Anatomy Based Management of RFA for Recurrent Thyroid Cancer

Article reviewed

Baek JH et al Ultrasound December 2021.

Dr.Guttler’s comments:

1. Thyroid RFA alternative to a second surgery.
2. Anatomic evaluation needed for the use of RFA.
3. 2 types of treatment alternatives. Cure or palliative treatment options.
4. Cure can be for 3 or fewer recurrent lesions in the neck.
5. Palliative for symptomatic lesions or impending invasion of vital structures.
6. Recurrent lesions have less safety margins than benign nodules and more complications.
7. Recurrent laryngeal nerve and vagus are are most likely complication sources.
8. Traumatic neuroma ( 1-17% after neck dissection) after neck dissection can be confused with recurrent cancer.
9. CT needed for deep structure evaluation.
10. RFA techniques: Lidocaine perilesional, hydrodissection, and moving shot technique.
11. Lidocaine superficial to the recurrent cancer

12.Hydrodissection between the tumor and the vital structures.

14. Moving shot technique is used to ablate the tumor.

15. Power (Watts) used based on the active tip size. 4 mm , 5-15 W, 5 mm 10-30 W, 7 mm 20-40 W, 10 mm 50-80 W

16. 6 studies compared RFA to surgery. 92-100% ablation.

Surgery 92%-98% recurrence free survival up to 6 years.

17. Tracheal involvement in recurrent cancers has increased mortality due to airway obstruction.

18. Hydrodissection is used to separate the perichondral involved tumor from the trachea.

19.Tumor in the lumin is treated with a stent inserted in push out the tumor for RF ablation.

20. Skin involvement image of recurrent tumor in the subcutaneous layer of the skin.

21. Skin involvement is difficult but not common. Skin necrosis blood oozing and poor quality of life can occur.

Early treatment is essential. Skin burns are a common complication. Hydrodissection can help prevent skin burns along with ice pack.

22. Complications rate higher than with benign nodules. (8-11% ) Discomfort and pain can be treated by additional lidocaine to the pain areas. Voice changes are also higher than RF for benign nodules. 1-8%.

23. Dr Baek’s paper clearly shows the good outcomes with RF for recurrent tumors, and low rates of complications.

24. Thyroid RFA is a useful procedure in for patients with high risk for more surgery or those who refuse more surgery.

25. The Korean teams of Professor Baek have added recurrent thyroid tumors to our potential use of thyroid RFA.

Bravo to all 8 listed on the paper.

26. My center does thyroid RFA for benign nodules, recurrent thyroid cancer lymph nodes and primary micropapillary thyroid cancer. We are available to use RF for recurrent tumors in the central compartment if you are against more surgery or a high risk to have more surgery.

Call 310-393-8860 or email to thyroid.manager@thyroid.com for details and evaluation.Ask for Alicia

Dr.G.