Microwave Ablation versus Surgical Resection for US-detected Multifocal T1N0M0 Papillary Thyroid Carcinoma: A 10-Center Study

Hyperthermia combined with opioid therapy: Enhancing cancer pain management and reducing surgical stress in gastrointestinal cancer patients

In this article, we evaluate the findings of the study by Qian et al, which explores the efficacy of combining hyperthermia with opioid therapy for enhanced cancer pain management in patients with middle and late-stage gastrointestinal tumors. The study undertakes a retrospective analysis comparing traditional opioid therapy to an integrated approach of hyperthermia and opioids across 70 patients, highlighting significant benefits in pain control, reduction of opioid dosage, and minimization of adverse reactions. In our article, we not only discuss these findings but also emphasize the broader implications for clinical practice, particularly in enhancing patient outcomes through innovative pain management strategies. We advocate for further research to establish more robust data supporting this approach and to explore the mechanistic insights that enable these benefits. This discussion reflects on the potential paradigm shift in managing debilitating cancer-related pain, urging a reevaluation of current practices to incorporate these findings effectively.

Risk Factors for Disease Progression in Thermal Ablation of Papillary Thyroid Cancer-A Large-sample Analysis

RATIONALE AND OBJECTIVES

This study aimed to analyze risk factors influencing disease progression in patients with papillary thyroid cancer (PTC) undergoing microwave ablation (MWA).

MATERIALS AND METHODS

In this retrospective single-center study, 889 patients (647 women; median age, 40 years; age range, 14-80 years) who underwent MWA for PTC from June 2015 to December 2022 were enrolled. A least-absolute shrinkage and selection operator Cox regression model was employed to identify important factors for disease progression. Cox univariable and multivariable regression analyses were conducted to evaluate the association of variables with disease progression. Variables achieving statistical significance (P<0.05) were incorporated into a prognostic prediction model.

RESULTS

The median follow-up period was 25 months. Disease progression-free survival rates at 1, 2, and 3 years were 99.6%, 97.2%, and 95.9%, respectively. Independent predictors of disease progression included multifocality (hazard ratio [HR]=2.3, 95% confidence interval [CI]: 1.2-4.3; P=0.011), ultrasound-detected extrathyroidal extension (HR=2.3, 95% CI: 1.2-4.3; P=0.010), and larger maximum diameters (HR=1.8, 95% CI: 1.1-3.0; P=0.026). Additionally, multiple tumors (HR=2.9, 95% CI: 1.4-6.0; P=0.003) and larger maximum diameters (HR=1.8, 95% CI: 1.0-3.0; p=0.038) were significantly associated with new tumor occurrence. The Cox regression fitting of the nomogram demonstrated moderate prediction efficiency (consistency index 0.715).

CONCLUSION

MWA is a feasible and effective treatment for patients with PTC. However, for patients with larger nodules, multiple nodules, and ultrasound-detected extrathyroidal extension, a more meticulous and precise ablation strategy is critical to minimize the risk of disease progression.

Multicenter study of thermal ablation versus partial thyroidectomy for paratracheal papillary thyroid microcarcinoma

OBJECTIVE

To compare the clinical outcomes of patients with unifocal paratracheal papillary thyroid microcarcinoma (PTMC) after thermal ablation (TA) vs. partial thyroidectomy (PT).

MATERIALS AND METHODS

This retrospective multicenter study included 436 patients with unifocal, clinical N0 paratracheal PTMC who underwent TA (210 patients) or PT (236 patients) between June 2014 and December 2020. The propensity score matching method was used to mitigate confounding factors between the two groups. Disease progression, progression-free survival (PFS), complications, and treatment variables were compared. Adjusted Cox regression models were utilized to assess the impact of treatment on disease progression.

RESULTS

After matching, a comparable incidence of disease progression (3.3% vs. 2.2%, p = 0.79) and comparable 5-year PFS rates (97.0% vs. 97.4%, p = 0.75) were observed between the TA and PT groups. Adjusted Cox regression models showed no significant correlation between TA and disease progression. TA was associated with shorter hospitalization (0 vs. 6.0 days), less estimated blood loss (0 vs. 15.0 mL), shorter incision length (0.3 vs. 6.0 cm), and lower costs ($1748.3 vs. $2898.0) compared with PT (all p < 0.001). The complication rate was 1.1% after TA and 3.3% after PT (p = 0.28), with permanent complications were exclusively observed in the PT group.

CONCLUSION

The mid-term incidence of disease progression and PFS rates were similar between TA and PT in patients with unifocal paratracheal PTMC. TA might represent a promising alternative treatment to PT for eligible patients with paratracheal PTMC.

KEY POINTS

Question Is thermal ablation a viable alternative treatment to partial thyroidectomy for treating paratracheal papillary thyroid microcarcinoma? Findings Comparable incidence of disease progression and 5-year progression-free survival rates were observed between thermal ablation and partial thyroidectomy. Clinical relevance Thermal ablation, as a minimally invasive procedure, provides a promising alternative to partial thyroidectomy, with comparable clinical outcomes for patients with paratracheal papillary thyroid microcarcinoma.

Impact of thyrotropin levels on outcomes in T1N0M0 papillary thyroid cancer after microwave ablation

OBJECTIVE

To evaluate the impact of thyroid-stimulating hormone (TSH) levels on tumor progression and survival in patients with uni- and multifocal T1N0M0 papillary thyroid cancer (PTC) treated with microwave ablation (MWA).

METHODS

This retrospective study analyzed the records of 525 patients with uni- and multifocal T1N0M0 PTC who underwent MWA from January 2015 to December 2022. Patients were stratified into uni-focal (U-PTC) and multifocal (M-PTC) groups and further categorized based on post-ablation TSH levels into low (≤1 mU/L), medium (1-2 mU/L), and high (>2 mU/L) subgroups. The tumor progression rates and progression-free survival were assessed.

RESULTS

In U-PTC patients, lower TSH levels were significantly associated with higher tumor progression rates (10.1%) compared to those in the medium (2.9%) and high (2.1%) TSH groups (p = .009). Conversely, in M-PTC patients, tumor progression rates did not vary significantly across TSH levels. Progression-free survival rates in U-PTC patients were notably lower at the 5-year mark in the low TSH group (85.7%) compared to the medium TSH group (96.5%, p = .046). However, progression-free survival rates in M-PTC patients showed convergence across all TSH levels by the 5-year follow-up.

CONCLUSION

Maintaining TSH levels within the normal range post-ablation may be appropriate for managing T1N0M0 PTC treated with MWA, but randomized controlled trials are needed to confirm optimal TSH targets and their impact on outcomes.

Advances in Image-Guided Ablation Therapies for Solid Tumors

Image-guided solid tumor ablation methods have significantly advanced in their capability to target primary and metastatic tumors. These techniques involve noninvasive or percutaneous insertion of applicators to induce thermal, electrochemical, or mechanical stress on malignant tissue to cause tissue destruction and apoptosis of the tumor margins. Ablation offers substantially lower risks compared to traditional methods. Benefits include shorter recovery periods, reduced bleeding, and greater preservation of organ parenchyma compared to surgical intervention. Due to the reduced morbidity and mortality, image-guided tumor ablation offers new opportunities for treatment in cancer patients who are not candidates for resection. Currently, image-guided ablation techniques are utilized for treating primary and metastatic tumors in various organs with both curative and palliative intent, including the liver, pancreas, kidneys, thyroid, parathyroid, prostate, lung, breast, bone, and soft tissue. The invention of new equipment and techniques is expanding the criteria of eligible patients for therapy, as now larger and more high-risk tumors near critical structures can be ablated. This article provides an overview of the different imaging modalities, noninvasive, and percutaneous ablation techniques available and discusses their applications and associated complications across various organs.