Radiofrequency Ablation for Thyroid Nodules and Cancer in the United States: Balancing a Transformation of Thyroid Care With Risk for Misuse.
Radiofrequency Ablation for Thyroid Nodules and Cancer in the United States: Balancing a Transformation of Thyroid Care With Risk for Misuse.
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DOI：
10.1016/j.eprac.2021.12.006
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发表时间：
2022-02
影响因子：
4.2
通讯作者：
Papaleontiou, Maria
中科院分区：
文献类型：
--
作者：
Haymart, Megan R.;Papaleontiou, Maria
射频消融（RFA）是甲状腺结节和癌症最常用的图像引导热消融技术，有可能极大地改变甲状腺肿瘤治疗的前景。RFA在亚洲和欧洲率先使用，目前在美国用于非侵入性地减小存在压迫症状和/或美容问题的良性实性甲状腺结节亚组的大小，并且较少用于治疗小型甲状腺癌和孤立的淋巴结转移。1迄今为止的研究表明，RFA后6 - 12个月体积减少高达80%，并持续长达5年。2-4这种创新的治疗方案消除了手术风险和住院治疗的需要，避免了疤痕，并提供了节省成本的潜力。5，6此外，与手术相比，RFA与生活质量改善和患者满意度提高相关。7，8然而，尽管这种新的治疗选择有许多好处，但也存在滥用的风险。首先，有来自其他癌症（如前列腺癌）的强有力的数据表明，当一种新的手术在经济上有利可图时，使用参数没有明确定义，经济利益可能会推动使用与患者需求一样多或超过患者需求。9例如，当调强放射疗法可用于前列腺癌时，迅速被采用，低风险疾病的男性很快就有了与高风险疾病男性相似的接受调强放射疗法的可能性。对于甲状腺结节和癌症的管理，医生和决策者应学习其他癌症类型的经验，并防止滥用，并就适当的适应症和合适的候选人提出明确的指导建议。
Radiofrequency ablation (RFA), the most commonly used image-guided thermal ablation technique for thyroid nodules and cancers, has the potential to dramatically change the landscape of thyroid tumor management. Pioneered in Asia and Europe, RFA is now used in the United States to noninvasively decrease the size of a subgroup of benign solid thyroid nodules when there are compressive symptoms and/or cosmetic concerns and, less frequently, to treat small thyroid cancers and isolated lymph node metastases. 1 Studies to date have demonstrated a decrease in volume of up to 80% occurring 6 to 12 months after RFA and persisting for up to 5 years. 2–4 This innovative treatment option eliminates surgical risks and the need for hospitalization, avoids scars, and offers potential for cost savings. 5, 6 In addition, compared with surgery, RFA has been associated with improved quality of life and higher patient satisfaction. 7, 8 However, despite the many benefits of this new management option, there is a risk for misuse.First, there are strong data from other cancers, such as prostate cancer, that when a new procedure is financially lucrative and parameters for use are not clearly defined, financial gain can drive use as much or more than patient need. 9 For example, when intensitymodulated radiotherapy became available for prostate cancer, there was rapid adoption, and men with low-risk disease soon had a similar likelihood of receiving intensity-modulated radiotherapy as men with high-risk disease. 9 For the management of thyroid nodules and cancer, physicians and policy makers should learn from experiences in other cancer types and prevent misuse with clear guideline recommendations on appropriate indications and suitable candidates.
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