Thyroid No Surgery 101: Another Non-Surgical Therapy Besides Ethanol Ablation PEI for Loco-Regional Recurrence of Well-Differentiated Thyroid Carcinoma
- Thirty-five recurrent well-differentiated thyroid carcinomas (RTC) in 32 patients were treated with RFA, between March 2008 and October 2011. RTCs were detected by regular follow-up ultrasound and confirmed by biopsy.
- All patients had fewer than 3 RTCs in the neck and were at high surgical risk or refused to undergo repeated surgery.
- Average number of RFA sessions were 1.3 (range 1-3).
- Post-RFA biopsy and ultrasound were performed.
- The mean follow-up period was 30 months. Pre- and post-RFA serum thyroglobulin values were evaluated.
- Several investigators have reported good local control results following RFA of the recurrent thyroid cancer.
Three procedures to prevent major organ injuries near tumors in level 6.
Metastatic tumor is detected in right level 6 on ultrasound (A, straight arrows). First, lidocaine is injected around tumor to separate invisible recurrent laryngeal nerve, trachea, and carotid artery from tumor and to provide pain control before ablation (B, arrowheads). Second, tumor is pulled away from three organs by tilting electrode during ablation (C, D, curved arrows). Third, cold fluid is injected around ablated tumor after ablation (E, arrowheads).
Three procedures to prevent major organ injuries near tumor in level 3.
Metastatic tumor (arrowhead) in right level 3 is detected near vagus nerve (straight arrow), common carotid artery (CCA) and internal jugular vein (IJV) on ultrasound (A). First, lidocaine is injected around tumor to separate visible vagus nerve (short arrow), CCA, IJV, and sternocleidomastoid muscle from tumor and to provide pain control before ablation (B, C, arrowheads). Second, tumor is pulled away from three major organs by tilting electrode during ablation (D, curved arrow). Third, cold fluid is injected around ablated tumor after ablation (not shown).
The mean follow-up period was 30 months (range, 6-49 months). At the last follow-up US examination, 31 recurrent tumors had completely disappeared (93.9%) (). The remaining 2 tumors in the level IV and level VI, decreased in volume (volume reduction rate, 84% and 53%, respectively) (): the first remained as a tiny calcified nodule, and the second remained as a hypoechoic nodule with an internal hyperechoic dot. The other 2 tumors in one patient were not eligible for US follow-up, as they had been removed by surgical resection
39-year-old man with recurrent thyroid cancer in right level 3.
Initial CT (A) and ultrasound (B) demonstrate recurrent nodule in right level 3 (arrows, 13 mm). One session of radiofrequency ablation (RFA) (1.0-cm electrode, 10-20 W, one minutes 20 seconds) is performed. Nodule shows decreased size with 76.9% volume reduction rate on post-RFA one-month follow-up ultrasound (not shown) and is invisible on 19-month follow-up ultrasound (C, arrows) and 22-month follow-up CT (D, arrows).
38-year-old woman with recurrent thyroid cancer in right level 6.
Initial CT (A) and ultrasound (B) show enhancing nodule in right level 6 (arrows, 18 mm). There is no enhancing nodule (arrows) on 2-month follow-up CT after radiofrequency ablation (RFA) (C). On ultrasound for post-RFA fine-needle aspiration (D), volume of this nodule was markedly reduced (87.0% volume reduction rate) and biopsy result was negative for malignancy.
85-year-old woman with two recurrent thyroid cancers in right level 4 (23 mm and 26 mm).
Recurrent node (23 mm) is seen on initial CT (A, arrows). Volume of this node is reduced, but it is still enhanced on CT scan after 1st radiofrequency ablation (RFA) (B, arrows). Suspicion of malignancy was demonstrated in this nodule on post-1st RFA biopsy. This nodule was surgically treated (C, arrows). Another recurrent node (26 mm) was completely treated with RFA (not shown).
Six patients experienced voice change immediately after RFA. Voice change was recovered in 5 patients. One patient without recovery was treated with vocal cord medialization. All 6 patients with voice change had tumors in the level VI. There were no other significant complications, and most of the patients tolerated the RFA procedure well. Although some patients reported a burning sensation, pain, or both, the symptoms were relieved by reducing the RF power or stopping the ablation for several seconds.
In conclusion, RFA can be effective in treating loco-regional, recurrent, and well-differentiated thyroid carcinoma in patients at high surgical risk.