Ultrasound-Guided Ethanol Percutaneous Ablation Versus Rescue Surgery in Patients With Locoregional Recurrence of Papillary Thyroid Cancer
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Objectives. Neck recurrence of papillary thyroid cancer (PTC) is frequently detected after initial surgery. The managementof these lesions may include rescue surgery (RS) or minimally invasive techniques in selected patients, but compara-tive studies evaluating the effectiveness and safety of these techniques are lacking. In this paper, we compared ultra-sound-guided ethanol ablation (EA) in selected patients to RS in a matched cohort. Methods. We retrospectively compared 41 patients and 41 matched PTC patients without known distant metastases, whounderwent ultrasound-guided EA or RS (matched reference group), who had 63 and 75 thyroid bed and/or lymphnode confirmed PTC recurrences during a median follow-up of 72.8 and 89.6 months, respectively. The primary out-come was time until structural recurrence, compared using Kaplan-Meier survival curves. The secondary outcomesincluded time until biochemical recurrence, plasma thyroglobulin (Tg) levels, American Thyroid Association (ATA) re-sponse-to-therapy categories by the last available observation, and treatment-derived complications in each group. Results. No significant differences were found between the EA and RS groups for time until structural recurrence (log-ranktest, P =0.94). The time until biochemical recurrence was also similar (P =0.51); and the plasma Tg concentration re-duction and proportions of patients in the ATA reclassification categories were also similar. A significantly higher pro-portion of patients in the RS group presented treatment-derived complications (29.27% vs. 9.75%, P <0.05). Conclusion. In this retrospective analysis, the treatment of PTC neck recurrence with EA in selected patients was compara-ble to RS in a matched reference group for the long-term risk of structural or biochemical relapse, but with a lowerrisk of treatment-derived complications. These results support the effectiveness and safety of this minimally invasivetechnique in the management of selected patients with recurrent PTC.
Abstract
Objectives. Neck recurrence of papillary thyroid cancer (PTC) is frequently detected after initial surgery. The managementof these lesions may include rescue surgery (RS) or minimally invasive techniques in selected patients, but compara-tive studies evaluating the effectiveness and safety of these techniques are lacking. In this paper, we compared ultra-sound-guided ethanol ablation (EA) in selected patients to RS in a matched cohort. Methods. We retrospectively compared 41 patients and 41 matched PTC patients without known distant metastases, whounderwent ultrasound-guided EA or RS (matched reference group), who had 63 and 75 thyroid bed and/or lymphnode confirmed PTC recurrences during a median follow-up of 72.8 and 89.6 months, respectively. The primary out-come was time until structural recurrence, compared using Kaplan-Meier survival curves. The secondary outcomesincluded time until biochemical recurrence, plasma thyroglobulin (Tg) levels, American Thyroid Association (ATA) re-sponse-to-therapy categories by the last available observation, and treatment-derived complications in each group. Results. No significant differences were found between the EA and RS groups for time until structural recurrence (log-ranktest, P =0.94). The time until biochemical recurrence was also similar (P =0.51); and the plasma Tg concentration re-duction and proportions of patients in the ATA reclassification categories were also similar. A significantly higher pro-portion of patients in the RS group presented treatment-derived complications (29.27% vs. 9.75%, P <0.05). Conclusion. In this retrospective analysis, the treatment of PTC neck recurrence with EA in selected patients was compara-ble to RS in a matched reference group for the long-term risk of structural or biochemical relapse, but with a lowerrisk of treatment-derived complications. These results support the effectiveness and safety of this minimally invasivetechnique in the management of selected patients with recurrent PTC.
참고문헌 (18)
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