Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
Introduction: In 2015, the American Thyroid Association’s treatment for low-risk papillary thyroid carcinoma (PTC) suggested de-escalation of treatment pathways. Instead of uniform total thyroidectomy and radioactive iodine, select patients with small cancers may qualify for active surveillance (AS). Unfortunately, many patients, specifically those who are young, have not been able to tolerate active surveillance due to fear of cancer progression and other negative effects on quality of life. Radiofrequency ablation (RFA) has emerged as a minimally invasive treatment for small (≤2 cm) low-risk PTC, potentially offering effective intervention with minimal complications while improving quality of life. This case series reports interim findings from a prospective clinical trial, exploring the feasibility, safety, and outcomes of RFA in treating small, low-risk PTC in Canada.
Study Aims and Design: This study aims to assess the feasibility and safety of RFA for small (≤2 cm) low-risk PTC by evaluating complication rates, preservation of thyroid function, and tumor volume reduction (VRR). Secondary objectives include examining the impact of RFA on patient quality of life (QoL) using surveys including the Decision Regret Scale, Fear of Progression Questionnaire–Short Form, Hospital Anxiety and Depression Scale, MD Anderson Symptom Inventory for thyroid cancer, and Body Image Scale.
Methods: Enrollment for the study is 40 patients and follow-up for this arm is 2 years. This case series evaluated RFA efficacy in 11 patients with low-risk PTC. Patients with a thyroid nodule ≤2 cm with a biopsy consistent with Bethesda V and VI, considered feasible for ablation were included. All patients received RFA under local anesthesia, utilizing a mixture of 1% lidocaine and 0.25% bupivacaine (50:50 v). The RFA procedure employed a moving-shot technique with an electrode tip, delivering thermal energy under continuous ultrasound guidance. Hydrodissection with D5 normal saline was used when lesions were close to critical structures (e.g., recurrent laryngeal nerve, trachea). Follow-up assessments were initially conducted at 4 weeks, 6 months, and 1 year to evaluate treatment outcomes. Follow-up was completed mirroring post-surgical thyroid cancer management, including ultrasound imaging and biochemical thyroid function tests. Complications were continuously monitored.
Case Results: At the 4-week follow-up, the average volume reduction ratio (VRR) for 9 patients was 42.38% (-75−61.9%). At 1-year follow-up, the average VRR for 2 patients was 94% (88−100%). Importantly, all patients have remained euthyroid as determined by biochemical assessments. Throughout the study, no adverse outcomes have been reported.
Conclusion: This is an interim analysis of the first observational trial to assess RFA's feasibility for low-risk thyroid cancer in Canada. There have been no reported complications. Patients followed for at least six months have shown either near-complete or complete resolution of their thyroid cancer.