Efficacy of radiofrequency ablation for recurrent thyroid cancer invading the airways

Efficacy of radiofrequency ablation for recurrent thyroid cancer invading the airways

Efficacy of radiofrequency ablation for recurrent thyroid cancer invading the airways
  • Efficacy of radiofrequency ablation for recurrent thyroid cancer invading the airways

  • DR.Guttler’s comments:
  1.  119 patients with 172 recurrent tumors.
  2. Mean volume reduction was 81% +- 56%.
  3. 124/172 tumors disappeared. ( 72% ). Mean follow up 48 months+-35 months.
  4. Tumors not in contact with the trachea had the highest disappearance rate.
  5. Contact at acute angles, right angles and obtuse angles with the trachea followed by intraluminal tracheal invasion. had less complete ablation.
  6. High complication rate for this type of ablation was 21%.
  7. Conclusion: Thyroid RFA is an effective and safe treatment for local control of recurrent thyroid cancer in the central neck.
  8. It should be considered an alternative to more thyroid surgery.
  9. RFA is more effective if done earlier before invasion of the trachea.
  10. Stent assisted RFA may be a good alternative for intraluminal tracheal invasion.

Efficacy of radiofrequency ablation for recurrent thyroid cancer invading the airways

Abstract

Objectives

To evaluate the efficacy of radiofrequency ablation (RFA) in patients with recurrent thyroid cancer invading the airways.

Methods

We reviewed patients who had undergone RFA for recurrent thyroid cancer in the central compartment after total thyroidectomy between January 2008 and December 2018. All tumors were classified according to their association with the laryngeal structure and trachea. The volume reduction rate (VRR) and complete disappearance rate were calculated, and their differences were determined relative to the association between the tumor and trachea. Complication rates associated with RFA were evaluated.

Results

The study population included 119 patients with 172 recurrent tumors. Mean VRR was 81.2% ± 55.7%, with 124 tumors (72.1%) completely disappearing after a mean follow-up of 47.9 ± 35.4 months. The complete disappearance rate of recurrent tumors not in contact with the trachea was highest, followed by tumors forming acute angles, right angles, and obtuse angles with the trachea, and tumors with intraluminal tracheal invasion (p value < 0.001). The overall complication rate was 21.4%.

Conclusions

RFA is effective and safe for the local control of recurrent tumors in the central neck compartment after total thyroidectomy, even for tumors invading the airways, and may be considered an alternative to surgical resection. The inverse relationship between RFA efficacy and airway invasion suggests that early RFA may benefit patients with recurrent tumors in the central neck compartment.

Key Points

• RFA achieved a mean VRR of 81.2% ± 55.7% and complete disappearance of 124 tumors (72.1%) after a mean follow-up of 47.9 ± 35.4 months.

• The complete disappearance rate of recurrent tumors not in contact with the trachea was the highest, followed by tumors forming acute angles, right angles, and obtuse angles with the trachea, and tumors with intraluminal tracheal invasion.

• Stent-assisted RFA may be a good alternative for palliative treatment of recurrent tumors with intraluminal tracheal invasion.

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