Thyroid RFA 101: RFA Treatment of Primary Thyroid Cancer: Early Results on 7 Patients.
Jung Hwan Baek MD,PhD
Asan Medical Center
added an update
RFA of primary thyroid cancer in Asan Medical Center, preliminary data
Will be introduced on Korean Congress of Radiology
Background: Surgery is the standard treatment for primary thyroid cancer patients; however, there are risk of complications can be increased in patients with high surgical risk. Ultrasound (US)-guided ¬-radiofrequency ablation (RFA) can be suggestive as alternatives to patients at high risk of surgery or those who refuse surgeries. Therefore this study evaluated the efficacy of RFA according to the types of thyroid cancers especially for patients with high surgical risk.
Methods: A total of 7 patients (two men and five women; age range, 49-83 years; mean, 69± 15 years) with 8 nodules of pathologically proven papillary carcinoma (five patients) and anaplastic carcinoma (two patients) were treated by US-guided RFA. Primary thyroid cancers were divided into 3 groups; 1) group 1: Anaplastic carcinoma, 2) group 2: Papillary macrocarcinoma, and 3) group 3: Papillary microcarcinoma. We evaluated the change of clinical symptoms, tumor volume and local tumor recurrence or metastasis after RFA. Patients were followed at 1, 6, and 12 months and every one year thereafter.
Results: All patients were tolerable to RFA. Among 8 tumors, 3 tumors (2 anaplastic and 1 papillary macrocarcinoma) were treated 2 times. In group 1, the initial mean volume of was 107.9 ± 78.6mL with neck bulging. In group 2, initial mean volume was 126.9mL with neck bulging. In group 3, initial mean volume of was 0.16 ± 0.1mL without cosmetic or symptomatic problems. In group 1, there was no improvement of clinical symptoms or neck bulging after RFA. In group 2,Macro papillary ca treated tumor showed size reduction (126.9mL vs. 0.8mL) and disappearance of color Doppler signal with improvement of neck bulging.The volume reduction ratio was 99.3%. In group 3, Micro-papillary mean volume also decreased to 0.09 ± 0.1mL and volume reduction ratio was 41.7%. No local tumor recurrence or metastatic lesion was detected during follow-up periods. No major complications were encountered.
Conclusions: In primary thyroid cancers, RFA achieved an excellent local tumor control effect for papillary macro- and microcarcinoma; however the clinical effect on anaplastic carcinoma is questionable.
Comments: Early results show promise in papillary cancers that may not want surgery or are too sick to undergo an operation.We await DR.Baek’s further studies on papillary cancer but RFA seem worthless for anaplastic thyroid cancer.
Richard Guttler MD,FACE,ECNU