Patients with locoregional recurrent medullary thyroid cancer (MTC). who received ultrasound-guided percutaneous ethanol ablation (UPEA) responded with a decrease in lesion size and a reduction in serum calcitonin levels. They were part of a study conducted by physicians from the Mayo Clinic and recently published in The American Surgeon.
The study also found no short- or long-term complications from the treatment. Overall survival at 5 years for patients receiving UPEA (n=5) was not statistically different from a cohort (n=43) that received surgery instead (0.62 vs 0.8, respectively; P =.88).
The authors stated, “Our institution believes this is an intervention with a safe profile and shows potential as an adjunct treatment in targeting focal structural disease, with results comparable to surgery in decline in serum calcitonin.”
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Forty-eight patients with oligometastatic MTC received treatment for locoregional recurrence after initial surgery. Of the 5 patients receiving UPEA, 4 patients had 2 sessions of UPEA with 1 to 3 nodes treated per session. The mean lesion size was 14 ± 6.2 mm preablation, with postablation sizes decreasing to 8.5 ± 4 mm (average decrease, -5.1 ± 4 mm).
Both the UPEA treatment group and the surgery group showed decreases in calcitonin levels: -1001 ± 2831 pg/mL vs -41 ± 1649 pg/mL, respectively (P =.46). Calcitonin levels prior to treatment appeared higher on average in the UPEA group (4505 ± 8655 pg/mL) than in the surgery group (1461 ± 2290 pg/mL), although the difference was not significant (P =.78).
After a second recurrence, 2 patients received another round of UPEA, while another 2 patients ultimately required surgery. The authors referenced previous studies of UPEA in papillary thyroid cancer that showed that UPEA can possibly increase the difficulty of future surgical treatments. No difficulties were found in the 2 patients in the current study who received surgery after UPEA, however.
Based on the results of the study, the authors wrote that UPEA could be a potential adjunct therapy for the treatment of recurrent MTC. “It may also be helpful in delaying surgical treatment so that additional lymph nodes may manifest themselves prior to surgical intervention,” they wrote.
The authors urged caution in the interpretation of their results due to the small number of patients who received UPEA, stating that further investigation is necessary to determine the exact patient population that can benefit from the procedure.
Yamashita TS, Rogers RT, Foster TR, et al. Ultrasound-guided percutaneous ethanol ablation for local regional recurrence of medullary thyroid cancer. Am Surg. Published online August 31, 2021. doi:10.1177/00031348211041563