Journal of Thyroid Disorders & Therapy
Open Access

Improvements of Thyroid Cancer Therapy Reduced Surgical Methods and Radiofrequency Ablation Parameters

Ranthu Bharn^{* *}Correspondence: Ranthu Bharn, Department of Medicine, University of Melbourne, Melbourne, Australia, Email:

Author info »

Descripition

The most predominant subtype of thyroid malignancies, constituting over 90% of cases, falls under Differentiated Thyroid Cancers (DTCs), encompassing papillary and follicular tumors. Primary thyroid cancer typically undergoes treatment involving surgery, Radioactive Iodine (RAI) ablation, and hormonal therapy. With a disease-specific survival rate reaching up to 90% in a 10-year follow-up, DTC exhibits a favorable prognosis and low mortality rates. However, the neck's recurrence rate varies from 20-59% based on the risk of recurrence. Recommendations for recurrent malignancies typically involve a second procedure followed by thyroid hormone treatment or RAI ablation, though reoperation may pose challenges due to fibrosis and deformation of the normal neck anatomy.

Recent research explores minimally invasive approaches for benign thyroid nodules and recurring thyroid malignancies, utilizing Ultrasonography (US)-guided ablation techniques like laser, radiofrequency, and ethanol ablation. International standards govern the use of Radiofrequency Ablation (RFA) on the thyroid, and guidelines for the thermal ablation of benign thyroid nodules have been published by various international associations. The Korean Society of Thyroid Radiology introduced thyroid RFA guidelines in 2012 and 2018, covering aspects of treating benign thyroid nodules and thyroid malignancies. Moreover, new research has scrutinized global standards for RFA of benign thyroid nodules.

While the Italian Scientific Society, the European Thyroid Association, and the Cardiovascular and Interventional Radiological Society of Europe have discussed suggestions for RFA of recurrent thyroid cancer, the KSThR stands as the sole contributor of guidelines for RFA of recurrent thyroid cancer. The KSThR recommends RFA for patients at high surgical risk or those who decline surgery for curative or palliative purposes.

Prior research has investigated the fundamental aspects of RFA for recurring thyroid cancer, including ablation technique, preprocedural assessment, effectiveness, and risks. Both short- and long-term studies have shown therapeutic effectiveness rates of 95.1% and 99.5% , respectively. Despite numerous studies reporting on the fundamental ideas and effectiveness of RFA for recurrent thyroid tumors, there remains a lack of comprehensive technical information to enhance efficacy and reduce complications.

According to KSThR recommendations, RFA may be employed to treat recurrent thyroid cancer in individuals at high surgical risk or those opting out of further surgery. Treatment options fall into two categories: Curative ablation and palliative maintenance. Curative ablation involves the total eradication of any recurrent malignancies observed on an ultrasound, especially when limited to three or fewer lesions on a neck ultrasound without metastatic tumors outside the neck. Palliative care is recommended for recurrent thyroid cancer causing cosmetic or symptomatic issues or on the verge of invading vital structures.

Post-procedure evaluation includes thyroid-specific CT, crucial for assessing treatment effectiveness, as a well-treated tumor exhibits size reduction and lack of enhancement. Monitoring serum Tg levels is vital for determining treatment effectiveness post-RFA. Reduction of tumor-related symptoms is also essential for assessing therapy efficacy, particularly for large tumors or those involving critical structures, where direct assessment of structural impairment is challenging.

Studies, including meta-analyses, indicate that RFA of recurrent thyroid tumors yields positive clinical outcomes. While curative treatment outcomes are well-established, clinical outcomes for palliative management are more nuanced, as complete tumor eradication is challenging, and most cases require combined therapy. Common RFA consequences include pain and discomfort, typically transient, with Lidocaine injections used for local pain relief. Post-RFA consequences such as bleeding, nerve damage, and skin burns have been documented, emphasizing the need for a thorough understanding of neck anatomy and the RFA process for the effective treatment of patients with high surgical risk or those unwilling to undergo repeated surgery.