Therapeutic outcomes and safety of radiofrequency ablation for primary papillary thyroid carcinoma: A game-changing meta-analysis

Abstract

Background

Radiofrequency ablation (RFA) is an emerging treatment option for small, low-risk papillary thyroid carcinoma (PTC). This systematic review and meta-analysis aimed to evaluate and compare the efficacy and safety profiles of RFA for primary T1a vs. T1b PTC.

Methods

PubMed, Web of Science, Embase, Google Scholar, and ScienceDirect databases were searched from inception to February 14, 2024 for studies reporting outcomes of RFA for T1a vs. T1b PTC with no known nodal or distant metastasis. The primary outcomes assessed were pooled proportions of tumor disappearance, volume reduction, complications, and recurrence.

Results

Twenty studies with 6,613 RFA-treated PTC nodules were included. The median age was 44 years, and the average follow-up was 36.4 months. The mean tumor volume and diameter were 168.9 mm³ and 0.69 cm, respectively. The pooled tumor disappearance rate was 94.3 % for all tumors, with rates of 96.1 % for T1a and 76.7 % for T1b lesions (p = 0.05). The disappearance rate increased from 61.8 % at 12 months to 91.5 % at 48 months post-RFA. The overall volume reduction rate (VRR) was 99.4 % for both T1a and T1b tumors, increasing from 36.8 % at 1 month to 99.6 % at 48 months. Tumor progression occurred in only 1.33 % of the cases overall, with low recurrence rates in both T1a (1.11 %) and T1b (4.21 %) lesions. New cancer foci and lymph node metastases were rare, observed in 0.81 % and 0.20 % of cases, respectively. The overall complication rate was 1.71 %, with transient voice change (0.44 %) and neck pain (0.30 %) being the most common.

Conclusions

RFA is a safe and effective minimally invasive treatment option for both T1a and T1b PTC, with high tumor disappearance and volume reduction rates and low complication and recurrence rates. The low progression rates in both tumor sizes suggest that RFA is a promising alternative to surgery for selected low-risk PTC patients. Prospective studies with standardized protocols are warranted to validate these findings.