Dr.Guttler’s comments: Complications, Protocol, Follow up and Conclusions
1. Complications are not common with treatment of small thyroid cancers but do occur.
2.RFA has an excellent safety profile for small thyroid cancers and benign nodules.
3. However, recurrent thyroid cancer includes voice change occurring more frequently than small thyroid cancers or benign thyroid nodules.
4. This can be mitigated by carefully evaluating the proximity of the tumor to the danger triangle on ultrasound, reducing the power of the generator if the patient reports pain, and performing hydrodissection to provide a thermal buffer.
5. If a nerve injury is detected, the nerve should be bathed with chilled D5W (rescue hydrodissection) until symptoms resolve.
6. Post surgery patients have different distorted anatomy and are more prone to complications.
7.RFA treatment for PTMC will likely increase in volume for the first 3-6 months, but may disappear in the following 12-18 months.
8.This is due to ablation of a margin of normal tissue around the tumor, and can give the false impression that the tumor is progressing.
9. The postoperative evaluation should include a physical exam, an ultrasound evaluation, TSH, and thyroglobulin.
10.RFA providers will see patients back at 1, 3, 6, and 12 months, and every 6 months thereafter.
Pre- and Post-procedural symptom score profiles are filled out by patients using a grade 0 to 10 scale. In addition, a cosmetic score is measured by a physician according to the following grades: 1, no palpable mass; 2, a palpable mass without cosmetic problems; 3, a cosmetic problem on swallowing only, 4 – visible cosmetic problem.
12.The volume reduction ratio (VRR) which is measured pre- and post-operatively on ultrasound. The VRR is equal to: (Initial volume – Final volume x 100/Initial volume).
13. Blood work to measure TSH pre- and post-operatively, and if indicated, thyroglobulin in recurrent thyroid cancer.
14. Long term follow up is recommended (greater than 5 years) until further studies on larger cohorts of patients are done to better understand the risk of disease recurrence and metastatic spread after RFA.
ThyroidRFA has been shown to be safe and effective for long-term local tumor control for low-risk PTMC in patients ineligible for surgery or those who do not wish to undergo active surveillance.
In certain clinical situations, RFA may be used for local control in small recurrent tumors or to palliate symptoms in unresectable cancer.
At my outpatient center I will do thyroid RFA for benign thyroid nodules, small thyroid cancers, and recurrent thyroid cancers using the protocol outlined above for the thyroid patient’s information.
Call me at 310-393-8860 or email to firstname.lastname@example.org.