Ethanol injection is an effective treatment for thyroid and lymph-node recurrences in patients with papillary thyroid cancer
(July 2007)
The background of the study. The most common sites of recurrence of papillary thyroid cancer are in the thyroid bed and cervical lymph nodes in the neck. In this study, the efficacy of the injection of ethanol as treatment for these local recurrences in patients with papillary cancer was evaluated.
How the study was done. Sixteen patients with recurrent papillary cancer in the thyroid bed or lymph nodes in their neck were studied. All had been treated by total thyroidectomy and removal of lymph nodes, and then with radioactive iodine (I-131) and thyroxine.
The treatment consisted of inserting a fine needle into the tumor with ultrasound guidance and slowly injecting 99 percent ethanol. Ultrasonography and biopsy were repeated at three-month intervals. Treatment was considered successful if the nodule disappeared, tumor cells were not seen if the nodule was biopsied, or the nodule had decreased by >50 percent in size.
The results of the study. The 16 patients had 24 nodules of recurrent cancer; 8 in the thyroid bed, 16 in lymph nodes (Table). Eight nodules were injected once, 18 twice, 2 three times, and 1 four times (average, 2). The average follow-up period was 24 months.
The changes in average nodule size also are shown in the Table. Eighty-three percent of the nodules decreased in size and 17 percent disappeared after an average of two injections. Follow-up biopsy revealed no tumor cells in 5 nodules and tumor cells in 15 nodules that had initially decreased by >50 percent and did not enlarge later.
| Table. Mean (Range) Changes in Nodule Size after Ethanol Injections in 16 Patients with Papillary Cancer. |
| |
No. |
Before |
After |
| All nodules (mm) |
24 |
10 (6–29) |
5 (0–17) |
| Thyroid bed (mm) |
8 |
12 (5–21) |
6 (0–14) |
| Lymph nodes (mm) |
16 |
8 (6–29) |
5 (0–20) |
All the patients had mild pain at the injection sites that lasted less than 24 hours.
The conclusions of the study. In patients with papillary thyroid cancer who have recurrent tumor in the thyroid bed or cervical lymph nodes, injections of ethanol decrease the size of the tumor and may completely destroy it.
The original article. Lim CY, Yun JS, Lee J, Nam KH, Chung WY, Park CS. Percutaneous et
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