Active Surveillance AS, Surgery or Radiofrequency Ablation RFA for Micro-Papillary Thyroid Cancer.
DR.Guttler’s comments on recent study.
- 1500 patients non-operative patients. 55,000 had surgery.
- Increasing age and size of the tumor led to led to differences in disease free survival DFS between those with or without surgery.
- 14-55 year old patients with < 4 cm tumors had no difference in 10 year DFS between surgery and no surgery.
- Mortality risk for not doing surgery has been studied.
- There is an escalating risk of not have surgery in age group > 60 and with tumor size > 2 cm.
- Larger tumors in the young patients <60 may be reasonably treated without surgery.
- This opens up the whole issue of what the patient wants to do about their cancer.
- We know many patients drop out of active surveillance not because it has shown growth or lymph node spread but just because they do not want a cancer in their neck for 40 years of observation called AS.
- They would elect to have surgery after they drop out.
- However, a third option is now available to them. Radiofrequency ablation RFA can be done as the first option and can be done if the patient started out having AS and refusing surgery.
- The size of the tumor that can be treated without surgery or AS in a younger patient may be up to 2 cm instead of 1.2 cm in the past.
- The location of the 2 cm cancer has to be in a good location and be free of neck lymph node disease.
- This article has results suggesting that over treatment with surgery may even happen with larger nodules in <60 year old patients.
- The relative impact of surgical intervention must be measured by it’s a real effect of DFS.
- This continuum of risk is a way to explain to the patient what the risks are with their size tumor and their age related to their specific prognosis.
- Armed with this information I predict there will be many opt for RFA as the primary treatment with cutting needle biopsy follow up procedure to determine effective ablation.
- Also as has happened with those whom elected AS as the first option, over half have opted to quit the program even though they had no reason to based on growth or lymph node disease.
- Opted out of AS can now be treated with RFA as these patients have a good DFS and do not need surgery.
Call me if you are trying to decide what to do if you are <60 with a small papillary thyroid cancer.
310-393-8860 or email to [email protected] for details of thyroid RFA.
Mortality Risk of Nonoperative papillary thyroid carcinoma:
Allen Ho et al
Thyroid 29 (10) 2019 p.1409-17