in Brief | Head & Neck Cancers | Thyroid Cancer
A new study highlights the efficacy of thermal ablation for papillary thyroid carcinoma
Time to read: 03:23
Time to listen: 07:04
Published on MedED: 11 November 2024
Originally Published: 6 November 2024
Sourced: JAMA Otolaryngology
Type of article: In Brief
MedED Catalogue Reference: MOCIB001
Category: Oncology
Cross Reference: Head and Neck Cancers, Radiology
Keywords: Papillary thyroid carcinoma, PTC, ablation, malignancy
Originally Published: 6 November 2024
Sourced: JAMA Otolaryngology
Type of article: In Brief
MedED Catalogue Reference: MOCIB001
Category: Oncology
Cross Reference: Head and Neck Cancers, Radiology
Keywords: Papillary thyroid carcinoma, PTC, ablation, malignancy
Key Takeaway
Top
Thermal ablation, including techniques like radiofrequency and microwave ablation, shows promising long-term outcomes for treating low-risk T1N0M0 papillary thyroid carcinoma (PTC), with high technical success and minimal complications.
Originally published in JAMA Otolaryngology,6 November 2024. This summary does not represent the original research, nor is it intended to replace the original research. Access the full Disclaimer Information
Papillary thyroid carcinoma (PTC) is the most common type of thyroid cancer, accounting for approximately 80% of cases in the developing world. Locally, a 2019 study at Chris Hani Baragwanath Hospital found that PTC made up 65% of the 143 thyroidectomies performed for malignancy, suggesting it may also be the dominant thyroid cancer in the region. 1
PTC generally has an excellent prognosis, with surgery – in particular lobectomy - the standard first-line surgical treatment for low-risk cases. More recently, active surveillance (AS) has emerged as a non-surgical option, supported by evidence of its safety and effectiveness. Nonetheless, AS remains underutilised, accounting for less than 1% of PTC cases annually.
Image-guided thermal ablation, including radiofrequency ablation (RFA), microwave ablation (MWA), and laser ablation (LA), presents a promising alternative to traditional treatments. These minimally invasive techniques have shown effectiveness in managing benign thyroid nodules and recurrent thyroid cancers, offering a viable option with fewer complications and quicker recovery times. However, despite their growing popularity, long-term data on the effectiveness of thermal ablation in treating PTC remains limited.
This multicentre study aimed to evaluate the long-term outcomes of thermal ablation for T1N0M0 PTC and explore its potential as a treatment option for low-risk patients. Conducted across four university-affiliated hospitals in China, the study enrolled 179 patients with T1N0M0 PTC tumours smaller than 20 mm.
The primary outcomes assessed were disease progression - lymph node involvement, new or persistent tumours - and disease-free survival (DFS).
Secondary outcomes assessed included tumour volume reduction, tumour disappearance, procedural success, and the development of complications.
Secondary outcomes assessed included tumour volume reduction, tumour disappearance, procedural success, and the development of complications.
The findings were as follows:
The mean age of patients was 45.8 years, with 65.9% being female and the mean follow-up period was 120.8 months
The median tumour volume was 88.0 mm³, with an interquartile range of 163.2 mm³.
Primary outcomes
During this period, disease progression occurred in 6.1% of patients (11 of 179), with 2.2% developing lymph node metastasis (LNM)
Two patients with LNM underwent additional ablation, which led to the disappearance of LNM after 16.5 months
One patient required total thyroidectomy with lymph node dissection due to occult tumours, while another with cervical LNM underwent AS with stable lesions after 55 months
Six patients (3.3%) developed new tumours, all of which were treated with additional ablation
At the 12-month follow-up, 73 tumours were visible on ultrasonography, with 44 undergoing post-ablation core needle biopsy (CNB), revealing degenerated tissue and fibrosis
Only one tumour remained persistent (0.6%), which required lobectomy
The volume reduction rate (VRR) was highly favourable, with 99% of tumours showing significant shrinkage during follow-up
Two patients with LNM underwent additional ablation, which led to the disappearance of LNM after 16.5 months
One patient required total thyroidectomy with lymph node dissection due to occult tumours, while another with cervical LNM underwent AS with stable lesions after 55 months
Six patients (3.3%) developed new tumours, all of which were treated with additional ablation
At the 12-month follow-up, 73 tumours were visible on ultrasonography, with 44 undergoing post-ablation core needle biopsy (CNB), revealing degenerated tissue and fibrosis
Only one tumour remained persistent (0.6%), which required lobectomy
The volume reduction rate (VRR) was highly favourable, with 99% of tumours showing significant shrinkage during follow-up
Secondary outcomes
In terms of secondary outcomes, all patients were successfully treated with a single ablation session, achieving a 100% technical success rate
While the volumes of the initial tumours increased slightly post-procedure, they gradually decreased over time, with the median VRR reaching 100% by the last follow-up
At this time, 97.2% of tumours had disappeared on ultrasonography, with T1a tumours showing a higher disappearance rate (99.4%) compared to T1b tumours (71.4%)
There were no significant differences in tumour disappearance between RFA and MWA procedures
Most patients tolerated the procedure well, with 17.3% reporting mild pain. One case of temporary voice hoarseness was noted, but there were no major complications such as hematoma or nerve injury
The study identified factors associated with a higher risk of progression, including tumour location (isthmus) and younger age. Conversely, male sex and right lobe tumours were associated with a lower progression risk, though these findings were not definitive
While the volumes of the initial tumours increased slightly post-procedure, they gradually decreased over time, with the median VRR reaching 100% by the last follow-up
At this time, 97.2% of tumours had disappeared on ultrasonography, with T1a tumours showing a higher disappearance rate (99.4%) compared to T1b tumours (71.4%)
There were no significant differences in tumour disappearance between RFA and MWA procedures
Most patients tolerated the procedure well, with 17.3% reporting mild pain. One case of temporary voice hoarseness was noted, but there were no major complications such as hematoma or nerve injury
The study identified factors associated with a higher risk of progression, including tumour location (isthmus) and younger age. Conversely, male sex and right lobe tumours were associated with a lower progression risk, though these findings were not definitive
In conclusion, the study demonstrates that thermal ablation is a promising treatment for T1N0M0 PTC, providing positive long-term outcomes with manageable complications. Its minimally invasive nature and high technical success rate suggest it could become a viable option for low-risk PTC patients, particularly in resource-limited settings. Further studies with larger sample sizes and longer follow-up are needed to validate these findings and establish thermal ablation as a first-line treatment for low-risk PTC.
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