ABSTRACT
ABSTRACT: Postsurgical recurrences or distant metastases of poorly differentiated and medullary thyroid carcinomas are usually managed without the relevant therapeutic aid of RAI treatment. In cases of metastatic thyroid cancer not amenable to a further surgical treatment, a multimodality adjunctive therapeutic approach may be employed to eradicate or control local or distant foci. Several loco-regional procedures have been proposed for inducing a clinically signiˆcant debulking of primary tumors or distant metastases. Ultrasound (US)-guided percutaneous ethanol injection, transarterial embolization and chemoembolization, and image-guided procedures based on thermal ablation (percutaneous laser ablation (PLA), radiofrequency ablation (RFA), high-intensity focused US (HIFU), microwaves (MVs), and cryoablation) have been tested on clinical or experimental grounds. On the basis of available clinical evidence, laser ablation may be considered for inducing a rapid and effective cytoreduction of the neoplastic burden in cervical recurrences of thyroid cancer that are not amenable to surgical or RAI treatment. Both PLA and RFA are effective procedures for the palliative treatment of liver and bone metastases of poorly differentiated and medullary thyroid carcinoma with disease progression. At present, the major limitation of their clinical use is the impossibility of an accurate real-time US monitoring of the margins of the area of necrosis induced by thermal ablation. Clinical data concerning treatments with cryoablation, HIFU, MW, and electroporation are still insufˆcient to recommend their use in current clinical practice. Loco-regional procedures should always be used together with external beam radiotherapy, chemotherapy, or targeted therapy as part of an integrated multidisciplinary approach to the management of advanced thyroid cancer.
