US-guided laser treatment of parathyroid adenomas

Liat Appelbaum, Shraga Nahum Goldberg, Tiziana Ierace, Giovanni Mauri, Luigi Solbiati

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: To determine the clinical efficacy of laser ablation for the tredatment of primary hyperparathyroidism (pHPT). Materials and methods: Twelve patients with pHPT were treated with laser ablation. Energy was administered by means of 1.5 m optical fibers percutaneously placed into the target via 21 G needles. A laser ablation unit (EchoLaser X4, Esaote) applied 3 W power for 400–600 s/fiber/insertion to a total 3600–9000 Joules of energy. Patient serum parathyroid hormone (PTH) and calcium levels were checked at baseline and thereafter every 6 months. Patients were followed-up for 2 years with serologic and contrast-enhanced ultrasound. Therapeutic success was defined as normal PTH and calcium levels together with disappearance of nodule-related symptoms. Results: All procedures were performed in single session. Immediately following ablation, contrast enhanced ultrasound confirmed that all but one target had become avascular (technical success rate 11/12; 92%), remaining avascular at all follow-up ultrasound examinations, thereafter. The mean volume of parathyroid nodules decreased from 0.54 cc to 0.36 cc (72.0%). Serum PTH and calcium levels were significantly lower at 1, 12 and 24 m compared to baseline (p < 0.01). By 6 m, PTH and calcium returned to normal and were stable until 24 m in all successfully treated patients. All cases of hyperparathyroid-related symptoms resolved by 6 m (ostealgia [n = 5], repeated renal colic [n = 5], vomiting [n = 3]). Only one patient (8%) reported transient dysphonia as a minor complication. Conclusion: Laser ablation of enlarged, symptomatic parathyroid glands is safe and well-tolerated and can produce long-term, sustained reduction of serum PTH and calcium levels.

Original languageEnglish
Pages (from-to)366-372
Number of pages7
JournalInternational Journal of Hyperthermia
Volume37
Issue number1
DOIs
Publication statusPublished - Jan 1 2020

Keywords

  • Laser ablation
  • parathyroid ablation
  • parathyroid adenoma
  • primary hyperparathyroidism

ASJC Scopus subject areas

  • Physiology
  • Physiology (medical)
  • Cancer Research

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