Thyroid No Surgery: Ablation of Micro-Cancers with Radiofrequency RFA Coming Soon

Thyroid No Surgery: Ablation of Micro-Cancers with Radiofrequency RFA Coming Soon

Thyroid No Surgery: Ablation of Micro-Cancers with Radiofrequency RFA Coming Soon
The recurrent cancers were separated from the normal structures by infusing 5% dextrose solution or lidocaine into the space between the cancer and the normal structures

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).

Reoperation Procedure

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.

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Figure 1a: Images of RFA in a 58-year-old woman with solitary recurrent papillary thyroid cancer at right cervical level Vl, according to the level system defined by the American Head and Neck Society. (a) Axial US image shows a recurrent tumor (black arrows) at the medial aspect of the right common carotid artery (white arrows).

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.

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Outpatient RFA ablation done by expert

DR.Roberto Valcavi with smaller probe shown below.

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Thyroid surgery more risky when a low volume

surgeon does the surgery.

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Thyroid friendly short probe with smaller gauge cool tip

for working in delicate small space of the neck.

sratmed_company

RFA generator used for thyroid work in Korea and Italy.

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