Percutaneous Ultrasound-Guided Laser Ablation Is Effective for Treating Selected Nodal Metastases in Papillary Thyroid Cancer
Percutaneous Ultrasound-Guided Laser Ablation Is Effective for Treating Selected Nodal Metastases in Papillary Thyroid Cancer
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DOI：
10.1210/jc.2012-2991
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发表时间：
2013-01-01
影响因子：
5.8
通讯作者：
Gharib, Hossein
中科院分区：
文献类型：
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作者：
Papini, Enrico;Bizzarri, Giancarlo;Gharib, Hossein
内容：微创手术可能有助于控制高危患者乳头状甲状腺癌（PTC）的局部颈部淋巴结转移。目的：我们的目的是评估超声（US）引导下激光消融（LA）非手术治疗PTC颈部小转移的有效性和安全性。设计和设置：我们进行了一项关于手术控制转移的试点研究，随后进行了一项前瞻性试验，随访12个月。参与者：参与者包括5名既往接受过甲状腺全切除术和颈淋巴结清扫术的PTC患者，在已经手术切除的区域中有8个新的淋巴结转移，淋巴结体积小于2 ml，并且没有放射性碘摄取。结果措施：我们评估甲状腺球蛋白（Tg）和US的变化，淋巴结6和12个月后，LA以及耐受性和副作用的proceeding.Results：一个单一的LA治疗诱导进行性体积减少的8个转移性淋巴结。平均基线体积从0.64 +/- 0.58 ml降至12个月对照时的0.07 +/- 0.06 ml。6个月时平均体积减少为64.4 +/- 0.19%（与基线相比P < 0.02），12个月时为87.7 +/- 0.11%（与基线相比P < 0.01）。未记录再生。在12个月对照时，LT 4的平均血清Tg从8.0 +/- 3.2 ng/ml降至2.0 +/- 2.5 ng/ml（与基线相比，P < 0.02）。3名患者（60%）在12个月对照时无法检测到Tg水平。2例患者疼痛可耐受，3例患者疼痛轻微。唯一的并发症是一名患者出现短暂的发声困难。1年后，没有癌症种植present.Conclusion：LA是一个耐受性良好的门诊程序，导致PTC的颈部淋巴结转移的快速cytoreduction。微创手术可代替手术，作为小负荷局部/区域疾病复发的预防性治疗。它们偶尔与解剖学或生物化学治疗有关，但需要长期随访或对照试验。（J Clin Endocrinol Metab 98：E92-E97，2013）
Context: Mini-invasive procedures may be useful for control of local neck nodal metastases of papillary thyroid cancer (PTC) in high-risk patients.Objective: Our objective was to assess the effectiveness and safety of ultrasound (US)-guided laser ablation (LA) for nonsurgical treatment of small-size neck metastases of PTC.Design and Setting: We conducted a pilot study on a surgically controlled metastasis, followed by a prospective trial with a 12-month follow-up.Participants: Participants included five patients with previous total thyroidectomy and neck dissection for PTC, with eight new lymph node metastases in an area already treated with surgical dissection and lymph node volume less than 2 ml and absent radioiodine uptake.Outcome Measures: We evaluated thyroglobulin (Tg) and US changes of the lymph nodes 6 and 12 months after LA as well as tolerability and side effects of the procedure.Results: A single LA treatment induced progressive volume reduction of the eight metastatic lymph nodes. Mean baseline volume decreased from 0.64 +/- 0.58 to 0.07 +/- 0.06 ml at 12-month control. Mean volume reduction was 64.4 +/- 0.19% at 6 months (P < 0.02 vs. baseline) and 87.7 +/- 0.11% at 12 months (P < 0.01 vs. baseline). No regrowth was registered. Mean serum Tg on LT4 decreased from 8.0 +/- 3.2 ng/ml to 2.0 +/- 2.5 ng/ml at 12-month control (P < 0.02 vs baseline). In three patients (60%) Tg levels were undetectable at 12-month control. Pain was tolerable in two cases and mild in three cases. Transient dysphonia in one patient was the only complication. After 1 yr, no cancer seeding was present.Conclusion: LA is a well-tolerated outpatient procedure that results in a rapid cytoreduction of cervical nodal metastases of PTC. Mini-invasive procedures may be used in lieu of surgery as an adjunctive therapy for small-burden local/regional disease recurrence. They are occasionally associated with an anatomical or biochemical cure, but long-term follow-up or controlled trials are needed. (J Clin Endocrinol Metab 98: E92-E97, 2013)