From the Departments of Radiology (J.H.K., T.J.Y., S.H.C., C.H.S.), Internal Medicine (W.S.Y., Y.J.P., D.J.P., B.Y.C.), Surgery (K.E.L., Y.K.Y.), and Otolaryngology-Head and Neck Surgery (M.W.S.), Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Internal Medicine, Dankook University Hospital, Republic of Korea (W.S.Y.); Department of Otolaryngology: Head and Neck Surgery, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea (K.H.K.); and Department of Internal Medicine, Chung-Ang University Hospital, College of Medicine, Chung-Ang University, 224-1 Heukseok-dong, Dongjak-gu, Seoul 156-755, Republic of Korea (B.Y.C.).
Radiology. 2015 Sep;276(3):909-18. doi: 10.1148/radiol.15140079. Epub 2015 Apr 3.
To evaluate the efficacy and safety of radiofrequency ablation (RFA) for localized small recurrent thyroid cancers less than 2 cm by comparing them with those at repeat surgery.
This retrospective study was institutional review board-approved, and informed consent was waived. From December 2008 to December 2011, this study evaluated 73 patients (17 men and 56 women; age, 50.3 years ± 13.6) with recurrent thyroid cancer who had been treated with RFA (n = 27) or repeat surgery (n = 46) who met the following criteria: (a) three or fewer recurrences or lesions with high probability of recurrence at ultrasonography; (b) no tumor other than the target tumors; and (c) at least 1 year of follow-up. RFA was recommended and performed in cases of surgical ineligibility, such as patient refusal and poor medical condition. Recurrence-free survival rates and posttreatment complication rates (eg, hoarseness and hypocalcemia) were compared between RFA and reoperation groups after adjustment with weighted analysis by using inverse probability of treatment weights.
After this adjustment, the 1- and 3-year recurrence-free survival rates were comparable (P = .681) for RFA (96.0% and 92.6%, respectively) and reoperation (92.2% and 92.2%, respectively) groups. The posttreatment hoarseness rate did not differ between the RFA (7.3% [1.8 of 24]) and reoperation (9.0% [3.6 of 39.5]) groups (P = .812), and posttreatment hypocalcemia occurred exclusively in the reoperation group (11.6% [4.6 of 39.5]) but not in the RFA group (0% [0 of 24]) (P = .083).
RFA may be an effective and safe alternative to repeat surgery in patients with locally recurrent small thyroid cancers.
通过比较射频消融（RFA）与重复手术治疗小于 2cm 的局部复发性小甲状腺癌的疗效和安全性。
本回顾性研究获得机构审查委员会批准，并豁免了知情同意。2008 年 12 月至 2011 年 12 月，本研究评估了 73 例（17 名男性，56 名女性；年龄 50.3 岁±13.6 岁）接受 RFA（n=27）或重复手术（n=46）治疗的复发性甲状腺癌患者，这些患者符合以下标准：（a）超声检查提示 3 次以内复发或有高度复发可能的病灶；（b）除目标肿瘤外无其他肿瘤；（c）至少随访 1 年。在患者拒绝或身体状况不佳等情况下，推荐并进行 RFA 治疗，不适合手术。使用逆概率治疗权重进行加权分析调整后，比较 RFA 组和重复手术组的无复发生存率和治疗后并发症发生率（如声音嘶哑和低钙血症）。
经过调整后，RFA 组（分别为 96.0%和 92.6%）和重复手术组（分别为 92.2%和 92.2%）的 1 年和 3 年无复发生存率相当（P=0.681）。RFA 组（7.3%[1.8/24]）和重复手术组（9.0%[3.6/39.5]）治疗后声音嘶哑发生率无差异（P=0.812），仅重复手术组（11.6%[4.6/39.5]）发生治疗后低钙血症，而 RFA 组未发生（0%[0/24]）（P=0.083）。
对于局部复发性小甲状腺癌患者，RFA 可能是重复手术的有效且安全的替代方法。
