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Liang X, Jiang B, Ji Y, Xu Y, Lv Y, Qin S, Huo L, Zhang H, Liu H, Shi T, Luo Y. Complications of ultrasound-guided thermal ablation of thyroid nodules and associated risk factors: an experience from 9667 cases. Eur Radiol 2024:10.1007/s00330-024-11023-9. [PMID: 39174654 DOI: 10.1007/s00330-024-11023-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 06/07/2024] [Accepted: 08/06/2024] [Indexed: 08/24/2024]
Abstract
OBJECTIVES To evaluate the safety of ultrasound-guided thermal ablation (UGTA) for thyroid nodules (TNs) by analysing complications and related risks. MATERIALS AND METHODS This retrospective, single-centre study reviewed patients who underwent UGTA (microwave or radiofrequency ablation) between January 2018 and March 2023. The incidence of complications was recorded and assessed during and immediately after ablation,1-3 h later, and at 1 month, 3 months, and 6 months. Univariate and multivariate analyses were performed to identify risk factors for hoarseness and haemorrhagic complications. RESULTS We reviewed 9667 cases in this study. Overall, 4494 (46.49%) cases underwent microwave ablation, while 5173 (53.51%) cases underwent radiofrequency ablation. The overall complication rate was 4.43%. The incidence of major complications was 1.94% (haemorrhage, 1.32%; hoarseness, 0.54%; and symptomatic aseptic necrosis, 0.08%). The incidence of minor complications was 2.45%. A large nodule volume, radiofrequency ablation, hyper-enhancing nodules, benign nodules, higher preoperative blood pressure, hyperthyroidism, and higher ablation power were independent risk factors for haemorrhage. Dorsal nodules and a higher ablation power were independent risk factors for hoarseness. All complications were resolved. CONCLUSION This study suggests that UGTA is a safe treatment for TNs. Several risk factors for haemorrhage and hoarseness should be considered before performing UGTA. Different ablation modalities should be considered for patients with different conditions. CLINICAL RELEVANCE STATEMENT Thermal ablation may be a safe treatment for eligible patients with TNs. KEY POINTS We analysed the complications and risk factors associated with UGTA in 9667 cases. The complication rate was 4.43%; 1.94% were major complications. Risk factors of haemorrhage and hoarseness should be considered. UGTA was a safe method for the treatment of TNs.
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Affiliation(s)
- Xi Liang
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Bo Jiang
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yongjiao Ji
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yanna Xu
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yanting Lv
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Si Qin
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Lanlan Huo
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Huimiao Zhang
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Hongrui Liu
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Tongming Shi
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yukun Luo
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, Beijing, China.
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Gong W, Zhang R, Zhang S, Zhai Y, Zheng C, Zhang D. Comparison between thermal ablation and surgery in low risk papillary thyroid carcinoma: a prospective study. Front Endocrinol (Lausanne) 2024; 15:1398208. [PMID: 39149120 PMCID: PMC11324463 DOI: 10.3389/fendo.2024.1398208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 07/22/2024] [Indexed: 08/17/2024] Open
Abstract
Objective To conduct a comparative analysis of the efficacy, safety, and impact on quality of life outcomes between thermal ablation and surgical interventions in patients diagnosed with papillary thyroid carcinoma (PTC). Methods A prospective study was undertaken, enrolling patients with PTC ≤5mm who underwent radiofrequency ablation (RFA), laser ablation (LA), or surgery, for analysis of efficacy and safety outcomes. The Thyroid Cancer-Specific Quality of Life questionnaire was administered to all patients before treatment and at 3, 6, and 12 months post-treatment. Results A total of 162 eligible patients were included in the study. Major complications were not observed in the RFA and LA groups, while five cases were reported in the surgery group, although no statistically significant differences were observed. Minor complications were documented in two, three, and 14 patients in the RFA, LA, and surgery groups, respectively, with no significant variances noted. Surgical duration and hospitalization time were notably shorter in the thermal ablation groups. At the final follow-up, complete disappearance of nodules was seen in 71.4% of cases treated with RFA and 71.0% of cases managed with LA, with no significant disparities between the groups. Both RFA and LA exhibited similar effects on quality of life, with thermal ablation techniques showing better functional outcomes in comparison to surgery. Across all groups, adverse effects were most pronounced at the 3-month post-treatment mark but gradually reverted to baseline levels in the thermal ablation group, contrasting with the surgery group. Conclusions For PTC ≤5mm, both RFA and LA exhibited similar cancer control outcomes and superior quality of life on par with surgery, while minimizing complications. These findings underscore the promise of RFA and LA as potential standard treatments for small PTCs, subject to further confirmation in future studies.
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Affiliation(s)
- Wenbo Gong
- Department of Thyroid and Head & Neck Surgery, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Runfang Zhang
- Department of Thyroid and Head & Neck Surgery, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Songtao Zhang
- Department of Thyroid and Head & Neck Surgery, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Yifei Zhai
- Department of Thyroid and Head & Neck Surgery, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Chen Zheng
- Department of Thyroid and Head & Neck Surgery, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Dongyan Zhang
- Department of Thyroid and Head & Neck Surgery, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
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de Robertis V, Achille G, Barbara F, Caivano F, Anzivino R, Guarino P, Barbara M. Minimally-invasive conservative techniques in management of thyroid carcinoma: a narrative review. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2024; 44:S82-S85. [PMID: 38745519 PMCID: PMC11098533 DOI: 10.14639/0392-100x-suppl.1-44-2024-n2843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 12/28/2023] [Indexed: 05/16/2024]
Abstract
Increased diagnostic surveillance and technological innovation have considerably increased the number of thyroidectomies for carcinoma in the last decades. While thyroidectomy remains the first line of treatment, other minimally-invasive and conservative options to be applied in very selected cases have been proposed. The objective of this review is to illustrate the advantages and disadvantages of these techniques.
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Affiliation(s)
| | - Gaetano Achille
- Otolaryngology and Head and Neck Unit,
IRCSS “G. Paolo II”, Bari,
Italy
| | | | | | - Roberta Anzivino
- Otolaryngology and Head and Neck Unit,
Ospedale Di Venere, Bari,
Italy
| | - Pierre Guarino
- Otolaryngology and Head and Neck Unit,
Ospedale Civile Santo Spirito, Pescara,
Italy
| | - Michele Barbara
- Otolaryngology and Head and Neck Unit,
Ospedale Di Venere, Bari,
Italy
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Freeman T, Pena O, Sag AA, Young S. Ablation of Primary and Recurrent Thyroid Cancer: Current and Future Perspectives. Semin Intervent Radiol 2024; 41:105-112. [PMID: 38993600 PMCID: PMC11236443 DOI: 10.1055/s-0044-1786537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2024]
Abstract
Thyroid cancer is the most common endocrine malignancy, and its incidence is increasing, driven in part by the advent of ultrasound, and subsequent increased detection of small, early thyroid cancers. Yet even for small tumors, thyroidectomy with lymph node dissection remains standard of care. Specific to well-differentiated thyroid cancer, surgery has come under scrutiny as a possible overtreatment, in light of stable and favorable survival rates even as guidelines have allowed fewer radical resections and lymph node dissections over time. Moreover, thyroid cancer unfortunately has a known recurrence rate regardless of therapy, and surgical re-intervention for local structural recurrence is eventually limited by scar. Radioactive iodine therapy, another accepted treatment, is minimally invasive but can only treat patients with iodine-avid tumors. For all of these reasons, image-guided thermal ablation has emerged as a valuable complementary tool as a thyroid-sparing, parathyroid-sparing, voice-sparing, repeatable, minimally invasive outpatient focal therapy for both primary and recurrent well-differentiated thyroid cancers. However, the data are still evolving, and this represents a new patient cohort for some interventional radiologists. Therefore, the goal of this review is to discuss the technique and evidence for ablation of patients with thyroid cancer.
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Affiliation(s)
- Toliver Freeman
- Department of Radiology, Louisiana State Medical School, New Orleans, Louisiana
| | - Olivia Pena
- Division of Interventional Radiology Duke University, Department of Radiology, Durham, North Carolina
| | | | - Shamar Young
- Division of Interventional Radiology, Department of Medical Imaging, University of Arizona, Tucson, Arizona
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Gao X, Yang Y, Wang Y, Huang Y. Efficacy and safety of ultrasound-guided radiofrequency, microwave and laser ablation for the treatment of T1N0M0 papillary thyroid carcinoma on a large scale: a systematic review and meta-analysis. Int J Hyperthermia 2023; 40:2244713. [PMID: 37604507 DOI: 10.1080/02656736.2023.2244713] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 07/31/2023] [Accepted: 07/31/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND To analyze the efficacy and safety of radiofrequency ablation (RFA), microwave ablation (MWA) and laser ablation (LA) in T1N0M0 papillary thyroid carcinoma (PTC) patients by evaluating data on several outcomes on a large scale. MATERIALS AND METHODS Literature searches were conducted in PUBMED, EMBASE and the Cochrane Library for studies of thermal ablation (TA) for treating T1N0M0 PTC. Data on the volume reduction rate (VRR) at the 12-month follow-up and final follow-up, complete disappearance rate, local recurrence rate, lymph node metastasis rate, and complication rate of RFA, MWA and LA were evaluated separately. RFA effects were compared between T1aN0M0 and T1bN0M0 patients. RESULTS A total of 36 eligible studies were included. RFA presented superior efficacy than MWA in 12-month VRR. At the final follow-up, the difference was slight in subgroups, showing a significant reduction. The complete disappearance rate of LA (93.00%) was higher than that of RFA (81.00%) and MWA (71.00%). Additionally, the local recurrence rate pooled proportions of MWA and RFA were both 2.00%, lower than that of the LA group (3.00%). There was no event of distant metastasis. The lymph node metastasis rates were similar, as RFA (1.00%) had the lowest. For minor complication rates, the pooled proportions of RFA (3.00%) were smaller than those of LA (6.00%) and MWA (13.00%). T1aN0M0 lesions presented with better outcomes than T1bN0M0 lesions. CONCLUSION RFA, MWA and LA were reliable in curing PTC, and RFA presented advantages in most outcomes. T1aN0M0 patients may experience fewer side effects than T1bN0M0 patients.
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Affiliation(s)
- Xuemeng Gao
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Yang Yang
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Yitong Wang
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Ying Huang
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
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Monpeyssen H. Transitioning from Traditional Academic Decision Making to Patient-Centric Healthcare Choices: The Example of Thyroid Thermal Ablation Techniques for Papillary Thyroid Microcarcinomas. Curr Oncol 2023; 30:9670-9675. [PMID: 37999121 PMCID: PMC10670327 DOI: 10.3390/curroncol30110701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/30/2023] [Accepted: 10/13/2023] [Indexed: 11/25/2023] Open
Abstract
Percutaneous thermal ablation techniques (TATs) have contributed to improving thyroid tumor management for almost twenty years [...].
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Wang C, Zhang Y. Current Application of Nanoparticle Drug Delivery Systems to the Treatment of Anaplastic Thyroid Carcinomas. Int J Nanomedicine 2023; 18:6037-6058. [PMID: 37904863 PMCID: PMC10613415 DOI: 10.2147/ijn.s429629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 10/18/2023] [Indexed: 11/01/2023] Open
Abstract
Anaplastic thyroid carcinomas (ATCs) are a rare subtype of thyroid cancers with a low incidence but extremely high invasiveness and fatality. The treatment of ATCs is very challenging, and currently, a comprehensive individualized therapeutic strategy involving surgery, radiotherapy (RT), chemotherapy, BRAF/MEK inhibitors (BRAFi/MEKi) and immunotherapy is preferred. For ATC patients in stage IVA/IVB, a surgery-based comprehensive strategy may provide survival benefits. Unfortunately, ATC patients in IVC stage barely get benefits from the current treatment. Recently, nanoparticle delivery of siRNAs, targeted drugs, cytotoxic drugs, photosensitizers and other agents is considered as a promising anti-cancer treatment. Nanoparticle drug delivery systems have been mainly explored in the treatment of differentiated thyroid cancer (DTC). With the rapid development of drug delivery techniques and nanomaterials, using hybrid nanoparticles as the drug carrier to deliver siRNAs, targeted drugs, immune drugs, chemotherapy drugs and phototherapy drugs to ATC patients have become a hot research field. This review aims to describe latest findings of nanoparticle drug delivery systems in the treatment of ATCs, thus providing references for the further analyses.
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Affiliation(s)
- Chonggao Wang
- Department of Thyroid Surgery, Nanjing Hospital of Chinese Medicine, Nanjing, 210001, People’s Republic of China
- School of Medicine, Southeast University, Nanjing, 210001, People’s Republic of China
| | - Yewei Zhang
- Hepatopancreatobiliary Center, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, 210009, People’s Republic of China
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Dong Y, Cheng Y, Jin P, Chen J, Ezzi S, Chen Y, Zhu J, Zhao Y, Zhang Y, Luo Z, Hong Y, Zhang C, Huang P. Important parameters should be paid attention in PTMC radiofrequency ablation. Sci Rep 2023; 13:13450. [PMID: 37596390 PMCID: PMC10439129 DOI: 10.1038/s41598-023-40532-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 08/11/2023] [Indexed: 08/20/2023] Open
Abstract
In order to provide clinical references for the RFA procedure and to study the pivotal factors affecting the recovery time of radiofrequency ablation (RFA) in patients with papillary thyroid microcarcinoma (PTMC), 176 patients with low-risk intrathyroidal PTMC were included in this research. We randomly divided the whole cohort into training and test groups at a ratio of 7:3. The two-sample t-test was used to detect differences between the two groups. Least absolute shrinkage and selection operator (LASSO) regression was used to select the best predictor variables for predicting the status of RFA zone. Multiple test methods were used to ensure the scientific nature and accuracy of the Cox proportional hazards model. We tested the performance for the parameters and revealed the best cut-off value of each variable by the ROC curve and log-rank tests. The results showed patients aged above 49 years old, with RFA energy above 2800 J, the average diameter of the original tumour above 0.6 cm, or the average diameter of ablation zone at 1 month after RFA above 1.1 cm are risk factors for RFA zone delayed healing.
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Affiliation(s)
- Yiping Dong
- Department of Ultrasound in Medicine, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, People's Republic of China
| | - Yanling Cheng
- Department of Nursing, Xijing 986 Hospital, Air Force Medical University, Xi'an, 710054, People's Republic of China
| | - Peile Jin
- Department of Ultrasound in Medicine, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, People's Republic of China
| | - Jifan Chen
- Department of Ultrasound in Medicine, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, People's Republic of China
| | - Sohaib Ezzi
- Zhejiang University School of Medicine, Hangzhou, 310058, People's Republic of China
| | - Yajun Chen
- Department of Ultrasound in Medicine, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, People's Republic of China
| | - Jianing Zhu
- Department of Ultrasound in Medicine, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, People's Republic of China
| | - Yanan Zhao
- Department of Ultrasound in Medicine, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, People's Republic of China
| | - Ying Zhang
- Department of Ultrasound in Medicine, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, People's Republic of China
| | - Zhiyan Luo
- Department of Ultrasound in Medicine, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, People's Republic of China
| | - Yurong Hong
- Department of Ultrasound in Medicine, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, People's Republic of China
| | - Chao Zhang
- Department of Ultrasound in Medicine, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, People's Republic of China.
| | - Pintong Huang
- Department of Ultrasound in Medicine, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, People's Republic of China.
- Research Center for Life Science and Human Health, Binjiang Institute of Zhejiang University, Hangzhou, 310053, People's Republic of China.
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Hu C, Liang S, Liu H, Yang J, Kang H, Guan S, Yan R, Xu E. Prediction of ablation zone disappearance after microwave ablation for the patients with papillary thyroid microcarcinoma using nomograph. Front Endocrinol (Lausanne) 2023; 14:1145958. [PMID: 37600691 PMCID: PMC10433776 DOI: 10.3389/fendo.2023.1145958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 04/11/2023] [Indexed: 08/22/2023] Open
Abstract
Objectives To construct a prognostic nomogram to predict the ablation zone disappearance for patients with papillary thyroid microcarcinoma (PTMC) after microwave ablation (MWA). Materials and methods From April 2020 to April 2022, patients with PTMC who underwent MWA treatment were collected retrospectively. Ultrasound (US) or contrast-enhanced ultrasound (CEUS) was performed at 1 day, 1, 3, 6, 12, 18 and 24 months after MWA to observe the curative effect after ablation. The volume, volume reduction rate (VRR) and complete disappearance rate of the ablation zone at each time point were calculated. Univariate and multivariate logistic regression analysis were used to determine the prognostic factors associated with the disappearance of the ablation zone after MWA, and the nomogram was established and validated. Results 72 patients with PTMCs underwent MWA were enrolled into this study. After MWA, no tumor progression (residual, recurrence or lymph node metastasis) and major postoperative complications occurred. The ablation zone in 28 (38.89%) patients did not completely disappear after MWA in the follow-up period. Three variables, including age (odds ratio [OR]: 1.216), calcification type (OR: 12.283), initial maximum diameter (OR: 2.051) were found to be independent prognostic factors predicting ablation zone status after MWA by multivariate analysis. The above variables and outcomes were visualized by nomogram (C-index=0.847). Conclusions MWA was a safe and effective treatment for PTMC. Older patients with macrocalcification and larger size PTMCs were more unlikely to obtain complete disappearance of ablation zones. Incomplete disappearance of ablation zone was not related to recurrence.
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Affiliation(s)
- Cai Hu
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzen, China
| | - Shuang Liang
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzen, China
| | - Huahui Liu
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzen, China
| | - Jing Yang
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzen, China
| | - Haiyu Kang
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzen, China
| | - Sainan Guan
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzen, China
| | - Ronghua Yan
- Department of Radiology, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
- Department of Radiology, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzen, China
| | - Erjiao Xu
- Department of Medical Ultrasonics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzen, China
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Zeng F, Zou B, Chen H, Luo M, Liu W. Analysis of Therapeutic Effect and Influencing Factors of Ultrasound-Guided Radiofrequency Ablation in the Treatment of Papillary Thyroid Microcarcinoma. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023. [PMID: 36880705 DOI: 10.1002/jum.16197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 02/02/2023] [Accepted: 02/02/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVES The current study sought to explore the effects of ultrasound (US)-guided radiofrequency ablation (RFA) on papillary thyroid microcarcinoma (PTMC) and influencing factors. METHODS PTMC patients were assigned to observation (US-guided RFA) and control (surgical operation) groups. A series of operation-related indexes (operation time, intraoperative bleeding, wound closure time, hospital stay, and expenses), visual analogue scale score, lesion size, and thyroid function-related indexes (thyroid-stimulating hormone [TSH], free triiodothyronine*** [FT3], free thyroxine [FT4]), inflammatory factors, and thyroglobulin antibody (TgAb) were assessed and compared. After a 6-month follow-up period, the complications and recurrence were recorded, in addition to analyses of postoperative recurrence cumulative incidence and evaluation of recurrence risk factors. RESULTS Operation-related indexes of the observation group were relatively decreased compared with the control group. In addition, the lesion volume in the observation group was lower compared to that in the control group at the 6th month after operation, whereas the volume reduction rate was higher. There were no significant differences in regard to thyroid function-related indexes in the observation group before/after operation. After operation, serum TSH levels and inflammatory factors, and TgAb levels were all diminished, while the FT3 and FT4 levels were both elevated in the observation group relative to the control group, and postoperative recurrence cumulative incidence was lower in the observation group. TSH and TgAb were established as the independent risk factors for recurrence after RFA in PTMC patients. CONCLUSIONS Our findings highlighted that US-guided RFA exhibits better efficacy, safety, and postoperative recovery and lower recurrence risk for PTMC.
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Affiliation(s)
- Fuqiang Zeng
- Department of Ultrasound, Zhongshan Hospital of Traditional Chinese Medicine, Zhongshan, China
| | - Bin Zou
- Department of Ultrasound, Zhongshan Hospital of Traditional Chinese Medicine, Zhongshan, China
| | - Huabin Chen
- Department of Ultrasound, Zhongshan Hospital of Traditional Chinese Medicine, Zhongshan, China
| | - Ming Luo
- Department of Surgery, Zhongshan Hospital of Traditional Chinese Medicine, Zhongshan, China
| | - Wenmin Liu
- Department of Ultrasound, Zhongshan Hospital of Traditional Chinese Medicine, Zhongshan, China
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11
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Chen Z, Zhang W, He W. Ultrasound-guided thermal ablation for papillary thyroid microcarcinoma: A systematic review. Clin Endocrinol (Oxf) 2023; 98:296-305. [PMID: 36471482 DOI: 10.1111/cen.14857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 11/29/2022] [Accepted: 12/03/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Thyroidectomy is the first-line treatment for papillary thyroid microcarcinoma (PTMC), but often involves aggressive overtreatment. Thermal ablation (TA) has been gradually used for the treatment of recurrent PTMC. However, it is not recommended for the treatment of primary PTMC according to the Korean and Italian guidelines. Therefore, this systematic review aimed to analyse the indications, efficacy, and safety of TA in the treatment of PTMC. DESIGN Systematic review. PATIENTS AND MEASUREMENTS A search strategy was developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. A total of 27 articles were included in this study until January 2022. RESULTS According to current guidelines and studies, we divided the indications of TA for PTMC into six primary and three secondary indications. Laser ablation (LA) has the advantages of a small needle, accurate output energy and precision ablation, and it is safe to important organs around the lesion. The patients recover quickly after radiofrequency ablation (RFA), with no major complications, recurrence, or lymph node metastasis. The volume reduction rate after RFA was the highest, followed by microwave ablation and LA, and the improvement in patient quality of life after TA was significantly better than after thyroidectomy. CONCLUSIONS TA is an effective alternative method for surgery in the treatment of low-risk PTMC and has the advantages of being minimally invasive, economical, having less bleeding and having a high postoperative quality of life.
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Affiliation(s)
- Zhiguang Chen
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wei Zhang
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wen He
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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12
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Koot A, Soares P, Robenshtok E, Locati LD, de la Fouchardiere C, Luster M, Bongiovanni M, Hermens R, Ottevanger P, Geenen F, Bartѐs B, Rimmele H, Durante C, Nieveen-van Dijkum E, Stalmeier P, Dedecjus M, Netea-Maier R. Position paper from the Endocrine Task Force of the European Organisation for Research and Treatment of Cancer (EORTC) on the management and shared decision making in patients with low-risk micro papillary thyroid carcinoma. Eur J Cancer 2023; 179:98-112. [PMID: 36521335 DOI: 10.1016/j.ejca.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 10/30/2022] [Accepted: 11/01/2022] [Indexed: 11/16/2022]
Abstract
The incidence of differentiated thyroid cancer (DTC) has been increasing worldwide, mostly, as an increase in the incidental detection of micro papillary thyroid carcinomas (microPTCs), many of which are potentially overtreated, as suggested by the unchanged mortality. Several international guidelines have suggested a less aggressive approach. More recently, it has been shown that active surveillance or minimally invasive treatments (MIT) are good alternatives for the management of these patients. In this context, patient participation in the decision-making process is paramount. The Endocrine Task Force of the European Organisation for Research and Treatment of Cancer (EORTC) has undertaken the task to establish consensus and define its position based on the scientific evidence concerning, 1) the current state of diagnostic and management options in microPTCs, including the current opinion of physicians about shared decision making (SDM), 2) the available evidence concerning patients' needs and the available decision instruments, and 3) to provide practical suggestions for implementation of SDM in this context. To improve SDM and patients' participation, knowledge gaps and research directions were highlighted.
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Affiliation(s)
- Anna Koot
- Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Center, 6525 GA Nijmegen, the Netherlands; Radboud Institute for Health Sciences, Department for Health Evidence, Radboud University Medical Center, 6500 HB Nijmegen, the Netherlands.
| | - Paula Soares
- Institute for Research and Innovation in Health - i3S/Institute of Molecular Pathology and Immunology of the University of Porto-IPATIMUP, 4200-135 Porto, Portugal; Faculty of Medicine of the University of Porto, Alameda Prof. Hernani Monteiro, 4200-319 Porto, Portugal
| | - Eyal Robenshtok
- Endocrinology and Metabolism Institute, Rabin Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Laura D Locati
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy; Translational Oncology Unit, IRCCS Instituti Clinici Scientifici Maugeri, Pavia, Italy
| | | | - Markus Luster
- Department of Nuclear Medicine, University Hospital Marburg, Marburg, Germany
| | - Massimo Bongiovanni
- Internal Medicine Unit, Department of Medicine, Ospedale di Circolo di Rho, ASST Rhodense, Milan, Italy
| | - Rosella Hermens
- Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, 6500 HB Nijmegen, the Netherlands
| | - Petronella Ottevanger
- Department of Internal Medicine, Division of Oncology, Radboud University Medical Center, 6525 GA Nijmegen, the Netherlands
| | - Frans Geenen
- Schildklierorganisatie Nederland (SON), the Netherlands
| | | | - Harald Rimmele
- Bundesverband Schilddrüsenkrebs - Ohne Schilddrüse Leben e.V., Germany
| | - Cosimo Durante
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00161 Rome, Italy
| | - Els Nieveen-van Dijkum
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Cancer Center Amsterdam, the Netherlands
| | - Peep Stalmeier
- Radboud Institute for Health Sciences, Department for Health Evidence, Radboud University Medical Center, 6500 HB Nijmegen, the Netherlands
| | - Marek Dedecjus
- Department of Endocrine Oncology and Nuclear Medicine, Maria Skłodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Romana Netea-Maier
- Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Center, 6525 GA Nijmegen, the Netherlands
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Li Y, Huo SN, Lu NC, Peng LL, Wei Y, Zhao ZL, Yu MA. A comparative study of quality of life in patients with papillary thyroid carcinoma undergoing microwave ablation vs. Total thyroidectomy. Int J Hyperthermia 2023; 40:2250935. [PMID: 37699584 DOI: 10.1080/02656736.2023.2250935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/02/2023] [Accepted: 08/17/2023] [Indexed: 09/14/2023] Open
Abstract
OBJECTIVE To compare the health-related quality of life (HRQoL) of patients with T1N0M0 papillary thyroid carcinoma (PTC) who underwent microwave ablation (MWA) and those who underwent total thyroidectomy (TT). MATERIALS AND METHODS From February 2018 to February 2022, 180 T1N0M0 PTC patients were enrolled in present study, including 90 in the MWA group and 90 in the TT group, respectively. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and Thyroid Cancer-Specific Quality of Life Questionnaire (THYCA-QoL) were completed by patients to evaluate their HRQoL scores. RESULTS According to the results of the EORTC-QLQ-C30, there was a significant difference in the scores of global health, physical, emotional, etc. between the two groups, which indicated that the quality of life in these items in the MWA group was better than those in the TT group (all p < 0.05). According to the results of the THYCA-QoL, all items had significant differences between the two groups except for headache, which demonstrated the thyroid-specific quality of life was higher in the MWA group than in the TT group (all p < 0.05). CONCLUSION Ultrasound (US)-guided MWA offers a significant advantage in HRQoL over TT in T1N0M0 PTC patients, which provides an important reference for MWA as an alternative strategy to TT.
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Affiliation(s)
- Yan Li
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, P.R. China
| | - Sheng-Nan Huo
- Department of Thyroid, Handan Hangang Hospital, Handan City, Hebei Province, P.R. China
| | - Nai-Cong Lu
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, P.R. China
| | - Li-Li Peng
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, P.R. China
| | - Ying Wei
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, P.R. China
| | - Zhen-Long Zhao
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, P.R. China
| | - Ming-An Yu
- Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, P.R. China
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Zhang D, Tang Q, Chen J, Wei Y, Chen J. Novel Development of Nanoparticles-A Promising Direction for Precise Tumor Management. Pharmaceutics 2022; 15:pharmaceutics15010024. [PMID: 36678653 PMCID: PMC9862928 DOI: 10.3390/pharmaceutics15010024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 12/04/2022] [Accepted: 12/09/2022] [Indexed: 12/24/2022] Open
Abstract
Although the clinical application of nanoparticles is still limited by biological barriers and distribution, with the deepening of our understanding of nanoparticles over the past decades, people are gradually breaking through the previous limitations in the diagnosis and treatment of tumors, providing novel strategies for clinical decision makers. The transition of nanoparticles from passive targeting to active tumor-targeting by abundant surface-modified nanoparticles is also a development process of precision cancer treatment. Different particles can be used as targeted delivery tools of antitumor drugs. The mechanism of gold nanoparticles inducing apoptosis and cycle arrest of tumor cells has been discovered. Moreover, the unique photothermal effect of gold nanoparticles may be widely used in tumor therapy in the future, with less side effects on surrounding tissues. Lipid-based nanoparticles are expected to overcome the blood-brain barrier due to their special characteristics, while polymer-based nanoparticles show better biocompatibility and lower toxicity. In this paper, we discuss the development of nanoparticles in tumor therapy and the challenges that need to be addressed.
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Affiliation(s)
- Dengke Zhang
- Department of Surgery, The Eighth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510275, China
| | - Qingqing Tang
- Department of Surgery, The Eighth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510275, China
| | - Juan Chen
- Department of Medicine & Rehabilitation, Tung Wah Eastern Hospital, Hong Kong, China
| | - Yanghui Wei
- Department of Surgery, The Eighth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510275, China
- Correspondence: (Y.W.); (J.C.)
| | - Jiawei Chen
- Department of Surgery, The Eighth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510275, China
- Correspondence: (Y.W.); (J.C.)
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Meta-Analysis of the Application Effect of Different Modalities of Thermal Ablation and Surgical Treatment in Papillary Thyroid Microcarcinoma. DISEASE MARKERS 2022; 2022:9714140. [PMID: 36217504 PMCID: PMC9547687 DOI: 10.1155/2022/9714140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 09/12/2022] [Indexed: 12/07/2022]
Abstract
Background Papillary thyroid microcarcinoma (PTMC) refers to papillary thyroid carcinoma (PTC) with a maximum diameter of 10 mm. Thermal ablation, including radiofrequency ablation (RFA), microwave ablation (MWA), and laser ablation (LA), has been applied in the treatment of benign thyroid nodules and captured extensive attention. At present, the application of thermal ablation in PTMC has been extensively reported, but outcomes such as volume reduction rate (VRR), complete remission rate (CRR), and adverse reaction rate (ARR) vary considerably. Therefore, this meta-analysis was performed to evaluate the safety and efficacy of different treatment methods of PTMC. Methods We did a systematic review and network meta-analysis. We searched PubMed, EMBase, and Cochrane-Library from the date of inception to January 10, 2022, to retrieve the VRR, CRR, and ARR of MWA, RFA, LA and surgical treatment of PTMC, and a meta-analysis was performed using the R meta-package. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated, and sensitivity analyses, cumulative meta-analyses, and publication bias were also performed. Relevant literature was retrieved with keywords; the eligible cohort studies were screened based on the established inclusion and exclusion criteria. Results A total of 1515 patients were included in the 12-month follow-up. The overall VRR was 86.25% (95% CI: 77.89, 94.60), and the VRR was RFA > WMA > LA, but the differences were not significant. A total of 1483 patients were included in the last follow-up. The overall VRR was 99.41% (95% CI: 99.11, 99.72), and the VRR was RFA > WMA > LA, but the differences were not significant. A total of 1622 patients showed complete remission at the last follow-up, and the overall CRR was 0.63 (95% CI: 0.46, 0.79). The CRR was RFA > LA > WMA, but the differences were not significant. A total of 1883 patients had adverse reactions at the last follow-up, and the overall ARR was 0.06 (95% CI: 0.03, 0.08). The ARR at the last follow-up was RFA = Surg < LA < WMA. The ARR of the RFA and Surg subgroups was significantly lower than that of the WMA subgroup. Conclusions Similar good efficacy and safety profiles were observed in WMA, RFA, LA, and surgical treatment in PTMC, among which RFA showed the best volume reduction, complete remission rate, and adverse reaction reduction. However, there is a slight bias in the limited literature included in this study, and we did not conduct or refer to mechanistic studies to confirm its specific mechanism of action. Clinicians are advised to use their discretion in the choice of treatment.
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Yang X, Gao M, Xu R, Tao Y, Luo W, Wang B, Zhong W, He L, He Y. Hyperthermia combined with immune checkpoint inhibitor therapy in the treatment of primary and metastatic tumors. Front Immunol 2022; 13:969447. [PMID: 36032103 PMCID: PMC9412234 DOI: 10.3389/fimmu.2022.969447] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 07/27/2022] [Indexed: 11/29/2022] Open
Abstract
According to the difference in temperature, thermotherapy can be divided into thermal ablation and mild hyperthermia. The main advantage of thermal ablation is that it can efficiently target tumors in situ, while mild hyperthermia has a good inhibitory effect on distant metastasis. There are some similarities and differences between the two therapies with respect to inducing anti-tumor immune responses, but neither of them results in sustained systemic immunity. Malignant tumors (such as breast cancer, pancreatic cancer, nasopharyngeal carcinoma, and brain cancer) are recurrent, highly metastatic, and highly invasive even after treatment, hence a single therapy rarely resolves the clinical issues. A more effective and comprehensive treatment strategy using a combination of hyperthermia and immune checkpoint inhibitor (ICI) therapies has gained attention. This paper summarizes the relevant preclinical and clinical studies on hyperthermia combined with ICI therapies and compares the efficacy of two types of hyperthermia combined with ICIs, in order to provide a better treatment for the recurrence and metastasis of clinically malignant tumors.
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Affiliation(s)
- Ximing Yang
- Medical School, Hunan University of Chinese Medicine, Changsha, China
| | - Miaozhi Gao
- Medical School, Hunan University of Chinese Medicine, Changsha, China
| | - Runshi Xu
- Medical School, Hunan University of Chinese Medicine, Changsha, China
| | - Yangyang Tao
- Medical School, Hunan University of Chinese Medicine, Changsha, China
| | - Wang Luo
- Medical School, Hunan University of Chinese Medicine, Changsha, China
| | - Binya Wang
- Medical School, Hunan University of Chinese Medicine, Changsha, China
| | - Wenliang Zhong
- Medical School, Hunan University of Chinese Medicine, Changsha, China
- Hunan Provincial Ophthalmology and Otolaryngology Diseases Prevention and Treatment with Traditional Chinese Medicine and Visual Function Protection Engineering and Technological Research Center, Changsha, China
| | - Lan He
- Hunan Provincial Key Laboratory for the Prevention and Treatment of Ophthalmology and Otolaryngology Diseases with Traditional Chinese Medicine, Changsha, China
- The First Hospital of Hunan University of Chinese Medicine, Changsha, China
| | - Yingchun He
- Medical School, Hunan University of Chinese Medicine, Changsha, China
- Hunan Provincial Ophthalmology and Otolaryngology Diseases Prevention and Treatment with Traditional Chinese Medicine and Visual Function Protection Engineering and Technological Research Center, Changsha, China
- Hunan Provincial Key Laboratory for the Prevention and Treatment of Ophthalmology and Otolaryngology Diseases with Traditional Chinese Medicine, Changsha, China
- *Correspondence: Yingchun He,
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Efficacy and Safety of Different Thermal Ablation Modalities for Papillary Thyroid Microcarcinoma: A Network Meta-Analysis. CONTRAST MEDIA & MOLECULAR IMAGING 2022. [DOI: 10.1155/2022/9448349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. Small thyroid-like carcinoma (PTMC) is one of the most common subtypes of thyroid cancer. The main treatment options include surgery and radiofrequency ablation (RFA), microwave ablation (MWA), and laser ablation (LA). Thermal ablation has the advantage of being less invasive and has fewer complications than traditional surgical treatment. Objective. The objective is to explore the efficacy and safety of PTMC by different thermal ablation modalities through a network meta-analysis. Methods. From the database establishment to October 2021, a computerized search of the Chinese Knowledge Infrastructure (CKNI), VIP Chinese Science and Technology Journal Full-Text Database (VP-CSJFD), WanFang Data journal article resource (WangFang), PubMed, the Cochrane Library, and Embase were performed to include the different methods of thermal ablation for small thyroid carcinoma. A retrospective study of different methods of thermal ablation of small thyroid carcinoma was included. Results. A total of 12 retrospective studies involving 1,926 patients with PTMC were included, all of which were of high quality. This study mainly involved RFA, MWA, LA, and ethanol combined with radiofrequency ablation (EA + RFA). Network meta-analysis showed no significant difference between interventions (
> 0.05) in terms of recurrence rate. Conclusions. Surgical resection may be the measure with the lowest recurrence rate after treatment of PTMC, LA may be the measure with the lowest incidence of complications after treatment, and RFA may be the measure with the least length of hospital stay, operation time, and postoperative lymph node metastasis rate. However, due to the limitations of network meta-analysis, this result still needs to be treated with caution, and more high-quality, large-sample clinical studies are recommended for further verification.
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Chen S, Mao Y, Chen G. Economic effect between surgery and thermal ablation for patients with papillary thyroid microcarcinoma: a systemic review and meta-analysis. Endocrine 2022; 76:9-17. [PMID: 35122627 PMCID: PMC8817154 DOI: 10.1007/s12020-022-02991-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 01/19/2022] [Indexed: 12/07/2022]
Abstract
BACKGROUND At present, there are still many controversies regarding the treatment of papillary thyroid microcarcinoma (PTMC). It is worth noting that thermal ablation has become a viable alternative for patients at high risk of surgery or those who wish to receive more active treatment than active surveillance. OBJECTIVE To investigate the economic benefits, efficacy, and safety of thermal ablation for patients with PTMC. METHODS We searched PubMed, Cochrane Library, Web of Science, and Embase for articles published from the database establishment to August 2021. All of the studies included were retrospective cohort analyses. In addition, meta-analysis was performed using the Stata15.1 versions and Review Manager5.3. Data were extracted according to the PRISMA guidelines by two professional doctors. RESULTS A total of 7 articles (1582 patients) were included in our systematic review and meta-analysis. We discovered that thermal ablation could shorten the hospitalization time (SMD, -3.82[95%CI, -5.25 to -2.40]), operation time (SMD, -5.67[95%CI, -6.65 to -4.68]), cost (SMD, -3.40 [95%CI, -5.06 to -1.75]) and reduce postoperative complications (OR, 0.07 [95%CI, 0.01 to 0.44]) than surgical treatment. In addition, our study also found that compared with surgery, there was no significant difference in the recurrence rate (OR, 1.53 [95% CI, 0.63 to 3.73]) and metastasis rate (OR, 0.47 [95% CI, 0.12 to 1.86]). CONCLUSION On the premise of being safe and effective, thermal ablation has better economic benefits than surgical treatment for patients with PTMC.
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Affiliation(s)
- Shuqian Chen
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, Fujian, China
| | - Yaqian Mao
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, Fujian, China
| | - Gang Chen
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, Fujian, China.
- Department of Endocrinology, Fujian Provincial Hospital, Fuzhou, 350001, Fujian, China.
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In vitro antitumor activity of nano-pulse stimulation on human anaplastic thyroid cancer cells through nitric oxide-dependent mechanisms. Bioelectrochemistry 2022; 145:108093. [DOI: 10.1016/j.bioelechem.2022.108093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 02/21/2022] [Accepted: 02/26/2022] [Indexed: 11/17/2022]
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Ding M, Wu GS, Gu JH, Shen DJ, Zhou R, Liu Y, Xie RL, Wang SR, Wang HC, Fei J. Pathology confirmation of the efficacy and safety of microwave ablation in papillary thyroid carcinoma. Front Endocrinol (Lausanne) 2022; 13:929651. [PMID: 35983517 PMCID: PMC9379369 DOI: 10.3389/fendo.2022.929651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 07/01/2022] [Indexed: 12/07/2022] Open
Abstract
BACKGROUND The incidence of papillary thyroid carcinoma (PTC) has rapidly increased in recent years. Microwave ablation (MWA) was proposed as an alternative treatment for PTC. This study aimed to investigate the efficacy and safety of MWA by exploring the postoperative pathology results of post-ablation lesions in patients with PTC. METHODS This study retrospectively analyzed data from 12 patients who underwent thyroid surgery after MWA treatment for primary PTC between January 2015 and November 2021 in six hospitals. RESULTS The average age of the 12 patients (8 female) was 45.3 ± 9.7 years. There was one patient with PTC (size > 1 cm) and 11 patients with micro-PTC (size ≤ 1 cm), of which eight patients had unifocal micro-PTC and three patients had multifocal micro-PTC. A total of 17 tumor foci with mean size of 6.2 ± 2.6 mm were treated by MWA. The median interval time between MWA and surgery was 6.6 months (range: 0.4-21.9 months). Intraoperatively, adherence to the anterior cervical muscle group was observed in three cases (3/12). Upon postoperative pathologic examination, all the post-ablation lesions of the eight unifocal micro-PTC and two multifocal micro-PTC showed no residual carcinomas. Outside the ablation zone, PTCs were detected in three cases, including two of the eight patients with unifocal micro-PTC and one of the three patients with multifocal micro-PTC. Cervical lymph node metastases were detected in seven patients (7/12). CONCLUSION MWA was feasible for the treatment of primary unifocal low-risk micro-PTC (T1aN0M0) with good efficacy and safety. However, the use of MWA for treating PTC (size > 1 cm) and multifocal micro-PTC remains controversial.
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Affiliation(s)
- Min Ding
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Gao-Song Wu
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jian-Hua Gu
- Department of General Surgery, Shanghai Ruijin Rehabilitation Hospital, Shanghai, China
- Department of General Surgery, Shanghai Punan Hospital, Shanghai, China
| | - Dong-Jie Shen
- Department of General Surgery, Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rui Zhou
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Ying Liu
- Department of Medical Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics and Traumatology, Yantai, China
| | - Rong-Li Xie
- Department of General Surgery, Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shu-Rong Wang
- Department of Medical Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics and Traumatology, Yantai, China
- Department of Medical Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China
- *Correspondence: Jian Fei, ; Shu-Rong Wang, ; Hong-Cheng Wang,
| | - Hong-Cheng Wang
- Department of Thyroid Surgery, The Second Affiliated Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, China
- *Correspondence: Jian Fei, ; Shu-Rong Wang, ; Hong-Cheng Wang,
| | - Jian Fei
- Department of General Surgery, Pancreatic Disease Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Research Institute of Pancreatic Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- State Key Laboratory of Oncogenes and Related Genes, Shanghai Cancer Institute, Shanghai Jiao Tong University, Shanghai, China
- Institute of Translational Medicine, Shanghai Jiao Tong University, Shanghai, China
- *Correspondence: Jian Fei, ; Shu-Rong Wang, ; Hong-Cheng Wang,
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Zhang L, Zhang GP, Zhan WW, Zhou W. The feasibility and efficacy of ultrasound-guided percutaneous laser ablation for multifocal papillary thyroid microcarcinoma. Front Endocrinol (Lausanne) 2022; 13:921812. [PMID: 36060950 PMCID: PMC9428260 DOI: 10.3389/fendo.2022.921812] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 07/26/2022] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the feasibility and efficacy of percutaneous laser ablation (PLA) for patients with multifocal papillary thyroid microcarcinoma (PTMC). MATERIALS AND METHODS A cohort of patients who underwent ultrasound (US)-guided PLA for primary PTMC were enrolled in this study. The patients were divided into a multifocal PTMC (multi-PTMC) group and a unifocal PTMC (uni-PTMC) group. Before PLA, conventional US and contrast-enhanced ultrasound (CEUS) were performed to evaluate the PTMC and cervical lymph nodes. The operation time, energy, power, amount of isolation liquid, and complications during PLA were recorded. Patients were followed up at 2 days, 1 month, 3 months, and 6 months, and every 6 months after that. Volume reduction rate (VRR), local tumor recurrence, and lymph node metastasis after PLA were observed. RESULTS The study included 12 patients with 26 PTMCs and 60 patients with 60 PTMCs. The operation time, total energy, and amount of isolation liquid in the multi-PTMC group were more than those in the uni-PTMC group (p = 0.000, 0.007, and 0.020, respectively). The mean follow-up durations in multi-PTMC and uni-PTMC groups were 19.75 ± 11.46 months (6-36 months) and 16.33 ± 10.01 months (4-40 months), with a similar VRR of the ablated lesions in the two groups. One and three cases with newly developed PTMCs were observed in the multi-PTMC group and the uni-PTMC group during follow-up, respectively. There was no regrowth of treated lesions, lymph node metastasis, or distant metastasis. At the end of the follow-up, all the ablated lesions in the two groups completely disappeared or only remained scar strips. CONCLUSION PLA is a safe and effective technique for treating multifocal PTMC, which might be an alternative technique for patients who are not eligible or are unwilling to undergo surgery.
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Agyekum EA, Fu JH, Xu FJ, Ren YZ, Akortia D, Chen Q, Qian XQ, Wang Y, Wang X. Ultrasound-Guided Thermal Ablation of Thyroid Nodules: Technicalities Progress and Clinical Applications, Especially in Malignant Thyroid Nodules. Front Oncol 2021; 11:761005. [PMID: 34868975 PMCID: PMC8637803 DOI: 10.3389/fonc.2021.761005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 10/28/2021] [Indexed: 12/07/2022] Open
Abstract
Thyroid nodules are commonly encountered in health care practice. They are usually benign in nature, with few cases being malignant, and their detection has increased in the adult population with the help of ultrasonography. Thyroidectomy or surgery is the first-line treatment and traditional method for thyroid nodules; however, thyroidectomy leaves permanent scars and requires long-term use of levothyroxine after surgery, which makes patients more reticent to accept this treatment. Thermal ablation is a minimally-invasive technique that have been employed in the treatment of benign and malignant thyroid nodules nodules, and have been shown to be effective and safe. Several studies, including long-term, retrospective, and prospective studies, have investigated the use of ablation to treat benign thyroid nodules and malignant thyroid nodules, including papillary thyroid carcinoma. Here, we review the recent progress in thermal ablation techniques for treating benign and malignant nodules, including their technicalities, clinical applications, pitfalls and limitations, and factors that could affect treatment outcomes. Special in-depth elaboration on the recent progress of the application of thermal ablation therapy in malignant thyroid nodules.
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Affiliation(s)
- Enock Adjei Agyekum
- Department of Ultrasound, Jiangsu University Affiliated People's Hospital, Zhenjiang, China.,School of Medicine, Jiangsu University, Zhenjiang, China
| | - Jian-Hua Fu
- Department of Interventional Radiology, Jiangsu University Affiliated People's Hospital, Zhenjiang, China
| | - Fei-Ju Xu
- Department of Ultrasound, Jiangsu University Affiliated People's Hospital, Zhenjiang, China
| | - Yong-Zhen Ren
- School of Medicine, Jiangsu University, Zhenjiang, China
| | - Debora Akortia
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Qing Chen
- Department of Ultrasound, Nanjing Lishui District Hospital of Traditional Chinese Medicine, Nanjing, China
| | - Xiao-Qin Qian
- Department of Ultrasound, Jiangsu University Affiliated People's Hospital, Zhenjiang, China
| | - Yuguo Wang
- Department of Ultrasound, Nanjing Lishui District Hospital of Traditional Chinese Medicine, Nanjing, China
| | - Xian Wang
- Department of Ultrasound, Jiangsu University Affiliated People's Hospital, Zhenjiang, China
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Wang X, Niu X, Mu S, Zhang M, Jiang W, Zhai L, Jiang D, Tang W, Zhao C. Analysis and evaluation of the efficacy of ultrasound-guided microwave ablation for papillary thyroid microcarcinoma. Int J Hyperthermia 2021; 38:1476-1485. [PMID: 34645358 DOI: 10.1080/02656736.2021.1988152] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE The choice of the most appropriate therapeutic approach for a diagnosed papillary thyroid microcarcinoma (PTMC) remains controversial. The present study aimed to evaluate the efficacy of microwave ablation (MWA) for unifocal PTMC with a diameter of ≤0.6 cm. METHODS A total of 63 consecutive patients with PTMC treated with MWA were studied retrospectively. MWA was performed using the hydrodissection technique and multidimensional fixed-needle principle. We analyzed the absorption of the MWA area and evaluated the prognosis over a follow-up period of 24 months. In addition, 83 patients with PTMC who underwent surgery were selected. The operating room characteristics and procedural complications of the two groups were compared. RESULTS In the MWA group, the volume of nodules (p < 0.05) decreased from 0.04 ± 0.03 cm3 to 0.0001 ± 0.0004 cm3 at the 24-month follow-up after MWA, and the volume reduction rate (p < 0.05) was 99.43 ± 1.58%. The incidence of temporary reactive hyperplastic lymphadenectasis was higher and that of other complications was lower in the MWA group than in the surgery group. One percent of the patients in the surgery group had recurrence or metastasis, but none were detected in the MWA group. The loss of thyroid tissue volume (p < 0.001), operating room time (p < 0.001), and the mean length of hospital stay (p < 0.001) were significantly lower in the MWA group than in the surgery group. CONCLUSION Ultrasound-guided MWA is an effective treatment strategy for unifocal PTMC with a diameter of ≤0.6 cm.
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Affiliation(s)
- Xinya Wang
- Department of Abdominal Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Xiaoyan Niu
- Department of Abdominal Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Shuang Mu
- Department of Abdominal Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Mingzhu Zhang
- Department of Abdominal Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Wenbin Jiang
- Health Management Center, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Lixue Zhai
- Department of Abdominal Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Danni Jiang
- Department of Abdominal Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Wanqing Tang
- Department of Abdominal Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Cheng Zhao
- Department of Abdominal Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
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Sorrenti S, Dolcetti V, Fresilli D, Del Gaudio G, Pacini P, Huang P, Camponovo C, Leoncini A, D’Andrea V, Pironi D, Frattaroli F, Trimboli P, Radzina M, Cantisani V. The Role of CEUS in the Evaluation of Thyroid Cancer: From Diagnosis to Local Staging. J Clin Med 2021; 10:jcm10194559. [PMID: 34640574 PMCID: PMC8509399 DOI: 10.3390/jcm10194559] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 09/17/2021] [Accepted: 09/20/2021] [Indexed: 12/25/2022] Open
Abstract
Ultrasound often represents the first diagnostic step for thyroid nodule evaluation in clinical practice, but baseline US alone is not always effective enough to achieve thyroid nodule characterization. In the last decades new ultrasound techniques, such as CEUS, have been introduced to evaluate thyroid parenchyma as recommended by EFSUMB guidelines, for use in clinical research field, although its role is not yet clear. Several papers show the potential utility of CEUS in the differential diagnosis of benign and malignant thyroid nodules and in the analysis of lymph node involvement in neoplastic pathology. Therefore, we carried out an evaluation of the literature concerning the role of CEUS in three specific areas: the characterization of the thyroid nodule, the evaluation of minimally invasive treatment and loco-regional staging of the lymph node in proven thyroid cancer. According to evidence reported, CEUS can also play an operative role in nodular thyroid pathology as it is able to guide ablation procedures on thyroid nodule and metastatic lymph nodes, to assess the radicality of surgery, to evaluate disease relapse at the level of the margins of ablated regions and to monitor the clinical evolution of necrotic areas in immediate post-treatment setting.
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Affiliation(s)
- Salvatore Sorrenti
- Department of Surgical Sciences, Faculty of Medicine, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy; (S.S.); (V.D.); (D.P.)
| | - Vincenzo Dolcetti
- Department of Radiological, Oncological, and Pathological Sciences, Faculty of Medicine, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy; (V.D.); (D.F.); (G.D.G.); (P.P.)
| | - Daniele Fresilli
- Department of Radiological, Oncological, and Pathological Sciences, Faculty of Medicine, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy; (V.D.); (D.F.); (G.D.G.); (P.P.)
| | - Giovanni Del Gaudio
- Department of Radiological, Oncological, and Pathological Sciences, Faculty of Medicine, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy; (V.D.); (D.F.); (G.D.G.); (P.P.)
| | - Patrizia Pacini
- Department of Radiological, Oncological, and Pathological Sciences, Faculty of Medicine, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy; (V.D.); (D.F.); (G.D.G.); (P.P.)
| | - Pintong Huang
- Department of Ultrasound in Medicine, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Zhejiang University, Hangzhou 310009, China;
- Research Center of Ultrasound in Medicine and Biomedical Engineering, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang University, Hangzhou 310009, China
| | - Chiara Camponovo
- Clinic for Endocrinology and Diabetology, Lugano Regional Hospital, Ente Ospedaliero Cantonale (EOC), 6900 Lugano, Switzerland; (C.C.); (P.T.)
| | - Andrea Leoncini
- Servizio di Radiologia e Radiologia Interventistica, Istituto di Imaging della Svizzera Italiana (IIMSI), Ente Ospedaliero Cantonale (EOC), 6900 Lugano, Switzerland;
| | - Vito D’Andrea
- Department of Surgical Sciences, Faculty of Medicine, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy; (S.S.); (V.D.); (D.P.)
| | - Daniele Pironi
- Department of Surgical Sciences, Faculty of Medicine, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy; (S.S.); (V.D.); (D.P.)
| | - Fabrizio Frattaroli
- Department of Surgery “P. Stefanini”, Faculty of Medicine, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy;
| | - Pierpaolo Trimboli
- Clinic for Endocrinology and Diabetology, Lugano Regional Hospital, Ente Ospedaliero Cantonale (EOC), 6900 Lugano, Switzerland; (C.C.); (P.T.)
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), 6900 Lugano, Switzerland
| | - Maija Radzina
- Radiology Research Laboratory, Riga Stradins University, LV-1007 Riga, Latvia;
- Medical Faculty, University of Latvia; Diagnostic Radiology Institute, Paula Stradina Clinical University Hospital, LV-1007 Riga, Latvia
| | - Vito Cantisani
- Department of Radiological, Oncological, and Pathological Sciences, Faculty of Medicine, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy; (V.D.); (D.F.); (G.D.G.); (P.P.)
- Correspondence:
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Zhu Y, Che Y, Gao S, Ren S, Tong M, Wang L, Yang F. Long-term follow-up results of PTMC treated by ultrasound-guided radiofrequency ablation: a retrospective study. Int J Hyperthermia 2021; 38:1225-1232. [PMID: 34402363 DOI: 10.1080/02656736.2021.1963850] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVES To confirm the long-term efficacy and safety of radiofrequency ablation (RFA) for low-risk papillary thyroid microcarcinoma (PTMC). METHODS We retrospectively reviewed data of 102 primary papillary thyroid carcinoma patients (82 women, 20 men; mean age: 43 [19] years) treated with radiofrequency ablation and thyroid-stimulating hormone (TSH) suppression therapy before December 2018. All patients were at high surgical risk or refused surgery. They were followed up at 1, 3, 6, 9, and 12 months and every 6-12 months thereafter using ultrasound and contrast-enhanced ultrasound. The volume and volume reduction ratio was calculated. Recurrence and lymph node or distant metastasis were evaluated. RESULTS The mean initial tumor diameter was 0.50 (0.29) cm; the mean initial volume was 0.06 (0.09) mL. At 1, 3, 6, 9, 12, 24, 36, 48, and 60 months after RFA, complete resorption rates were 0, 0, 9.8 (10/102), 33.3 (34/102), 91.2 (93/102), 96.1 (98/102), 99 (101/102), 100, and 100%, respectively. Two patients had developed ipsilateral neck lymph node metastasis in regions IV and VI at 30- and 18-month follow-ups, respectively. After RFA, 3/102 patients (2.9%) developed hoarseness-the main side effect. No life-threatening or delayed complications occurred. The TSH value in the initial period was 0.06 (0.02) µIU/mL; the rate of reaching the TSH target was 85.7%. The TSH value at follow-up was 1.47 (0.91) µIU/mL; the compliance rate was 99.3%. CONCLUSIONS Ultrasound-guided RFA for PTMC is highly effective and safe. RFA can serve as a minimally invasive treatment for PTMC patients who refuse surgery or active surveillance.
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Affiliation(s)
- Yalin Zhu
- Department of Ultrasound, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Ying Che
- Department of Ultrasound, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Shuhang Gao
- Department of Ultrasound, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Shuangsong Ren
- Department of Ultrasound, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Mengying Tong
- Department of Ultrasound, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Lina Wang
- Department of Ultrasound, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Fang Yang
- Department of Ultrasound, The First Affiliated Hospital of Dalian Medical University, Dalian, China
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Fröhlich E, Wahl R. Nanoparticles: Promising Auxiliary Agents for Diagnosis and Therapy of Thyroid Cancers. Cancers (Basel) 2021; 13:cancers13164063. [PMID: 34439219 PMCID: PMC8393380 DOI: 10.3390/cancers13164063] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/06/2021] [Accepted: 08/10/2021] [Indexed: 12/12/2022] Open
Abstract
Simple Summary Thyroid cancer (TC) is rare relative to cancers of many other organs (breast, prostate, lung, and colon). The majority of TCs are differentiated tumors that are relatively easy to treat and have a good prognosis. However, for anaplastic TC, a rapidly growing and aggressive tumor, treatment is suboptimal because the effective drugs cause severe adverse effects. Drug delivery by nanocarriers can improve treatment by reducing side effects. This can either be mediated through better retention in the tumor tissue due to size (passive targeting) or through the attachment of specific molecules that zero in on the cancer cells (active targeting). Nanoparticles are already used for diagnosis and imaging of TC. For unresectable anaplastic TC, nanoparticle-based treatments, less suitable for deeply located cancers, could be useful, based on low-intensity focused ultrasound and near-infrared irradiation. All potential applications of nanoparticles in TC are still in the preclinical phase. Abstract Cancers of the endocrine system are rare. The majority are not highly malignant tumors. Thyroid cancer (TC) is the most common endocrine cancer, with differentiated papillary and follicular tumors occurring more frequently than the more aggressive poorly differentiated and anaplastic TC. Nanoparticles (NP) (mainly mesoporous silica, gold, carbon, or liposomes) have been developed to improve the detection of biomarkers and routine laboratory parameters (e.g., thyroid stimulating hormone, thyroglobulin, and calcitonin), tumor imaging, and drug delivery in TC. The majority of drug-loaded nanocarriers to be used for treatment was developed for anaplastic tumors because current treatments are suboptimal. Further, doxorubicin, sorafenib, and gemcitabine treatment can be improved by nanotherapy due to decreased adverse effects. Selective delivery of retinoic acid to TC cells might improve the re-differentiation of de-differentiated TC. The use of carbon NPs for the prevention of parathyroid damage during TC surgery does not show a clear benefit. Certain technologies less suitable for the treatment of deeply located cancers may have some potential for unresectable anaplastic carcinomas, namely those based on low-intensity focused ultrasound and near-infrared irradiation. Although some of these approaches yielded promising results in animal studies, results from clinical trials are currently lacking.
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Affiliation(s)
- Eleonore Fröhlich
- Center for Medical Research, Medical University Graz, 8036 Graz, Austria;
- Institute for Clinical Chemistry and Pathobiochemistry, Department for Diagnostic Laboratory Medicine, University Hospital Tuebingen, 72076 Tuebingen, Germany
| | - Richard Wahl
- Institute for Clinical Chemistry and Pathobiochemistry, Department for Diagnostic Laboratory Medicine, University Hospital Tuebingen, 72076 Tuebingen, Germany
- Correspondence: ; Tel.: +49-7071-2983136
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Al-Mohammed HI, Sulieman A, Mayhoub FH, Salah H, Lagarde C, Alkhorayef M, Aldhebaib A, Kappas C, Bradley DA. Occupational exposure and radiobiological risk from thyroid radioiodine therapy in Saudi Arabia. Sci Rep 2021; 11:14557. [PMID: 34267237 PMCID: PMC8282852 DOI: 10.1038/s41598-021-93342-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 06/17/2021] [Indexed: 01/05/2023] Open
Abstract
Worldwide, thyroid cancer accounts for some 10% of total cancer incidence, most markedly for females. Thyroid cancer radiotherapy, typically using 131I (T1/2 8.02 days; β- max energy 606 keV, branching ratio 89.9%), is widely adopted as an adjunct to surgery or to treat inoperable cancer and hyperthyroidism. With staff potentially receiving significant doses during source preparation and administration, radiation protection and safety assessment are required in ensuring practice complies with international guidelines. The present study, concerning a total of 206 patient radioiodine therapies carried out at King Faisal Specialist Hospital and Research Center over a 6-month period, seeks to evaluate patient and occupational exposures during hospitalization, measuring ambient doses and estimating radiation risk. Using calibrated survey meters, patient exposure dose-rate estimates were obtained at a distance of 30-, 100- and 300 cm from the neck region of each patient. Occupational and ambient doses were measured using calibrated thermoluminescent dosimeters. The mean and range of administered activity (AA, in MBq) for the thyroid cancer and hyperthyroidism treatment groups were 4244 ± 2021 (1669-8066), 1507.9 ± 324.1 (977.9-1836.9), respectively. The mean annual occupational doses were 1.2 mSv, that for ambient doses outside of the isolation room corridors were found to be 0.2 mSv, while ambient doses at the nursing station were below the lower limit of detection. Exposures to staff from patients being treated for thyroid cancer were less compared to hyperthyroidism patients. With a well-defined protocol, also complying with international safety requirements, occupational exposures were found to be relatively high, greater than most reported in previous studies.
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Affiliation(s)
- H I Al-Mohammed
- Department of Radiological Sciences, College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University, P.O. Box 84428, Riyadh, 11671, Saudi Arabia
| | - A Sulieman
- Radiology and Medical Imaging Department, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, P.O. Box 422, Alkharj, 11942, Saudi Arabia.
| | - Fareed H Mayhoub
- King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Hassan Salah
- Nuclear Medicine Department, INAYA Medical Collage, Riyadh, 13541, Saudi Arabia
- College of Medical Radiologic Science, Sudan University of Science and Technology, P.O. Box 1908, Khartoum, 11111, Sudan
| | - Celestino Lagarde
- King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - M Alkhorayef
- Department of Radiological Sciences, College of Applied Medical Sciences, King Saud University, P.O. Box 10219, Riyadh, 11433, Saudi Arabia
- Department of Physics, Centre for Nuclear and Radiation Physics, University of Surrey, Guildford, GU2 7XH, Surrey, UK
| | - Ali Aldhebaib
- Radiological Sciences Program, College of Applied Medical Sciences (COMAS), King Saud Bin Abdulaziz University for Health Sciences (KSAU-US), King Abdul Aziz Medical City (KAMC), King Abdullah International Medical Research Centre (KAIMRC), National Guard Health Affairs (NGHA), Riyadh, Kingdom of Saudi Arabia
| | - C Kappas
- Department of Medical Physics, Medical School, University of Thessaly, 41110, Larissa, Greece
| | - D A Bradley
- Department of Physics, Centre for Nuclear and Radiation Physics, University of Surrey, Guildford, GU2 7XH, Surrey, UK
- Centre for Applied Physics and Radiation Technologies, School of Engineering and Technology, Sunway University, Jalan Universiti, 47500, Bandar Sunway, Selangor, Malaysia
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Lu C, Li X, Chu X, Li R, Li J, Wang J, Wang Y, Xu Y, Chen G, Xu S, Liu C. Clinical Effects of Microwave Ablation in the Treatment of Low-Risk Papillary Thyroid Microcarcinomas and Related Histopathological Changes. Front Endocrinol (Lausanne) 2021; 12:751213. [PMID: 34603216 PMCID: PMC8482998 DOI: 10.3389/fendo.2021.751213] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 08/27/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE This study aimed to evaluate the feasibility and efficacy of ultrasound-guided percutaneous microwave ablation (MWA) in the treatment of low-risk papillary thyroid microcarcinoma (PTMC), and to observe the histopathological changes after MWA. METHODS MWA was performed under ultrasound guidance for 73 unifocal PTMC patients without clinically cervical or distant metastasis. The target ablation zone exceeded the tumor edge (judged by contrast-enhanced US) to avoid marginal residue and recurrence. Ultrasound evaluation was performed at 1 day, 1, 3, 6, 12 and 24 months after treatment, and thyroid function evaluation at the first 6 months. Repeated fine needle aspiration cytology or core needle biopsy pathology was performed at 3 or 6 months after MWA to evaluate residual tumors. Any adverse event associated with MWA was evaluated. RESULTS The follow-up after MWA lasted 6 (6, 12) months. Tumor volume decreased significantly from 0.06 mm3 (0.04, 0.11 mm3) to 0.03 mm3 (0.00, 0.06 mm3) at 12 months after MWA (P< 0.001), with a median volume reduction ratio of 80.28% (-7.43, 100%) and 16 cases (21.92%) presenting complete remission. The largest diameter, volume and ablation energy were found to be different in patients with and without complete remission 12 months after MWA. On histopathological examinations, no atypical or malignant follicular cells were identified after thermal ablation. The most common pathological characteristics were fibroblastic proliferation (34/39, 87.18%) and chronic inflammation (32/39, 82.05%), followed by infarction (21/39, 53.85%). Five patients were transferred to thyroidectomy and 4 of them were confirmed with local recurrence and/or lymph node metastasis. Serum thyrotropin decreased transiently after MWA (P< 0.01) but normalized thereafter. No serious and permanent complications were reported. CONCLUSIONS MWA is a safe and effective treatment for low-risk PTMC. Fibroblastic proliferation and chronic inflammation are the most common pathological changes after MWA of PTMC.
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Affiliation(s)
- Chenya Lu
- Endocrine and Diabetes Center, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
| | - Xingjia Li
- Endocrine and Diabetes Center, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
- Key Laboratory of TCM Syndrome & Treatment of Yingbing of State Administration of Traditional Chinese Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
| | - Xiaoqiu Chu
- Endocrine and Diabetes Center, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
| | - Ruiping Li
- Department of Pathology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
| | - Jie Li
- Department of Ultrasound, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
| | - Jianhua Wang
- Department of General Surgery, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
| | - Yalin Wang
- Endocrine and Diabetes Center, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
| | - Yang Xu
- Endocrine and Diabetes Center, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
| | - Guofang Chen
- Endocrine and Diabetes Center, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
- Key Laboratory of TCM Syndrome & Treatment of Yingbing of State Administration of Traditional Chinese Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
| | - Shuhang Xu
- Endocrine and Diabetes Center, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
- *Correspondence: Shuhang Xu, ; Chao Liu,
| | - Chao Liu
- Endocrine and Diabetes Center, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
- Key Laboratory of TCM Syndrome & Treatment of Yingbing of State Administration of Traditional Chinese Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
- *Correspondence: Shuhang Xu, ; Chao Liu,
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