Department of Radiology, Thyroid Center, Daerim St. Mary's Hospital, Seoul, Korea.
AJR Am J Roentgenol. 2011 Aug;197(2):W331-6. doi: 10.2214/AJR.10.5345.
The purpose of this study was to evaluate the efficacy and safety of ultrasound-guided radiofrequency ablation (RFA) in the control of metastatic well-differentiated thyroid carcinoma in patients for whom surgery is not feasible.
Between December 2004 and June 2008, 12 metastatic differentiated thyroid carcinomas (mean diameter, 13.8 mm; range, 4-28 mm) in 10 patients (six women, four men; mean age, 44.8 years) were treated with RFA. The inclusion criteria for RFA were fewer than three metastatic tumors confirmed with ultrasound-guided fine-needle aspiration biopsy, no metastatic tumor beyond the neck at RFA, and infeasibility of surgery. A radiofrequency generator and 18-gauge internally cooled electrodes with a 7-cm shaft length and 0.5- and 1-cm active tips were used depending on the size of the targeted tumors. Ten of the 12 metastatic tumors (83%) were treated in a single session of RFA, and the other two required two sessions. The ablation time ranged from 60 to 900 seconds.
After treatment, the mean largest diameter decreased significantly from 13.8 ± 7.0 mm to 3.3 ± 3.9 mm (p = 0.002), as did mean volume, from 55.5 ± 50.3 mm(3) to 5.7 ± 9.3 mm(3) (p = 0.002). At the last follow-up evaluation, the serum thyroglobulin concentration had decreased in 7 of 10 patients. One patient had dysphonia immediately after RFA of a left surgical bed.
Although surgery is the standard treatment of locally metastatic thyroid cancer, RFA is effective for locoregional control of metastatic well-differentiated thyroid carcinoma in patients for whom surgery is infeasible.
本研究旨在评估超声引导下射频消融（RFA）在控制手术不可行的转移性分化型甲状腺癌患者中的疗效和安全性。
2004 年 12 月至 2008 年 6 月，10 例患者（6 例女性，4 例男性；平均年龄 44.8 岁）的 12 个转移性分化型甲状腺癌病灶（平均直径 13.8mm；范围 4-28mm）接受了 RFA 治疗。RFA 的纳入标准为：经超声引导下细针抽吸活检证实转移性肿瘤少于 3 个，RFA 时颈部以外无转移性肿瘤，且手术不可行。根据目标肿瘤的大小，使用射频发生器和 18 号内部冷却电极，电极长 7cm，有效尖端长 0.5-1cm。12 个转移性肿瘤中有 10 个（83%）在单次 RFA 治疗中得到治疗，另外 2 个需要两次治疗。消融时间从 60 秒到 900 秒不等。
治疗后，平均最大直径从 13.8±7.0mm 显著减小至 3.3±3.9mm（p=0.002），平均体积从 55.5±50.3mm3减小至 5.7±9.3mm3（p=0.002）。在最后一次随访评估时，10 例患者中有 7 例血清甲状腺球蛋白浓度降低。1 例患者在左侧手术床的 RFA 后立即出现声音嘶哑。
虽然手术是局部转移性甲状腺癌的标准治疗方法，但对于手术不可行的转移性分化型甲状腺癌患者，RFA 是局部区域控制的有效方法。
