Radiofrequency ablation and percutaneous ethanol injection treatment for recurrent local and distant well-differentiated thyroid carcinoma

Ann Surg. 2006 Aug;244(2):296-304. doi: 10.1097/01.sla.0000217685.85467.2d.

Abstract

Objective: To assess the long-term efficacy of radiofrequency ablation (RFA) and percutaneous ethanol (EtOH) injection treatment of local recurrence or focal distant metastases of well-differentiated thyroid cancer (WTC).

Background: RFA and EtOH injection techniques are new minimally invasive surgical alternatives for treatment of recurrent WTC. We report our experience and long-term follow-up results using RFA or EtOH ablation in treating local recurrence and distant focal metastases from WTC.

Methods: Twenty patients underwent treatment of biopsy-proven recurrent WTC in the neck. Sixteen of these patients had lesions treated by ultrasound-guided RFA (mean size, 17.0 mm; range, 8-40 mm), while 6 had ultrasound-guided EtOH injection treatment (mean size, 11.4 mm; range, 6-15 mm). Four patients underwent RFA treatment of focal distant metastases from WTC. Three of these patients had CT-guided RFA of bone metastases (mean size, 40.0 mm; range, 30-60 mm), and 1 patient underwent RFA for a solitary lung metastasis (size, 27 mm). Patients were then followed with routine ultrasound, I whole body scan, and/or serum thyroglobulin levels for recurrence at the treatment site.

Results: No recurrent disease was detected at the treatment site in 14 of the 16 patients treated with RFA and in all 6 patients treated with EtOH injection at a mean follow-up of 40.7 and 18.7 months, respectively. Two of the 3 patients treated for bone metastases are free of disease at the treatment site at 44 and 53 months of follow-up, respectively. The patient who underwent RFA for a solitary lung metastasis is free of disease at the treatment site at 10 months of follow-up. No complications were experienced in the group treated by EtOH injection, while 1 minor skin burn and 1 permanent vocal cord paralysis occurred in the RFA treatment group.

Conclusions: RFA and EtOH ablation show promise as alternatives to surgical treatment of recurrent WTC in patients with difficult reoperations. Further long-term follow-up studies are necessary to determine the precise role these therapies should play in the treatment of recurrent WTC.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Antineoplastic Agents / administration & dosage*
  • Bone Neoplasms / secondary
  • Bone Neoplasms / surgery
  • Carcinoma, Papillary / drug therapy
  • Carcinoma, Papillary / secondary
  • Carcinoma, Papillary / surgery*
  • Catheter Ablation*
  • Disease-Free Survival
  • Ethanol / administration & dosage*
  • Female
  • Follow-Up Studies
  • Humans
  • Injections, Intralesional
  • Longitudinal Studies
  • Lung Neoplasms / secondary
  • Lung Neoplasms / surgery
  • Male
  • Middle Aged
  • Minimally Invasive Surgical Procedures
  • Neoplasm Recurrence, Local / drug therapy
  • Neoplasm Recurrence, Local / surgery*
  • Radiography, Interventional
  • Thyroglobulin / blood
  • Thyroid Neoplasms / drug therapy
  • Thyroid Neoplasms / surgery*
  • Tomography, X-Ray Computed
  • Ultrasonography, Interventional
  • Whole Body Imaging

Substances

  • Antineoplastic Agents
  • Ethanol
  • Thyroglobulin