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RF ablation may be option for some microscopic papillary thyroid cancers

JAMA Otolaryngology-Head and Neck Surgery
Reuters Health - 16/02/2022 - Radiofrequency ablation (RFA) was safe and effective for treating selected low-risk papillary microcarcinomas of the thyroid (mPTC) in a systematic review and meta-analysis.

However, most included patients were from Asia, and guidelines differ in the US, favoring active surveillance instead.

As reported in JAMA Otolaryngology-Head and Neck Surgery, Dr. Tessa van Ginhoven of University Medical Centre Rotterdam and colleagues searched the literature and identified 15 studies for inclusion in the meta-analysis. The studies included 1,770 patients (mean age, 45; 78%, women) with 1,822 tumors that were treated with RFA; 49 tumors underwent an additional RFA session and one underwent two additional sessions.

The mean follow-up was 33 months and the pooled complete disappearance rate at the end of follow-up was 79%.

The overall tumor progression rate was 1.5%. Local residual mPTCs in the ablation area were found in seven tumors (0.4%); new mPTCs in the thyroid were seen in 15 patients (0.9%); and four patients (0.2%) developed lymph node metastases during follow-up. No distant metastases were detected.

Forty-five patients had minor complications. Three major complications occurred: two voice changes lasting >2 months and one cardiac arrhythmia.

Dr. van Ginhoven did not respond to requests for a comment, but three U.S. experts provided perspectives in emails to Reuters Health. All noted the limitations of a retrospective analysis and that current American Thyroid Association guidelines recommend observation only for thyroid nodules <1 cm without extrathyroidal extension or sonographically suspicious lymph nodes.

Dr. Pankaj Sharda, Director, Thyroid Program, Fox Chase Cancer Center, noted that the study provides "solid evidence about the efficacy and safety of RFA in selected mPTC patients." However, he added, "This and other studies looking at immediate intervention in low-risk mPTC patients have not shown any significant clinical benefit in patient outcomes."

"Active surveillance in mPTC is a very safe and effective approach and salvage therapy when implemented is almost equally effective as compared to upfront intervention," he said. "Less is more! RFA, as a treatment of choice, is very safe and effective in selected low-risk mPTC patients and can be considered as a step-up treatment if there is interval progression of disease on active surveillance."

Dr. Eren Berber, Vice-Chair, Endocrine Surgery at Cleveland Clinic in Ohio, said, "Although, for the most part, the findings don't apply to the U.S., nevertheless, it is noteworthy that research on thyroid RFA continues at an exponential speed and thyroid RFA may be an option in certain well-selected scenarios."

Dr. Tammy Holm, an assistant professor at the University of Cincinnati and a UC Health thyroid cancer surgeon, commented, "In places where micro-PTC is diagnosed and treated more readily, RFA presents an excellent opportunity to scale down from an OR-based surgical intervention to an office-based one, with outcomes and complication rates that are on par with surgery."

"Moreover," she said, "(the study) introduces the potential for using RFA in select cases where perhaps there is progression of mPTC under surveillance or with patients suffering from an excess of anxiety related to active surveillance."

"RFA is potentially an incredibly valuable tool for the management of thyroid cancer and a skill that endocrine surgeons must develop in order to provide the best possible care for their patients with both benign and malignant disease," she added. "Large-scale prospective studies looking to establish the efficacy of RFA as an alternative or even adjunct to surgery will be valuable moving forward."

SOURCE: https://bit.ly/3gRHJml JAMA Otolaryngology-Head and Neck Surgery, online February 10, 2022.

By Marilynn Larkin

© 2023 The Author(s). Published by Medicom Medical Publishers.
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