Review

Authors: Ralph P Tufano, Pia Pace-Asciak, Jonathon O Russell...

Thermal and chemical ablation are minimally invasive procedures that avoid removal of the thyroid gland and target symptomatic nodules directly. Internationally, Radiofrequency ablation (RFA) is among one of the most widely used thermal ablative techniques, and is gaining traction in North America. Surgery remains the standard of care for most thyroid cancer, and in the right clinical setting, Active Surveillance (AS) can be a reasonable option for low risk disease. Minimally invasive techniques have emerged as an alternative option for patients deemed high risk for surgery, or for those patients who wish to receive a more active treatment approach compared to AS. Herein, we review the literature on the safety and efficacy of RFA for treating benign non-functioning thyroid nodules, autonomously functioning thyroid nodules, primary small low risk thyroid cancer (namely papillary thyroid cancer) as well as recurrent thyroid cancer.

Topics: Catheter Ablation; History, 21st Century; Humans; Neoplasm Recurrence, Local; Radiofrequency Ablation; Thyroid Cancer, Papillary; Thyroid Neoplasms; Thyroid Nodule; Treatment Outcome

PubMed: 34248853
DOI: 10.3389/fendo.2021.698689

Meta-Analysis

Authors: Sam P J van Dijk, Hannelore I Coerts, Sabrina T G Gunput...

IMPORTANCE

Papillary microcarcinomas of the thyroid (mPTCs) account for an increasing proportion of thyroid cancers in past decades. The use of radiofrequency ablation (RFA) has been investigated as an alternative to surgery. The effectiveness and safety of RFA has yet to be determined.

OBJECTIVE

To evaluate the effectiveness and safety of RFA for low-risk mPTC.

DATA SOURCES

Embase, MEDLINE via Ovid, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, and the top 100 references of Google Scholar were searched from inception to May 28, 2021.

STUDY SELECTION

Articles reporting on adult patients with mPTC treated with RFA were included. Studies that involved patients with pre-ablation lymph node or distant metastases, recurrence of disease, or extrathyroidal extension were excluded. Final article selection was conducted by multiple reviewers based on consensus. The proportion of eligible articles was 1%.

DATA EXTRACTION AND SYNTHESIS

This meta-analysis was conducted in accordance with the MOOSE guidelines. Random and fixed-effect models were applied to obtain pooled proportions and 95% CIs.

MAIN OUTCOMES AND MEASURES

The primary outcome was the complete disappearance rate of mPTC. Secondary outcomes were tumor progression and complications.

RESULTS

Fifteen studies were included in this meta-analysis. A total of 1770 patients (1379 women [77.9%]; mean [SD] age, 45.4 [11.4] years; age range, 42.5-66.0 years) with 1822 tumors were treated with RFA; 49 tumors underwent 1 additional RFA session and 1 tumor underwent 2 additional RFA sessions. Mean (SD) follow-up time was 33.0 (11.4) months (range, 6-131 months). The pooled complete disappearance rate at the end of follow-up was 79% (95% CI, 65%-94%). The overall tumor progression rate was 1.5% (n = 26 patients), local residual mPTC in the ablation area was found in 7 tumors (0.4%), new mPTC in the thyroid was found in 15 patients (0.9%), and 4 patients (0.2%) developed lymph node metastases during follow-up. No distant metastases were detected. Three major complications occurred (2 voice changes lasting >2 months and 1 cardiac arrhythmia). Minor complications were described in 45 patients.

CONCLUSIONS AND RELEVANCE

The findings of this systematic review and meta-analysis suggest that RFA is a safe and efficient method to treat selected low-risk mPTCs. Radiofrequency ablation could be envisioned as step-up treatment after local tumor growth under active surveillance for an mPTC or initial treatment in patients with mPTCs with anxiety about active surveillance.

Topics: Carcinoma, Papillary; Female; Humans; Male; Radiofrequency Ablation; Thyroid Neoplasms

PubMed: 35142816
DOI: 10.1001/jamaoto.2021.4381

Review

Authors: F Garrido Pareja, P Pérez Naranjo, M D Redondo Olmedilla...

Radiofrequency ablation is a well-known, safe, and effective method for treating benign thyroid nodules and recurring thyroid cancer as well as parathyroid adenomas that has yielded promising results in recent years. Since the Korean Society of Thyroid Radiology introduced the devices and the basic techniques for radiofrequency ablation in 2012, radiofrequency ablation has been approved all over the world and both the devices and techniques have improved. This review aims to instruct interventional radiologists who are doing or intend to start doing radiofrequency ablation of thyroid and parathyroid lesions, as well as thyroid and parathyroid specialists who provide pre- and post-operative care, in the training, execution, and quality control for radiofrequency ablation of thyroid nodules and parathyroid adenomas to optimize the efficacy and safety of the treatment.

Topics: Humans; Parathyroid Diseases; Parathyroid Neoplasms; Radiofrequency Ablation; Thyroid Nodule

PubMed: 36030086
DOI: 10.1016/j.rxeng.2022.01.002

Review

Authors: Koji Tomita, Yusuke Matsui, Mayu Uka...

PURPOSE

This review aimed to summarize the treatment outcomes of percutaneous radiofrequency ablation (RFA) and microwave ablation (MWA) for metastatic liver tumors based on the findings of published studies over the last decade.

MATERIALS AND METHODS

Literature describing the survival outcomes of ablation therapy for liver metastases was explored using the PubMed database on April 26, 2022, and articles published in 2012 or later were selected. The included studies met the following criteria: (i) English literature, (ii) original clinical studies, and (iii) literature describing overall survival (OS) of thermal ablation for metastatic liver tumors. All case reports and cohort studies with fewer than 20 patients and those that evaluated ablation for palliative purposes were excluded.

RESULTS

RFA was the most commonly used method for ablation, while MWA was used in several recent studies. RFA and MWA for liver metastases from various primary tumors have been reported; however, majority of the studies focused on colorectal cancer. The local control rate by RFA and MWA varied widely among the studies, ranging approximately 50-90%. Five-year survival rates of 20-60% have been reported following ablation for colorectal liver metastases by a number of studies, and several reports of 10-year survival rates were also noted.

CONCLUSION

Comparative studies of local therapies for colorectal liver metastases demonstrated that RFA provides comparable survival outcomes to surgical metastasectomy and stereotactic body radiation therapy.

Topics: Catheter Ablation; Colorectal Neoplasms; Humans; Liver Neoplasms; Microwaves; Radiofrequency Ablation; Retrospective Studies; Treatment Outcome

PubMed: 36097234
DOI: 10.1007/s11604-022-01335-5

Review

Authors: Natalie H Strand, Jonathan M Hagedorn, Tyler Dunn...

Radiofrequency ablation (RFA) is a minimally invasive treatment modality that utilizes high-frequency alternating current to destroy targeted tissues through thermal ablation. This manuscript provides an overview of the advancements in RFA, focusing on its mechanism of action and technological innovations. RFA technology was first introduced in the early 1900's, and its use has expanded and evolved, especially in its current utility in the treatment of painful conditions. As the technology has evolved, new techniques, applications and modalities have expanded its use and improved its efficacy. RFA works by applying radiofrequency energy through specialized electrodes, leading to resistive heating and coagulation necrosis. Its advantages include precise tissue targeting, minimal invasiveness, reduced complications, and faster recovery compared to traditional surgical interventions. Technological advancements in RFA have led to improved treatment outcomes. Multi-electrode systems allow for larger ablation zones. Image-guided RFA improves treatment planning and minimizes damage to healthy tissues. Cooled-tip and perfusion electrodes address limitations such as heat sink effects, enhancing RFA's efficacy in challenging anatomical regions. These developments have expanded RFA's applications to liver tumors, lung tumors, renal tumors, cardiac arrhythmias, and chronic pain syndromes. In conclusion, RFA has emerged as a safe and effective thermal ablation technique. Understanding its mechanism of action and integrating advanced technologies have significantly enhanced treatment outcomes. Continued research and innovation in RFA hold immense potential for further improving patient care and outcomes.

Topics: Humans; Radiofrequency Ablation; Catheter Ablation

PubMed: 39043563
DOI: 10.21037/apm-23-457

Comparative Study

Authors: Arwa Younis, Chadi Tabaja, Ryan Kleve...

BACKGROUND

Comparative efficacy and safety data on radiofrequency ablation (RFA) versus pulsed field ablation (PFA) for common idiopathic left ventricular arrhythmia (LV-VAs) locations are lacking.

OBJECTIVES

This study sough to compare RFA with PFA of common idiopathic LV-VAs locations.

METHODS

Ten swine were randomized to PFA or RFA of LV interventricular septum, papillary muscle, LV summit via distal coronary sinus, and LV epicardium via subxiphoid approach. Ablations were delivered using an investigational dual-energy (RFA/PFA) contact force (CF) and local impedance-sensing catheter. After 1-week survival, animals were euthanized for lesion assessment.

RESULTS

A total of 55 PFA (4 applications/site of 2.0 KV, target CF ≥10 g) and 36 RFA (CF ≥10 g, 25-50 W targeting ≥50 Ω local impedance drop, 60-second duration) were performed. LV interventricular septum: average PFA depth 7.8 mm vs RFA 7.9 mm (P = 0.78) and no adverse events. Papillary muscle: average PFA depth 8.1 mm vs RFA 4.5 mm (P < 0.01). Left ventricular summit: average PFA depth 5.6 mm vs RFA 2.7 mm (P < 0.01). Steam-pop and/or ventricular fibrillation in 4 of 12 RFA vs 0 of 12 PFA (P < 0.01), no ST-segment changes observed. Epicardium: average PFA depth 6.4 mm vs RFA 3.3 mm (P < 0.01). Transient ST-segment elevations/depressions occurred in 4 of 5 swine in the PFA arm vs 0 of 5 in the RFA arm (P < 0.01). Angiography acutely and at 7 days showed normal coronaries in all cases.

CONCLUSIONS

In this swine study, compared with RFA, PFA of common idiopathic LV-VAs locations produced deeper lesions with fewer steam pops. However, PFA was associated with higher rates of transient ST-segment elevations and depressions with direct epicardium ablation.

Topics: Animals; Swine; Catheter Ablation; Radiofrequency Ablation; Arrhythmias, Cardiac; Heart Ventricles

PubMed: 38878017
DOI: 10.1016/j.jacep.2024.04.025

Authors: Masamichi Kimura, Ryo Matsuoka, Koji Nishikawa...

BACKGROUND Sarcomatoid hepatocellular carcinoma is a rare, primary malignant liver cancer. Its pathogenesis is unknown, but it often occurs in patients who have undergone repeated antitumor therapies for hepatocellular carcinoma. Sarcomatoid hepatocellular carcinoma is more likely to recur and has a worse prognosis than that of hepatocellular carcinoma. As no specific features have been identified in the symptoms, serological findings, or imaging findings, it is difficult to accurately diagnose the disease before surgical resection or autopsy. CASE REPORT An 83-year-old woman was diagnosed with hepatocellular carcinoma 20 years ago. Radiofrequency ablation was initially performed. Thereafter, invasive, non-surgical treatments were repeated. The most recent treatment was 4 years ago, during which computed tomography suggested recurrent hepatocellular carcinoma. However, upon needle biopsy, histological examination revealed spindle-shaped tumor cells and actively mitotic cells. Immunohistochemical analysis showed negative results for Arginase-1, HepPar1, and Glypican3 and positive results for AE1/AE3, CK7, and vimentin. Therefore, sarcomatoid hepatocellular carcinoma was diagnosed, which was treated with radiofrequency ablation but progressed rapidly thereafter. Considering the rapid disease progression, the patient was treated conservatively. However, the patient's general condition gradually deteriorated, resulting in death. CONCLUSIONS Compared with hepatocellular carcinoma, sarcomatoid hepatocellular carcinoma is more prone to recurrence and has a poorer prognosis. Therefore, aggressive surgical resection seems to be the most appropriate treatment for sarcomatoid hepatocellular carcinoma at present. Additional hepatic resection or follow-up imaging in a short period should be considered at the time of diagnosis of sarcomatoid hepatocellular carcinoma by biopsy, considering the risk of seeding or recurrence.

Topics: Female; Humans; Aged, 80 and over; Carcinoma, Hepatocellular; Liver Neoplasms; Biopsy, Needle; Radiofrequency Ablation; Catheter Ablation

PubMed: 37194213
DOI: 10.12659/AJCR.939126

Meta-Analysis Comparative Study

Authors: Xiaoyan Kong, Liangchen Wang, Yuchen Sun...

OBJECTIVE

To compare the efficacy, safety and patients' quality of life of radiofrequency ablation (RFA) and surgery in the treatment of papillary thyroid microcarcinoma (PTMC).

METHODS

MEDLINE, EMBASE, Cochrane, CNKI and other databases were searched for studies on radiofrequency ablation versus traditional surgery for PTMC up to October 2022. RevMan5.4 software was used for Meta-analysis.

RESULTS

10 articles were selected from 392 articles, including 873 cases of radiofrequency ablation and 781 cases of open surgery. After meta-analysis, the incidence of postoperative complications in the radiofrequency ablation group was lower than that in the surgery group, and the difference was statistically significant [OR=0.24, 95%CI (0.14,0.41), P<0.001]. There were no significant differences in lymph node metastasis rate, local recurrence rate, and new tumor rate between the two groups [OR=1.6, 95%CI (0.21, 12.41), P>0.05; OR=0.85, 95%CI (0.05, 13.8), P>0.05; OR=0.12, 95%CI (0.01, 0.98), P>0.05]. The treatment time and hospital stay in the radiofrequency ablation group were shorter than those in the open surgery group [MD=-49.99, 95%CI (-62.02, -37.97), P<0.001; MD=-5.21, 95%CI(-7.19,-3.23),P<0.001], and the cost was significantly lower than that of the traditional surgery group [SMD=-14.97, 95%CI (-19.14, -10.81), P<0.001]. The quality of life of patients in the radiofrequency ablation group was higher than that in the surgery group [MD=-1.61, 95%CI (-2.06, -1.17), P<0.001].

CONCLUSION

Compared with traditional open surgery, radiofrequency ablation for papillary thyroid microcarcinoma has the advantages of less trauma, fewer complications, faster recovery and higher quality of life. The indications need to be strictly controlled in the treatment.

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/PROSPERO/, identifier (CRD42022374987).

Topics: Humans; Carcinoma, Papillary; Postoperative Complications; Quality of Life; Radiofrequency Ablation; Thyroid Neoplasms; Thyroidectomy; Treatment Outcome

PubMed: 39072279
DOI: 10.3389/fendo.2024.1352503

Meta-Analysis

Authors: YouCai Liu, XinLei Zhao, JiaXuan Zhou...

OBJECTIVE

The objective of the study is to systematically analyze the safety and efficacy of radiofrequency ablation (RFA) therapy for the treatment of patients with knee osteoarthritis (KOA) and to assess the methodological quality of the published studies.

METHODS

By searching the PubMed, Embase, and CENTRAL databases, we retrieved and collected relevant randomized controlled trials (RCTs) published up to June 26, 2023.

RESULTS

We included 13 RCTs, involving a total of 865 patients. Compared with the control group, the RFA group had significantly reduced pain scores at 1-2 weeks, 4 weeks, 12 weeks, and 24 weeks post-treatment, with standardized mean differences of -1.24 (95% confidence interval [CI]: -1.99--0.49; p = 0.001; I = 91%), -0.76 (95% CI: -1.27--0.26; p = 0.003; I = 76%), -1.70 (95% CI: -2.56--0.83; p = 0.0001; I = 94%), and -2.26 (95% CI: -3.49--1.04; p = 0.0003; I = 95%).

CONCLUSIONS

RFA, as an adjunctive treatment modality, demonstrates potential in the treatment of patients with KOA. This method may become a primary treatment strategy for these patients.

Topics: Humans; Osteoarthritis, Knee; Radiofrequency Ablation; Randomized Controlled Trials as Topic; Treatment Outcome; Pain Measurement

PubMed: 39079243
DOI: 10.24875/CIRU.23000395

Meta-Analysis Review

Authors: Wei Xu, Shihui Li, Fang Cheng...

OBJECTIVE

Thermal ablation, including microwave ablation (MWA) and radiofrequency ablation (RFA), has been recommended for the treatment of primary hyperparathyroidism (PHPT) and refractory secondary hyperparathyroidism (SHPT). This meta-analysis was conducted to evaluate the efficacy and safety of MWA and RFA in patients with PHPT and refractory SHPT.

METHODS

Databases including PubMed, EMbase, the Cochrane Library, CNKI (China National Knowledge Infrastructure), and Wanfang were searched from inception to December 5, 2022. Eligible studies comparing MWA and RFA for PHPT and refractory SHPT were included. Data were analyzed using Review Manager software, version 5.3.

RESULTS

Five studies were included in the meta-analysis. Two were retrospective cohort studies, and three were RCTs. Overall, 294 patients were included in the MWA group, and 194 patients were included in the RFA group. Compared with RFA for refractory SHPT, MWA had a shorter operation time for a single lesion (P < 0.01) and a higher complete ablation rate for a single lesion ≥ 15 mm (P < 0.01) but did not show a difference in the complete ablation rate for a single lesion < 15 mm (P > 0.05). There were no significant differences between MWA and RFA for refractory SHPT concerning parathyroid hormone (P > 0.05), calcium (P > 0.05), and phosphorus levels (P > 0.05) within 12 months after ablation, except that calcium (P < 0.01) and phosphorus levels (P = 0.02) in the RFA group were lower than those in the MWA group at one month after ablation. There was no significant difference between MWA and RFA concerning the cure rate of PHPT (P > 0.05). There were no significant differences between MWA and RFA for PHPT and refractory SHPT concerning the complications of hoarseness (P > 0.05) and hypocalcaemia (P > 0.05).

CONCLUSION

MWA had a shorter operation time for single lesions and a higher complete ablation rate for large lesions in patients with refractory SHPT. However, there was no significant difference in efficacy and safety between MWA and RFA in cases of both PHPT and refractory SHPT. Both MWA and RFA are effective treatment methods for PHPT and refractory SHPT.

Topics: Humans; Calcium; Ablation Techniques; Retrospective Studies; Microwaves; Radiofrequency Ablation; Hyperparathyroidism, Secondary; Treatment Outcome; Phosphorus; Catheter Ablation

PubMed: 36892812
DOI: 10.1007/s11255-023-03543-y