Galan Carlos, Kwatra Devanshu, Vijendren Ananth, Patel Anant, Rajaguru Kanchana, Dimitriadis Panagiotis A, Mochloulis George
ENT Department, Clinica Universidad de Navarra, Madrid, Spain.
Lister Thyroid Centre, East and North Hertfordshire Teaching NHS Trust, Stevenage, UK.
Eur Arch Otorhinolaryngol. 2025 Jul 12. doi: 10.1007/s00405-025-09563-x.
To evaluate the efficacy and safety of radiofrequency ablation (RFA) for lateral cervical recurrence of metastatic thyroid carcinoma compared to revision surgery (after a primary thyroidectomy and selective neck dissection) and RFA in the central compartment or thyroid bed. This review focuses on studies that differentiate between lateral and central neck RFA, as lesion location might influence outcomes and complication rates.
A systematic review was conducted using the PRISMA guidelines, looking at articles that address management of thyroid cancer recurrence in the lateral neck. Data on tumor volume reduction, thyroglobulin (Tg) levels, recurrence rates, and complications were analyzed.
Eight studies were include in this review. Across 252 patients treated with RFA, complete nodule disappearance was reported in up to 97% of cases, with therapeutic success rates ranging from 92 to 100%. Volume reduction rates (VRR) reached 93-100% at 24-60 months. Thyroglobulin levels consistently decreased post-treatment, with reductions from baseline values as high as 37 ng/mL to < 1 ng/mL. Recurrence-free survival was 90.8-96% at 1-3 years, and up to 94.5% at 6 years in long-term follow-up. Radiofrequency ablation demonstrated a favorable safety profile: transient voice changes occurred in 3.7-8.6% of patients, mainly in central lesions, with no reported cases of hypocalcemia. Surgery showed higher complication rates, including hypocalcemia (8.7-30%) and permanent voice changes. Comparative studies showed that while surgery may offer more frequent biochemical remission, RFA remains effective with fewer complications.
RFA is an effective, minimally invasive alternative for lateral cervical recurrence of thyroid cancer. Its high efficacy and superior safety profile make it a valuable option, particularly for patients avoiding revision surgery. Differentiating lateral and central RFA is important, as both show comparable efficacy, though central RFA has a higher complication risk.
与翻修手术（在初次甲状腺切除和选择性颈部清扫术后）以及中央区或甲状腺床的射频消融术（RFA）相比，评估射频消融术治疗转移性甲状腺癌侧颈部复发的疗效和安全性。本综述重点关注区分侧颈部和中央区RFA的研究，因为病变位置可能会影响治疗结果和并发症发生率。
按照PRISMA指南进行系统综述，查阅有关甲状腺癌侧颈部复发管理的文章。分析了肿瘤体积缩小、甲状腺球蛋白（Tg）水平、复发率和并发症的数据。
本综述纳入了八项研究。在接受RFA治疗的252例患者中，高达97%的病例报告结节完全消失，治疗成功率在92%至100%之间。在24至60个月时，体积缩小率（VRR）达到93%至100%。治疗后甲状腺球蛋白水平持续下降，从基线值高达37 ng/mL降至<1 ng/mL。1至3年的无复发生存率为90.8%至96%，长期随访6年时高达94.5%。射频消融术显示出良好的安全性：3.7%至8.6%的患者出现短暂声音改变，主要发生在中央区病变，未报告低钙血症病例。手术显示出更高的并发症发生率，包括低钙血症（8.7%至30%）和永久性声音改变。比较研究表明，虽然手术可能更频繁地实现生化缓解，但RFA并发症较少且仍然有效。
RFA是治疗甲状腺癌侧颈部复发的一种有效、微创的替代方法。其高疗效和卓越的安全性使其成为一个有价值的选择，特别是对于避免翻修手术的患者。区分侧颈部和中央区RFA很重要，因为两者疗效相当，尽管中央区RFA的并发症风险更高。
