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Du Q, Li X, Lin Z, Dong L, Liu F, Liang P. Value of the three-dimensional visualization ablation planning system in ultrasound-guided percutaneous microwave ablation for malignant adrenal tumors: A clinical comparative study. J Cancer Res Ther 2024:01363817-990000000-00092. [PMID: 38801760 DOI: 10.4103/jcrt.jcrt_2315_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 03/22/2024] [Indexed: 05/29/2024]
Abstract
OBJECTIVE We aimed to assess the efficacy and safety of the three-dimensional visualization ablation planning system (3DVAPS) in ultrasound-guided percutaneous microwave ablation (US-PMWA) for malignant adrenal tumors (MATs). METHODS A retrospective analysis was conducted on a cohort of 62 unilateral MAT cases from March 2011 to November 2022. There were a total of 62 lesions, with a mean maximum diameter of 5.4 ± 2.7 cm (range, 1.4-15.7 cm). The patients were categorized into the following, based on the pre-operative planning method: 3D planning (n = 32) and 2D planning (n = 30) groups. A comparative analysis was performed on various parameters, including ablation techniques, tumor-related prognosis, and incidence of complications. This analysis encompassed indicators, such as overall survival (OS) rate and local tumor progression (LTP), among others. RESULTS The median follow-up period was 30 months (range, 3-84 months). Notably, compared with the 2D planning group, the 3D planning group exhibited significant disparities in the number of punctures (P = 0.035) and incidence of complications (P = 0.029) and had no significant difference in the OS (P > 0.05) but had a significantly lower LTP rate (6.2% vs. 23.3%, P = 0.033). In the 3D planning group, the sub-group with a tumor diameter of < 5 cm exhibited a significantly less number of punctures (P = 0.039), lower input energy (P = 0.002), and a shorter ablation time (P = 0.001), compared with the sub-group with a tumor diameter of ≥ 5 cm, but there was no significant difference in the LTP and OS rates between the two sub-groups (P > 0.05). CONCLUSIONS The use of 3DVAPS in US-PMWA of MATs was advantageous, especially in lesions with a diameter of ≥ 5 cm. It can help in developing more rational surgical plans, reducing the incidence of complications, and extending the local recurrence-free survival time of patients and can add a certain value for precise treatment and expand the indications for ablation.
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Affiliation(s)
- Qiaowei Du
- Department of Interventional Ultrasound, the Fifth Center of Chinese PLA General Hospital, Beijing, China
- Chinese PLA Medical School, Beijing, China
| | - Xin Li
- Department of Interventional Ultrasound, the Fifth Center of Chinese PLA General Hospital, Beijing, China
| | - Zheng Lin
- Department of Interventional Ultrasound, the Fifth Center of Chinese PLA General Hospital, Beijing, China
- Chinese PLA Medical School, Beijing, China
| | - Linan Dong
- Department of Interventional Ultrasound, the Fifth Center of Chinese PLA General Hospital, Beijing, China
| | - Fangyi Liu
- Department of Interventional Ultrasound, the Fifth Center of Chinese PLA General Hospital, Beijing, China
| | - Ping Liang
- Department of Interventional Ultrasound, the Fifth Center of Chinese PLA General Hospital, Beijing, China
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Ji L, Wu Q, Gu J, Deng X, Zhou W, Fan X, Zhou F. Ultrasound-guided percutaneous laser ablation for papillary thyroid microcarcinoma: a retrospective analysis of 37 patients. Cancer Imaging 2019; 19:16. [PMID: 30894228 PMCID: PMC6425672 DOI: 10.1186/s40644-019-0204-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 03/13/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Over the past ten years, more papillary thyroid microcarcinoma (PTMC) has been diagnosed more frequently due to the development of imaging technology, and the incidence of PTMC has increased significantly. Ultrasound-guided percutaneous laser ablation (PLA) is mainly used for benign thyroid nodules, and few studies have been published on the use of PLA for PTMC. In the present study, a retrospective analysis was performed to explore the efficacy of PLA for PTMC. METHODS A total of 37 patients with PTMC who underwent PLA were included in this study. Measurement of the lesion volume and serum thyroid hormone levels and clinical evaluation were performed at 1, 3, 6, and 12 months and every 6 months thereafter. RESULTS We found that all patients were successfully treated with PLA without serious complications. At the last follow-up visit, 12/37 (32.4%) primary lesions had disappeared, and 24/37 (64.9%) remained as cicatricial hyperplasia. One patient (2.7%) had cervical lymph node metastasis at 24 months post-operatively and underwent open surgery. CONCLUSION Our initial studies suggest that ultrasound-guided PLA is a safe and effective treatment for PTMC.
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Affiliation(s)
- Lili Ji
- Department of Ultrasonography, The Affiliated Infectious Diseases Hospital of Soochow University, 2 Xier Road, Suzhou, 215101, China
| | - Qin Wu
- Department of Ultrasound, The Affiliated Suzhou Hospital of Nanjing Medical University, No. 1 Lijiang Road, Suzhou, 215163, China
| | - Jun Gu
- Center for Medical Ultrasound, The Affiliated Suzhou Hospital of Nanjing Medical University, 16 Baita Road, Suzhou, 215001, China.
| | - Xuedong Deng
- Center for Medical Ultrasound, The Affiliated Suzhou Hospital of Nanjing Medical University, 16 Baita Road, Suzhou, 215001, China
| | - Wei Zhou
- Department of Ultrasound, Rui Jin Hospital, School of Medicine, Shanghai Jiao Tong University, 197 Ruijin 2 Road, Shanghai, 200025, China
| | - Xing Fan
- Department of Ultrasound, The Affiliated Suzhou Hospital of Nanjing Medical University, No. 1 Lijiang Road, Suzhou, 215163, China
| | - Feng Zhou
- Department of Ultrasound, The Affiliated Suzhou Hospital of Nanjing Medical University, No. 1 Lijiang Road, Suzhou, 215163, China
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Liang P, Wu S, Li X, Yu J, Yu X, Cheng Z, Liu F, Han Z, Duan S. Ultrasound-guided percutaneous microwave ablation assisted by a three-dimensional visualization preoperative treatment planning system for larger adrenal metastasis (D ≥ 4 cm): Preliminary results. J Cancer Res Ther 2019; 15:1477-1483. [DOI: 10.4103/jcrt.jcrt_39_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Pacella CM, Mauri G, Cesareo R, Paqualini V, Cianni R, De Feo P, Gambelunghe G, Raggiunti B, Tina D, Deandrea M, Limone PP, Mormile A, Giusti M, Oddo S, Achille G, Di Stasio E, Misischi I, Papini E. A comparison of laser with radiofrequency ablation for the treatment of benign thyroid nodules: a propensity score matching analysis. Int J Hyperthermia 2017; 33:911-919. [PMID: 28605944 DOI: 10.1080/02656736.2017.1332395] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
PURPOSE To compare technique efficacy and safety of laser ablation (LA) and radiofrequency ablation (RFA) in treatment of benign thyroid nodules. MATERIALS AND METHODS Institutional review board approval was obtained, and patients' consent was waived. 601 nodules were treated from May 2009 to December 2014 at eight centres, 449 (309 females, age 57 ± 14 years) with LA and 152 (107 females, age 57 ± 14 years) with RFA. A matched cohort composed of 138 patients from each group was selected after adjustment with propensity score matching. Factors influencing volume reduction at 6 and 12 months and complications were evaluated. RESULTS No significant differences were observed in the baseline characteristics between groups after propensity score matching adjustment. Mean nodule reduction at 6 and 12 months was -67 ± 19% vs. -57 ± 21% (p < 0.001) - 70 ± 19% vs. -62 ± 22% (p = 0.001) in LA group and in RFA group, respectively. Nodules with volume >30 mL had significantly higher percentage volume reduction at 6 and 12 months (-69 ± 19 vs. -50 ± 21, p = 0.001) and (-73 ± 18 vs. -54 ± 23 8, p = 0.001) in the LA group than in the RFA group, respectively. In both groups, operator's skills affected the results. Major complications occurred in 4 cases in each group (p = 0.116) Conclusions: LA and RFA showed nearly similar outcome but LA was slightly more effective than RFA in large nodules. Operator's skills could be crucial in determining the extent of nodule volume reduction regardless of the used technique.
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Affiliation(s)
| | - Giovanni Mauri
- b Department of Interventional Radiology , European Institute of Oncology , Milan , Italy
| | - Roberto Cesareo
- c Thyroid Disease Center "S.M. Goretti" Hospital , Latina , Italy
| | | | - Roberto Cianni
- c Thyroid Disease Center "S.M. Goretti" Hospital , Latina , Italy
| | - Pierpaolo De Feo
- d Department of Internal Medicine , University of Perugia , Perugia , Italy
| | | | | | - Doris Tina
- e Endocrinology Unit, Atri Hospital , Atri , Italy
| | - Maurilio Deandrea
- f Thyroid Disease Center "A. Costa" Mauriziano Hospital , Turin , Italy
| | - Pier Paolo Limone
- f Thyroid Disease Center "A. Costa" Mauriziano Hospital , Turin , Italy
| | - Alberto Mormile
- f Thyroid Disease Center "A. Costa" Mauriziano Hospital , Turin , Italy
| | - Massimo Giusti
- g Endocrinology Department , AOU-IST IRCSS San Martino University of Genoa , Genoa , Italy
| | - Silvia Oddo
- g Endocrinology Department , AOU-IST IRCSS San Martino University of Genoa , Genoa , Italy
| | - Gaetano Achille
- h Cervico-Facial Ultrasound Diagnostic and Interventional Unit , Institute of Oncology of Bari , Bari , Italy
| | - Enrico Di Stasio
- i Institute of Biochemistry and Clinical Biochemistry , Rome Catholic University "Sacro Cuore" , Rome , Italy
| | - Irene Misischi
- j Department of Endocrinology , "Regina Apostolorum" Hospital , Albano Laziale , Italy
| | - Enrico Papini
- j Department of Endocrinology , "Regina Apostolorum" Hospital , Albano Laziale , Italy
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Detection of the Single-Session Complete Ablation Rate by Contrast-Enhanced Ultrasound during Ultrasound-Guided Laser Ablation for Benign Thyroid Nodules: A Prospective Study. BIOMED RESEARCH INTERNATIONAL 2016; 2016:9565364. [PMID: 27999819 PMCID: PMC5141549 DOI: 10.1155/2016/9565364] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Revised: 10/08/2016] [Accepted: 11/07/2016] [Indexed: 01/22/2023]
Abstract
This study aimed to investigate the single-session complete ablation rate of ultrasound-guided percutaneous laser ablation (LA) for benign thyroid nodules. LA was performed in 90 patients with 118 benign thyroid nodules. Contrast-enhanced ultrasound (CEUS) was used to evaluate complete nodule ablation one day after ablation. Thyroid nodule volumes, thyroid functions, clinical symptoms and complications were evaluated 1, 3, 6, 12, and 18 months after ablation. Results showed that all benign thyroid nodules successfully underwent LA. The single-session complete ablation rates for nodules with maximum diameters ≤2 cm, 2-3 cm and ≥3 cm were 93.4%, 70.3% and 61.1%, respectively. All nodule volumes significantly decreased than that one day after ablation (P < 0.05); at the final evaluation, the volume decreased from 6.16 ± 5.21 mL to 0.05 ± 0.01 mL. Thyroid functions did not show significant differences at one month after ablation compared with that before (P > 0.05). Three patients had obvious pain during ablation; one (1.1%) had recurrent laryngeal nerve injury, but the voice returned to normal within 6 months after treatment. Thus, ultrasound-guided LA can effectively inactivate benign thyroid nodules. LA is a potentially viable minimally invasive treatment that offers good cosmetic effects.
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Di Costanzo GG, D'Adamo G, Tortora R, Zanfardino F, Mattera S, Francica G, Pacella CM. A novel needle guide system to perform percutaneous laser ablation of liver tumors using the multifiber technique. Acta Radiol 2013; 54:876-81. [PMID: 23761559 DOI: 10.1177/0284185113489825] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Previous studies have shown that laser ablation with the multifiber technique is effective in the treatment of liver tumors. However, the correct positioning of multiple needles may be challenging. PURPOSE To investigate the use of a novel needle guide system that was developed to perform percutaneous laser ablation of liver tumors with the multifiber technique under ultrasonographic guidance. MATERIAL AND METHODS Between February 2009 and June 2011, 116 patients (104 hepatocellular carcinomas and 12 metastases) with 127 liver nodules (median diameter, 3.0 cm; range, 1.5-6.0) were treated. Nineteen nodules were in high-risk locations. A needle guide with separate channels to insert two needles in a parallel position and at a prefixed distance was used. RESULTS Needles were positioned inside the target nodule easily and quickly, and correct spacing (1.5-1.8 cm) between light sources was immediately achieved. Complete tumor ablation was achieved in a single session in 112 (88.2%) lesions. In nodules ≤3.0 cm and >3.0 cm in size, ablation was complete in 93.6% and 79.6% of cases, respectively. Of note, complete ablation was achieved in 91.7% of nodules up to 5.0 cm. CONCLUSION With the new guidance system, needles could be inserted in parallel fashion, which facilitated positioning the needles in geometrical configurations to maximize the ablative effect. Worthy of note, the complete ablation rate in nodules >3.0 cm using the new guide system was higher than what has been reported in the literature so far.
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Affiliation(s)
| | | | | | | | | | - Giampiero Francica
- Diagnostic and Interventional Ultrasound Unit, Camilliani Hospital, Naples
| | - Claudio Maurizio Pacella
- Regina Apostolorum Hospital, Diagnostic Imaging and Interventional Radiology, Albano Laziale, Italy
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Glover AR, Ip JCY, Zhao JT, Soon PSH, Robinson BG, Sidhu SB. Current management options for recurrent adrenocortical carcinoma. Onco Targets Ther 2013; 6:635-43. [PMID: 23776337 PMCID: PMC3681406 DOI: 10.2147/ott.s34956] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Adrenal cortical carcinoma (ACC) is a rare cancer that poses a number of management challenges due to the limited number of effective systemic treatments. Complete surgical resection offers the best chance of long-term survival. However, despite complete resection, ACC is associated with high recurrence rates. This review will discuss the management of recurrent ACC in adults following complete surgical resection. Management should take place in a specialist center and treatment decisions must consider the individual tumor biology of each case of recurrence. Given the fact that ACC commonly recurs, management to prevent recurrence should be considered from initial diagnosis with the use of adjuvant mitotane. Close follow up with clinical examination and imaging is important for early detection of recurrent disease. Locoregional recurrence may be isolated, and repeat surgical resection should be considered along with mitotane. The use of radiotherapy in ACC remains controversial. Systemic recurrence most often involves liver, pulmonary, and bone metastasis and is usually managed with mitotane, with or without combination chemotherapy. There is a limited role for surgical resection in systemic recurrence in selected patients. In all patients with recurrent disease, control of excessive hormone production is an important part of management. Despite intensive management of recurrent ACC, treatment failure is common and the use of clinical trials and novel treatment is an important part of management.
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Affiliation(s)
- Anthony R Glover
- Kolling Institute of Medical Research, Cancer Genetics Laboratory, Royal North Shore Hospital and University of Sydney, St Leonards, Australia
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Kirschner LS. The next generation of therapies for adrenocortical cancers. Trends Endocrinol Metab 2012; 23:343-50. [PMID: 22626690 DOI: 10.1016/j.tem.2012.04.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Revised: 04/06/2012] [Accepted: 04/06/2012] [Indexed: 01/06/2023]
Abstract
Adrenocortical carcinoma (ACC) is a rare cancer for which few treatment options have been available. Currently, the best available treatment involves combination chemotherapy with the adrenolytic drug mitotane, although the response rate remains modest. Over the past 10 years there has been renewed interest in the field owing to the recognition that targeted therapies may provide new avenues for effective treatment of this deadly disease. Molecular analyses have revealed specific signaling alterations in ACC, and advances in drug development have generated the tools to block these pathways. Although convincing evidence for the effectiveness of targeted therapies is not currently available, these studies are in progress and should shift the prognosis of this disease in the years to come.
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Affiliation(s)
- Lawrence S Kirschner
- Division of Endocrinology, Diabetes, and Metabolism, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA.
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Li X, Fan W, Zhang L, Zhao M, Huang Z, Li W, Gu Y, Gao F, Huang J, Li C, Zhang F, Wu P. CT-guided percutaneous microwave ablation of adrenal malignant carcinoma. Cancer 2011; 117:5182-8. [DOI: 10.1002/cncr.26128] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Revised: 01/19/2011] [Accepted: 02/17/2011] [Indexed: 01/29/2023]
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Tacon LJ, Prichard RS, Soon PSH, Robinson BG, Clifton-Bligh RJ, Sidhu SB. Current and emerging therapies for advanced adrenocortical carcinoma. Oncologist 2011; 16:36-48. [PMID: 21212436 DOI: 10.1634/theoncologist.2010-0270] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Adrenocortical carcinoma (ACC) is a rare but aggressive malignancy with a poor prognosis. Complete surgical resection offers the only potential for cure; however, even after apparently successful excision, local or metastatic recurrence is frequent. Treatment options for advanced ACC are severely limited. Mitotane is the only recognized adrenolytic therapy available; however, response rates are modest and unpredictable whereas systemic toxicities are significant. Reported responses to conventional cytotoxic chemotherapy have also been disappointing, and the rarity of ACC had hampered the ability to undertake randomized clinical studies until the establishment of the First International Randomized Trial in Locally Advanced and Metastatic Adrenocortical Carcinoma. This yet-to-be reported study seeks to identify the most effective first- and second-line cytotoxic regimens. The past decade has also seen increasing research into the molecular pathogenesis of ACCs, with particular interest in the insulin-like growth factor signaling pathway. The widespread development of small molecule tyrosine kinase inhibitors in broader oncological practice is now allowing for the rational selection of targeted therapies to study in ACC. In this review, we discuss the currently available therapeutic options for patients with advanced ACC and detail the molecular rationale behind, and clinical evidence for, novel and emerging therapies.
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Affiliation(s)
- Lyndal J Tacon
- Cancer Genetics Unit, Hormones and Cancer Group, Kolling Institute of Medical Research, Department of Endocrinology, Royal North Shore Hospital, St. Leonards 2065 NSW Australia.
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Current world literature. Curr Opin Ophthalmol 2009; 20:333-41. [PMID: 19535964 DOI: 10.1097/icu.0b013e32832e478f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bibliography. Current world literature. Obesity and nutrition. Curr Opin Endocrinol Diabetes Obes 2008; 15:470-5. [PMID: 18769222 DOI: 10.1097/med.0b013e328311f3cb] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Papini E, Bizzarri G, Pacella CM. Percutaneous laser ablation of benign and malignant thyroid nodules. Curr Opin Endocrinol Diabetes Obes 2008; 15:434-9. [PMID: 18769216 DOI: 10.1097/med.0b013e32830eb89a] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW Percutaneous image-guided procedures, largely based on thermal ablation, are at present under investigation for achieving a nonsurgical targeted cytoreduction in benign and malignant thyroid lesions. RECENT FINDINGS In several uncontrolled clinical trials and in two randomized clinical trials, laser ablation has demonstrated a good efficacy and safety for the shrinkage of benign cold thyroid nodules. In hyperfunctioning nodules, laser ablation induced a nearly 50% volume reduction with a variable frequency of normalization of thyroid-stimulating hormone levels. Laser ablation has been tested for the palliative treatment of poorly differentiated thyroid carcinomas, local recurrences or distant metastases. SUMMARY Laser ablation therapy is indicated for the shrinkage of benign cold nodules in patients with local pressure symptoms who are at high surgical risk. The treatment should be performed only by well trained operators and after a careful cytological evaluation. Laser ablation does not seem to be consistently effective in the long-term control of hyperfunctioning thyroid nodules and is not an alternative treatment to 131I therapy. Laser ablation may be considered for the cytoreduction of tumor tissue prior to external radiation therapy or chemotherapy of local or distant recurrences of thyroid malignancy that are not amenable to surgical or radioiodine treatment.
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Affiliation(s)
- Enrico Papini
- Department of Endocrinology, Regina Apostolorum Hospital, Albano, Rome, Italy.
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