Ultrasound-guided Ethanol Percutaneous Ablation versus Rescue Surgery in Patients with Loco-regional Recurrence of Papillary Thyroid Cancer.

Abstract

Purpose:

Neck recurrences of papillary thyroid cancer (PTC) are frequently detected after initial surgery. Management of these lesions may include rescue surgery or minimally invasive techniques in selected patients, but comparative studies evaluating effectiveness and safety are lacking. In this paper we performed a comparison of ultrasound-guided ethanol ablation (EA) in selected patients versus rescue surgery (RS) in a matched cohort.

Methods:

We retrospectively compared 41 patients and 41 matched PTC patients without known distant metastases, who underwent ultrasound-guided EA or RS, (matched reference group) over 63 and 75 thyroid bed and/or lymph node confirmed PTC recurrences with a median follow-up of 72.83 and 89.6 months, respectively. Main outcome was time until structural recurrence, compared using Kaplan-Meier survival curves. Secondary outcomes included: time until biochemical recurrence, plasma thyroglobulin (Tg) levels and ATA Response-to-therapy categories by last available observation, and treatment-derived complications in each group.

Results:

No differences were found between EA and RS groups for time until structural recurrence (Log-Rank test, p=0.94). Time until biochemical recurrence was also similar (p=0.51); and plasma Tg concentration reductions and proportions of patients in ATA reclassification categories were also similar. A significantly higher proportion of patients in the RS group presented treatment-derived complications (21.42% vs. 9.3%; p<0.05).

Conclusion:

In this retrospective analysis, treatment of PTC neck recurrences with ethanol ablation in selected patients was comparable to rescue surgery in a matched reference group for the long-term risk of structural or biochemical relapse, but with a lower risk of treatment-derived complications. These results support the effectiveness and safety of this minimally invasive technique in the management of selected patients with papillary thyroid cancer recurrence.

• Authors: Santiago Tofe, I Aki Arguelles, Cristina Alvarez, Alvaro Tofe, Alessandra Repetto, Antonia Barcelo, Vicente Pereg
• Journal: Clinical and experimental otorhinolaryngology (Clin Exp Otorhinolaryngol) (Aug 23 2023) ISSN: 1976-8710 [Print] Korea (South)
• PMID: 37641858 (Publication Type: Journal Article)