Radiofrequency Ablation of Cervical Thyroid Cancer Metastases—Experience of Endocrinology Practices in the United States

Radiofrequency ablation (RFA) is used in the United States to treat benign thyroid nodules; however, experience with treating cervical recurrence/persistence of papillary thyroid cancer (PTC) is limited. Objective To evaluate the efficacy RFA for the treatment of cervical recurrence/persistence of PTC in the United States. Although it is well recognized that surgery is the treatment of choice for recurrent thyroid cancer in the neck, some patients are not surgical candidates, or may not want to undergo repeat surgeries after their initial resection. While active surveillance is an option for selected patients, many patients have anxiety with this approach and may choose intervention despite no progression in tumor kinetics or size [30, 31]. RFA is emerging as an alternative option for these patients. RFA is minimally invasive and has a lower complication rate than surgery; however, use in recurrent cervical PTC recurrence is still limited in the United States [12-14, 17]. The results of our study are illustrative of the real-world outpatient application and results using this technique. Technical success has traditionally been defined as a 50% volume reduction in the thermal ablation literature with regards to benign thyroid nodules; however, in case of malignancy, treatment should be with curative intent. Therefore, we have defined complete success as a 100% volume reduction that mimics the results after surgery, and have recognized that a near-complete response of 90% volume reduction is likely to be clinically similar to a complete response, as the remaining tissue may not be viable or may have only microscopic disease that can be monitored. This is further supported by the low post procedure Tg levels in these patients.