Nodule size as predictive factor of efficacy of radiofrequency ablation in treating autonomously functioning thyroid nodules

No defined pre-treatment factors are able to predict the response to radiofrequency ablation (RFA) of an autonomously functioning thyroid nodule (AFTN).Primary endpoint was to evaluate the success rate of RFA to restore euthyroidism in a cohort of adult patients with small solitary AFTN compared with medium-sized nodules. Secondary endpoints included nodule volume reduction and rate of conversion from hot nodules to cold using scintiscan.This was a 24-month prospective monocentric open parallel-group trial. Twenty-nine patients with AFTN were divided into two groups based on thyroid volume: 15 patients with small nodules (12 mL) in group A and 14 patients with medium nodules (12 mL) in group B. All patients underwent a single session of RFA and were clinically, biochemically, and morphologically evaluated at baseline and at 1, 6, 12 and 24 months after treatment.After RFA, there was greater nodule volume reduction in group A compared with group B (p  0.001 for each follow-up point). In group A, there was a greater increase in TSH levels than in group B at 6 (p = 0.01), 12 (p = 0.005), and 24 months (p  0.001). At 24 months, the rate of responders was greater in group A than in group B (86 vs. 45%; p  0.001). In group A, 86% of nodules converted from hot to cold compared with 18% in group B (p  0.001).A single session of RFA was effective in restoring euthyroidism in patients with small AFTNs. Nodule volume seems to be a significant predictive factor of the efficacy of RFA in treating AFTN

Radiofrequency Ablation on Autonomously Functioning Thyroid Nodules: A Critical Appraisal and Review of the Literature

Background: Thyroid nodules are an extremely common occurrence, as their prevalence in the general population is estimated to range between 50 and 70%. Some of these nodules are autonomously functioning such that they can cause hyperthyroidism over time. In this case, surgery and radioiodine represent the standard of care. Nevertheless, patients might have contraindications or be unwilling to undergo these treatments. Minimally-invasive ultrasound-guided techniques, such as laser and radiofrequency ablation (RFA), have been recently introduced into clinical practice as an alternative treatment for symptomatic benign thyroid nodules. Due to their efficacy and tolerability, these techniques have become increasingly available and their usage has been extended also to autonomously functioning thyroid nodules (AFTN). Methods: In this narrative review, we will describe the studies reporting the therapeutic effects of RFA on AFTN, the studies reporting how RFA compares to the other treatment modalities, as well as the current indications for the use of RFA in patients with AFTN. For this purpose, a comprehensive literature search was independently conducted by three investigators on PubMed, EMBASE, and the Cochrane Library from inception up to February 2020 to identify published articles concerning the effects of RFA on AFTN. Results and Conclusions: Current consensus statements and guidelines support the notion that RFA should be regarded as a first-line therapy for non-functioning benign thyroid nodules, while it remains a valid second-line option for AFTN treatment in case of contraindications or patient unwillingness to undergo surgery or radioiodine

Complexes of Tc(V) and Tc(III) with tridentate Schiff bases derived from S-Methyl dithiocarbazate. Crystal structures of chloro-[S-methyl-3-(2-hydroxy-1-naphtyl methylene) dithiocarbazato(2-)]oxotechnetium(V) and dichloro[S-methyl-3-(2-hydroxybenzilidene) dithiocarbazato(1)]bis (triphenylphosphine) technetium(III).

--

Technetium(V)-nitrido complexes of dithiocarbazic acid derivatives. Reactivity of [Tc≡N]2+ core towards Schiff bases derived from S-methyl dithiocarbazate. Crystal structures of [S-methyl 3-(2-hydroxyphenylmethylene)dithiocarbazato]nitrido(triphenylphos-phine)technetium(V) and bis(S-methyl 3-isopropylidenedithiocarbazato)nitridotechnetium(V)

none8---noneA. MARCHI; A. DUATTI; R. ROSSI; L. MAGON; R. PASQUALINI; V. BERTOLASI; V. FERRETTI; G. GILLIA., Marchi; Duatti, Adriano; R., Rossi; L., Magon; R., Pasqualini; Bertolasi, Valerio; Ferretti, Valeria; G., Gill

Selective Internal Radiation Therapy with SIR-Spheres for the Treatment of Unresectable Colorectal Hepatic Metastases

The purpose of this study was to evaluate the effectiveness of colorectal cancer (CRC) liver metastasis radioembolization with yttrium-90 (Y90), assessing toxicity and survival rates in patients with no response to chemotherapy through our 3-year experience. From February 2005 to January 2008, we treated 41 patients affected by CRC from a cohort of selective internal radiation therapy patients treated at our institution. All patients examined showed disease progression and arrived for our observation with an abdominal CT, a body PET, and a hepatic angiography followed by gastroduodenal artery coiling previously performed by us. We excluded patients with a bilirubin level > 1.8 mg/dl and pulmonary shunt > 20% but not patients with minor extrahepatic metastases. On treatment day, under fluoroscopic guidance, we implanted a dose of Y90 microspheres calculated on the basis of liver tumoral involvement and the body surface area formula. All patients were discharged the day after treatment. We obtained, according to Response Evaluation Criteria on Solid Tumors, a complete response in 2 patients, a partial response in 17 patients, stable disease in 14 patients, and progressive disease in 8 patients. In all cases, we obtained a carcinoembryonic antigen level decrease, especially in the week 8 evaluation. Technical success rate was 98% and technical effectiveness estimated at 3 months after treatment was 80.5%. Side effects graded by Common Terminology Criteria on Adverse Events were represented by one grade 4 hepatic failure, two grade 2 gastritis, and one grade 2 cholecystitis. The median survival and the progression-free survival calculated by Kaplan-Meier analysis were 354 and 279 days, respectively. In conclusion, according to our 3-year experience, Y90 SIR-Spheres radioembolization is a feasible and safe method to treat CRC liver metastases, with an acceptable level of complications and a good response rate

Laser Ablation versus Radiofrequency Ablation for thyroid nodules: Twelve-month results of a randomized trial (LARA II study)

CONTEXT: Radiofrequency ablation (RFA) seems to achieve a significantly larger nodule volume reduction rate (VRR) than laser ablation (LA) in benign non-functioning thyroid nodules (BNTNs).OBJECTIVE: To compare the efficacy and safety of both treatments at 12-month follow-up in patients with solid or predominantly solid BNTN.DESIGN: Single-center, 12-month, randomized, superiority, open-label, parallel-group trial.SETTING: Outpatient clinic.PATIENTS AND INTERVENTIONS: Sixty patients with a solitary BNTN or dominant nodule characterized by pressure symptoms/cosmetic problems were randomly assigned (1:1 ratio) to receive either a single session of RFA or LA. 29 patients per group completed the study.MAIN OUTCOME MEASURE: s: VRR and proportion of nodules with more than 50% reduction (technical success rate).RESULTS: At 12 months, VRR was 70.9\ub116.9% and 60.0\ub119.0% in the RFA and LA groups, respectively (p=0.024). This effect was confirmed in the linear regression model that was adjusted for age, sex, nodule baseline volume and proportion of cellular components (RFA treatment: beta=0.390; p=0.009). No significant between-group difference was observed in the technical success rate at 12 months post-treatment. A statistically significant improvement was observed from the baseline to the 12-month follow-up for compression (RFA: 4.6 \ub1 2.6 and 1.3\ub10.8, p<0.001 and LA: 4.6 \ub1 2.1 and 1.6\ub10.8, respectively, p<0.001) and cosmetic (RFA: 3.4\ub10.6 and 1.3\ub10.5, p<0.001 and LA: 3.4\ub10.5 and 1.4\ub10.6, p<0.001) scores although the between-group differences were not significant.CONCLUSION: RFA achieved a significantly larger nodule volume reduction at 12 months; however, the technical success rate was similar in the RFA and LA groups

A Rare Complication following Thyroid Percutaneous Ethanol Injection: Plummer Adenoma

Percutaneous ethanol injection (PEI) is a technique used only for benign thyroid nodules, cystic or mixed cystic-solid with a large fluid component. It is a quite low-cost, safe, and outpatient method of treatment. Rare and severe complications have been described after PEI: jugular vein thrombosis and severe ethanol toxic necrosis of the larynx combined with necrotic dermatitis. Moreover, only four thyrotoxicosis cases due to Graves’ disease have been reported. We report a case of 58-year-old female with a voluminous thyroid cystic nodule, occupying almost the entire left thyroid lobe. Our patient had already performed surgical visit and intervention of thyroidectomy had been proposed to her, which she refused. At baseline, our patient has a normal thyroid function with negative autoantibodies. According to the nodular structure, intervention of PEI has been performed with a significant improvement of compressive symptoms and cosmetic disorders. About 30 days after treatment, there was a significant volume reduction, but patient developed an acclaimed symptomatic thyrotoxicosis. After ruling out several causes of hyperthyroidism and according to the thyroid scintigraphy findings, we made the diagnosis of Plummer adenoma. To our knowledge, our patient is the first case of Plummer adenoma following PEI treatment of nontoxic thyroid nodule

Selective Internal Radiation Therapy with SIR-Spheres for the Treatment of Unresectable Colorectal Hepatic Metastases

The purpose of this study was to evaluate the effectiveness of colorectal cancer (CRC) liver metastasis radioembolization with yttrium-90 (Y90), assessing toxicity and survival rates in patients with no response to chemotherapy through our 3-year experience. From February 2005 to January 2008, we treated 41 patients affected by CRC from a cohort of selective internal radiation therapy patients treated at our institution. All patients examined showed disease progression and arrived for our observation with an abdominal CT, a body PET, and a hepatic angiography followed by gastroduodenal artery coiling previously performed by us. We excluded patients with a bilirubin level > 1.8 mg/dl and pulmonary shunt > 20% but not patients with minor extrahepatic metastases. On treatment day, under fluoroscopic guidance, we implanted a dose of Y90 microspheres calculated on the basis of liver tumoral involvement and the body surface area formula. All patients were discharged the day after treatment. We obtained, according to Response Evaluation Criteria on Solid Tumors, a complete response in 2 patients, a partial response in 17 patients, stable disease in 14 patients, and progressive disease in 8 patients. In all cases, we obtained a carcinoembryonic antigen level decrease, especially in the week 8 evaluation. Technical success rate was 98% and technical effectiveness estimated at 3 months after treatment was 80.5%. Side effects graded by Common Terminology Criteria on Adverse Events were represented by one grade 4 hepatic failure, two grade 2 gastritis, and one grade 2 cholecystitis. The median survival and the progression-free survival calculated by Kaplan-Meier analysis were 354 and 279 days, respectively. In conclusion, according to our 3-year experience, Y90 SIR-Spheres radioembolization is a feasible and safe method to treat CRC liver metastases, with an acceptable level of complications and a good response rate