Radiofrequency ablation and percutaneous ethanol injection treatment for recurrent local and distant well-differentiated thyroid carcinoma.
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.
Monchik
Jack M
JM
Division of Endocrine Surgery, Brown Medical School, Rhode Island Hospital, Providence, RI 02903, USA.
Donatini
Gianluca
G
Iannuccilli
Jason
J
Dupuy
Damian E
DE
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D001859:Bone Neoplasms / Q000556:secondary / Q000601:surgery; D002291:Carcinoma, Papillary / Q000188:drug therapy / Q000556:secondary / Q000601:surgery*; D017115:Catheter Ablation; D018572:Disease-Free Survival; D000431:Ethanol / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015552:Injections, Intralesional; D008137:Longitudinal Studies; D008175:Lung Neoplasms / Q000556:secondary / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000601:surgery*; D015641:Radiography, Interventional; D013954:Thyroglobulin / Q000097:blood; D013964:Thyroid Neoplasms / Q000188:drug therapy / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D018084:Ultrasonography, Interventional; D051598:Whole Body Imaging
D000970:Antineoplastic Agents; D000431:Ethanol; D013954:Thyroglobulin