RFA for Recurrent Thyroid Cancers: Anatomy-Based Management

RFA for Recurrent Thyroid Cancers: Anatomy-Based Management

Baek JH et al

Leading expert in RFA use for thyroid nodules and cancer has an accepted publication in Ultrasonography

I have seen the article and here are my thoughts

Dr.Guttler’s comments:

1. Thyroid cancers usually have good prognosis.

2. Recurrences are common.

3. Surgery is the standard treatment for recurrent cancer.

4. Re-operation increases risk of complications.

5. High risk patient or one that refuses another surgery can be treated by ablation procedures.

6. RFA is the main ablation procedure we use for recurrent cancers.

7. Ultrasound evaluation: Recurrent mass volume and location near vital structures.

8. Safety margins are reduced compared to benign nodules. This increase complication rates,

9. Central neck location of the recurrent nerve makes it the most likely to be affected.

10 The variations of the vagus nerve especially when it is medial to the carotid may be more at risk.

11. Other vital structures are the trachea, esophagus,skin, great vessels, and other nerves and need to be located before therapy.

12. Prior surgery can displace structures and a traumatic neuroma, found in 2% post surgery can look like a recurrent mass.

13.CT is needed to evaluate areas not easily seen on neck ultrasound.

14.CT is effective in finding recurrent cancer not seen by ultrasound.

15. Two types of treatment. One aims for cure when 3 or less recurrent lesions are present. The other is palliative when symptoms are present or pending invasion of vital structures.

16. No Size limit of the lesion but large recurrences may need combination with external beam or chemotherapy.

17. Three techniques are needed. Lidocaine, Hydrodissection and moving shot.

18. Trachea involvement can be treated with the use of hydrodissection.

19. Tumor inside the trachea needs RFA  stent assisted ablation.

20 Multiple tumor  invasion of different organs requires RFA plus external beam.

21. RFA before prevents fistula formation when EBT is done without RFA.

22. Recurrence in the skin is not common can be treated with RFA to prevent skin necrosis.

23. Skin burns are most common complication with skin recurrence.

24. Hydrodissection and ice bag can prevent skin burns.

25. Hydrodissection can separate early stage tumors from the trachea or skin.

26. Call me at 310-393-8860 or mail to thyroid.manager@thyroid.com for a consultation and alternative treatment.

27. Ask for Alicia


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