe alternative to repeat surgery in patients with locally recurrent small thyroid cancers.
Outpatient RFA ablation done by expert
DR.Roberto Valcavi with smaller probe shown below.
Thyroid surgery more risky when a low volume
surgeon does the surgery.
Thyroid friendly short probe with smaller gauge cool tip
for working in delicate small space of the neck.
RFA generator used for thyroid work in Korea and Italy.