Percutaneous ultrasound-guided laser ablation is effective for treating selected nodal metastases in papillary thyroid cancer

Enrico Papini, Giancarlo Bizzarri, Antonio Bianchini, Dario Valle, Irene Misischi, Rinaldo Guglielmi, Massimo Salvatori, Luigi Solbiati, Anna Crescenzi, Claudio Maurizio Pacella, Hossein Gharib

Research output: Contribution to journalArticle

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Abstract

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.

Original languageEnglish
JournalJournal of Clinical Endocrinology and Metabolism
Volume98
Issue number1
DOIs
Publication statusPublished - Jan 2013

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Laser Therapy
Laser ablation
Thyroglobulin
Ultrasonics
Neoplasm Metastasis
Dissection
Lymph Nodes
Neck
Dysphonia
Neck Dissection
Surgery
Thyroidectomy
Lymph Node Excision
Outpatients
Therapeutics
Outcome Assessment (Health Care)
Papillary Thyroid cancer
Safety
Recurrence
Pain

ASJC Scopus subject areas

  • Biochemistry
  • Clinical Biochemistry
  • Endocrinology
  • Biochemistry, medical
  • Endocrinology, Diabetes and Metabolism

Cite this

Percutaneous ultrasound-guided laser ablation is effective for treating selected nodal metastases in papillary thyroid cancer. / Papini, Enrico; Bizzarri, Giancarlo; Bianchini, Antonio; Valle, Dario; Misischi, Irene; Guglielmi, Rinaldo; Salvatori, Massimo; Solbiati, Luigi; Crescenzi, Anna; Pacella, Claudio Maurizio; Gharib, Hossein.

In: Journal of Clinical Endocrinology and Metabolism, Vol. 98, No. 1, 01.2013.

Research output: Contribution to journalArticle

Papini, E, Bizzarri, G, Bianchini, A, Valle, D, Misischi, I, Guglielmi, R, Salvatori, M, Solbiati, L, Crescenzi, A, Pacella, CM & Gharib, H 2013, 'Percutaneous ultrasound-guided laser ablation is effective for treating selected nodal metastases in papillary thyroid cancer', Journal of Clinical Endocrinology and Metabolism, vol. 98, no. 1. https://doi.org/10.1210/jc.2012-2991
Papini, Enrico ; Bizzarri, Giancarlo ; Bianchini, Antonio ; Valle, Dario ; Misischi, Irene ; Guglielmi, Rinaldo ; Salvatori, Massimo ; Solbiati, Luigi ; Crescenzi, Anna ; Pacella, Claudio Maurizio ; Gharib, Hossein. / Percutaneous ultrasound-guided laser ablation is effective for treating selected nodal metastases in papillary thyroid cancer. In: Journal of Clinical Endocrinology and Metabolism. 2013 ; Vol. 98, No. 1.
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abstract = "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.",
author = "Enrico Papini and Giancarlo Bizzarri and Antonio Bianchini and Dario Valle and Irene Misischi and Rinaldo Guglielmi and Massimo Salvatori and Luigi Solbiati and Anna Crescenzi and Pacella, {Claudio Maurizio} and Hossein Gharib",
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AU - Papini, Enrico

AU - Bizzarri, Giancarlo

AU - Bianchini, Antonio

AU - Valle, Dario

AU - Misischi, Irene

AU - Guglielmi, Rinaldo

AU - Salvatori, Massimo

AU - Solbiati, Luigi

AU - Crescenzi, Anna

AU - Pacella, Claudio Maurizio

AU - Gharib, Hossein

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N2 - 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.

AB - 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.

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