Palliative role of ultrasound-guided percutaneous ethanol ablation in controlling selected regional nodal recurrences in patients with distantly metastatic papillary thyroid carcinoma

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: MON 471-496-Thyroid Neoplasia & Case Reports
Monday, June 17, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board MON-472
Ian D Hay*, Robert A Lee, Jennifer R Geske, Carl C Reading and J William Charboneau
Mayo Clinic, Rochester, MN
Papillary thyroid carcinoma often presents with regional nodal involvement, but distantly metastatic papillary thyroid carcinoma (DMPTC) is rare. In pTNM stage II PTC patients, younger than 45 years, most have neck nodal metastases (NNM) at presentation and many live with distant spread for decades. By contrast, the majority of stage IVC patients are at high-risk of death from PTC. Both younger and older patients (any T, N1, M1) with DMPTC may develop regional nodal recurrences (RNR), which can be diagnosed with sonography, are rarely life-threatening, but often resist radioiodine therapy, and are conventionally treated by neck re-exploratory surgery. Ultrasound-guided percutaneous ethanol ablation (UPEA) for selected RNR is a “simple, effective, outpatient procedure” (JCEM 97:2623,2012), which has proved to be a safe and cheaper alternative to surgery in patients with localized PTC. To date, its role in controlling RNR in DMPTC has not been reported. During 1997-2012, we used UPEA to treat selected RNR in 34 patients with DMPTC. The 34 treated patients (19M, 15F) were aged 15-86 years (median 61 years); 8 stage II, 26 IVC. Each of 61 NNM (mean largest size 8mm, range 3-30 mm), selected for UPEA, was initially treated in two outpatient sessions on successive days (Thyroid Intl 2:1,2012). To date, 59 NNM in 32 patients have been reassessed. All ablated NNM decreased in size; none had significant detectable Doppler flow. Only one patient had temporary hoarseness; no vocal cord paresis occurred; 25 (42%) of the 59 NNM disappeared on re-scanning. None of the UPEA-treated NNM, followed on average for 60 months (range 13-152), required further intervention. 5/7 stage II patients (71%) and 19/25 stage IVC patients (76%) subsequently developed “new” NNM at sites requiring more surgery and/or further UPEA. The majority (34/42, 81%) of these later “recurrent” episodes were managed successfully by UPEA, rather than further surgery. UPEA of selected RNR in DMPTC has proved effective and in these 34 patients prevented, to date, 68 expensive, potentially hazardous, neck re-explorations. Estimating an average cost-saving of about $38,400 per UPEA procedure (JCEM 96:2717,2011) , it is likely that these particular 34 patients, by avoiding further surgery, saved themselves, to date, approximately $2.611 million. We would conclude that UPEA, performed by dedicated sonographers, is, therefore not only safe and effective, but also considerably cheaper than the traditional surgical alternative.

Nothing to Disclose: IDH, RAL, JRG, CCR, JWC

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