Ethanol Ablation Shows Promise in Thyroid Cancer Treatment
METHODOLOGY:
Previous studies have shown durable responses to ethanol ablation in 60%-95% of treated MLNs. Identifying patients who will benefit from this nonsurgical option is crucial to reducing the risk for complications from multiple surgeries.
Researchers identified 75 patients (median age, 57 years; 57% women) with papillary thyroid carcinoma who underwent ethanol ablation for MLNs at the Norwegian Radium Hospital, Oslo, Norway, from 2007 to 2020. All patients had undergone total or subtotal thyroidectomy as primary treatment, followed by one or more sessions of 131 I ablation.
I ablation. A total of 134 ethanol ablation-treated MLNs were included in the analysis: 57 lesions were located in the central neck region, whereas the remaining 77 lesions were distributed across the left and right lateral regions.
Patients were followed up for a median of 119 months, with treatment response assessed through clinical examinations and ultrasound. The outcomes of ethanol ablation and the time to recurrence were evaluated.
Ultrasonographic features of MLNs, history of lymph node surgery, BRAF V600E mutation status, and aggressive subtypes were evaluated as predictors of response to ethanol ablation treatment.
TAKEAWAY:
Ethanol ablation achieved a durable response in 98 (73%) of treated MLNs, with 49 nodes showing a lasting response after a single procedure and 49 requiring multiple treatments.
Pure cystic MLNs showed a 100% response rate to ethanol ablation, which was significantly higher than that of solid or partially cystic nodes (74%; P = .039). Additionally, smaller MLNs (≤ 0.5 mL) had a higher response rate than larger lesions (77% vs 53%; P = .045). No significant difference in response was seen between patients with the BRAF V600E mutation and those without it.
= .039). Additionally, smaller MLNs (≤ 0.5 mL) had a higher response rate than larger lesions (77% vs 53%; = .045). No significant difference in response was seen between patients with the mutation and those without it. Among 57 patients who attained locoregional control with no detectable disease on the neck, 44 achieved it solely through ethanol ablation. No major complications occurred following ethanol ablation, with transient postprocedure hoarseness noted in 6.7% of patients.
Patients with three or more treated MLNs were more likely to need additional surgery or have persistent nodes (odds ratio [OR], 6.945; P = .017). Moreover, lower disease stages (I and II) were associated with better outcomes following ethanol ablation compared with stages III and IV (OR, 30.510; P = .005) in multivariable analysis.
IN PRACTICE:
'Our results suggest that neither a positive BRAF mutation status nor an aggressive histological subtype in the primary tumor is crucial to determine if the patient will be a suitable candidate for EA [ethanol ablation],' the authors wrote.
'While surgery remains the first-line treatment, further evidence is needed to better understand any potential role of EA as an alternative to surgery in selected cases, also in surgically untreated neck regions,' they added.
SOURCE:
This study was led by Pål Stefan Frich, The Norwegian Radium Hospital, Oslo University Hospital in Oslo, Norway. It was published online in The Journal of Clinical Endocrinology & Metabolism .
LIMITATIONS:
The exclusion of many eligible patients increased the risk for selection bias, affecting the generalizability of the findings. The sample size was limited and division into small subgroups reduced the study's statistical power. The retrospective design and long follow-up periods posed a risk for information bias due to incomplete documentation.
DISCLOSURES:
This study was supported by grants from the Ødegaard and Frimann-Dahls foundation. The authors declared no relevant conflicts of interest.
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