BACKGROUND
By 2030, thyroid cancer will be the fourth-leading cancer diagnosis. Most of these new cases will be small (<1 cm), early-stage papillary thyroid microcarcinomas (mPTCs). Most cases of mPTCs are very slow-growing and rarely spread, raising the question as to how these cancers should be treated. While surgery is almost always curative, it is unclear of surgery is always needed. Surgery does have a small risk of complications such as hypoparathyroidism and damage to the recurrent laryngeal nerve, which can lead to loss of one’s voice and breathing difficulty. Because of this, many experts feel that surgery is not always required for mPTCs. In fact, in 2015, the American Thyroid Association thyroid cancer guidelines recommended that close monitoring of mPTCs without surgery, called active surveillance, for could be used as an alternative to surgery.

Radiofrequency ablation (RFA) is a nonsurgical, minimally invasive technique that has been shown to shrink thyroid nodules. RFA uses a needle inserted into the nodule that uses alternating electromagnetic current to generate heat to destroy thyroid cells. RFA lies in between surgery and active surveillance. It is less invasive than surgery yet may be a suitable treatment option for those who do not wish to pursue active surveillance alone. Currently, the literature lacks large-scale studies examining the effectiveness of RFA in treating mPTCs. The primary goal of this article was to analyze the efficacy and safety of RFA for low-risk mPTC.

THE FULL ARTICLE TITLE
van Dijk SPJ et al Assessment of radiofrequency ablation for papillary microcarcinoma of the thyroid: A systematic review and meta-analysis JAMA Otolaryngol Head Neck Surg. Epub 2022 Feb 10

SUMMARY OF THE STUDY
The authors performed a meta-analysis, which is a statistical method combining results of multiple similar studies, of adult patients treated with RFA for mPTC that had not spread beyond the thyroid gland. A total of 1770 patients from 15 different studies (11 from China and 4 from South Korea) were included in the meta-analysis.

The average follow-up time was 33 months. The cancer completely disappeared in 79% of patients with mPTC after RFA. Only 26 (1.5%) patients showed growth of the cancer after RFA — of those 7 (0.4%) had growth in the area of the original cancer, 15 (0.9%) developed new cancers in the thyroid and 4 (0.2%) developed cancer in the lymph nodes of the neck. No patients treated with RFA developed distant spread of their thyroid cancer, and only 0.17% of patients suffered complications from the RFA procedure itself, all of which resolved on their own after 3 months.

WHAT ARE THE IMPLICATIONS OF THIS STUDY?
This study supports RFA as a safe, effective and minimally invasive treatment for low-risk papillary microcarcinoma. RFA, when used along with active surveillance, has the potential to reshape current treatment for mPTC.

— Philip Segal, MD

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