Using Ethanol or Radiofrequency Ablation RFA for Those <1.5 cm Classic papillary Cancer in Patients Who Don’t Want to Just Use Active Surveillance or Surgery: The future use
RFA and Ethanol ablation have been used in treatment of recurrent thyroid cancers in the neck lymph nodes and in some studies By Kim et al in small recurrent thyroid cancers in poor risk patients for surgery and those refusing surgery. The results were comparable to recurrent surgery and less injury to the parathyroids. They concluded RFA was a safe alternative to repeat surgery in patients with recurrent local small thyroid cancers.Zhao et al J.Endocrine Investigation 2016, found 9 articles with 189 patients treated with RFA for recurrent thyroid cancer who refused surgery or were not a candidate due to other illnesses. Improved prognosis in these cases with decrease in thyroglobulin, and size of the cancers. They concluded that RFA was a promising treatment for patients refusing another surgery and who other illnesses preventing surgery.Kim et al European Radiology 2016 found that the major complication rates for thyroid cancer ablation was higher 5.4% to 1% for benign nodules.Minor complications were the same for both groups. 0.4% of the patients had persistent symptoms post RFA.
Suh et al in Thyroid 2016 reported 270 patients treated with RFA or ethanol for local recurrent thyroid cancer. Both causes significant decrease in volume. RFA had more complete disappearances 69% vs 54% for ethanol. Recurrence was low for both. They concluded that both were acceptable treatment for management of locally recurrent thyroid cancers for poor risk surgery patients or those that refuse more surgery.
Comment: These alternative methods may also be used to treat those <1.5 cm classic papillary cancers that are offered active surveillance instead of surgery. Some may not like the fact the cancer even if harmless is still in their neck. RFA or Ethanol ablation would be effective in this group.
Call 310-393-8860 ask for Metthew about details.
Richard Guttler M,FACE,ECNU
image of a patient treated by radiofrequency ablation RFA