Clin Exp Otorhinolaryngol.  2023 Nov;16(4):380-387. 10.21053/ceo.2023.00689.

Ultrasound-Guided Ethanol Percutaneous Ablation Versus Rescue Surgery in Patients With Locoregional Recurrence of Papillary Thyroid Cancer

• Tofé S
• Argüelles I
• Álvarez C
• Tofé
• Repetto A
• Barceló A
• Pereg V

• KMID: 2548366
• DOI: http://doi.org/10.21053/ceo.2023.00689

Abstract

Objectives
Neck recurrence of papillary thyroid cancer (PTC) is frequently detected after initial surgery. The management of these lesions may include rescue surgery (RS) or minimally invasive techniques in selected patients, but comparative studies evaluating the effectiveness and safety of these techniques are lacking. In this paper, we compared ultrasound-guided ethanol ablation (EA) in selected patients to RS in a matched cohort.
Methods
We retrospectively compared 41 patients and 41 matched PTC patients without known distant metastases, who underwent ultrasound-guided EA or RS (matched reference group), who had 63 and 75 thyroid bed and/or lymph node confirmed PTC recurrences during a median follow-up of 72.8 and 89.6 months, respectively. The primary outcome was time until structural recurrence, compared using Kaplan-Meier survival curves. The secondary outcomes included time until biochemical recurrence, plasma thyroglobulin (Tg) levels, American Thyroid Association (ATA) response-to-therapy categories by the last available observation, and treatment-derived complications in each group.
Results
No significant differences were found between the EA and RS groups for time until structural recurrence (log-rank test, P=0.94). The time until biochemical recurrence was also similar (P=0.51); and the plasma Tg concentration reduction and proportions of patients in the ATA reclassification categories were also similar. A significantly higher proportion of patients in the RS group presented treatment-derived complications (29.27% vs. 9.75%, P<0.05).
Conclusion
In this retrospective analysis, the treatment of PTC neck recurrence with EA in selected patients was comparable to RS in a matched reference group for the long-term risk of structural or biochemical relapse, but with a lower risk of treatment-derived complications. These results support the effectiveness and safety of this minimally invasive technique in the management of selected patients with recurrent PTC.

Keyword

Ethanol Ablation; Neck Surgery; Recurrent Thyroid Cancer; Minimally Invasive Technique

Figure

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  Fig. 1. Disposition of patients with papillary thyroid cancer (PTC). Propensity score matching included patient demographics, followup duration, tumoral burden measured by number and size of lesions, primary tumor histology, and plasma thyroglobulin levels. DTC, differentiated thyroid cancer; PEI, percutaneous ethanol injection; RS, rescue surgery; EA, ethanol ablation.

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  Fig. 2. Kaplan-Meier survival curves for (A) time to structural relapse and (B) time to biochemical relapse in patients undergoing ethanol ablation versus rescue surgery. Statistical comparison of survival curves. S(t) means survival as a function of time. Log-rank test: (A) P=0.94, (B) P=0.52; Wilcoxon test: (A) P=0.86, (B) P=0.48.

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