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Excerpt
For the last several years, RFA has been used for the treatment of liver tumors including primary and metastatic tumors, and particularly in the United States for “unresectable” liver tumors. In addition, the use of RFA has been expanded to other organs. RFA for tumors of the kidney and bone is becoming one of the standard therapies under appropriate indications. Other organs for which RFA has been introduced for tumor ablation but is still considered to be experimental or investigational include the lung, prostate, central nervous system such as the brain, breast, endocrine organs such as the adrenal gland, islet cell, pancreas, spleen, head and neck organs, retroperitoneal, pelvic, subcutaneous or muscular tissues, and so forth.
Parathyroid gland has been ablated previously by other methods such as ethanol injection. RFA can be technically performed for the ablation of the parathyroid gland as reported by Dr Carrafiello; however, this needs further investigation. Currently, the standard treatment for hyperparathyroidism secondary to parathyroid adenoma or hyperplasia is surgical resection. Parathyroidectomy can presently be performed safely and effectively, although invasively.
To further evaluate RFA for hyperparathyroidism, the safety and efficacy with a longer follow-up need to be investigated. In contradistinction to RFA for “unresectable malignant” tumors of the liver, RFA for hyperparathyroidism is generally for “resectable benign” lesions; therefore, absolute safety should be achieved. RFA burn injury to the surrounding organs, including the esophagus, trachea, and vascular structures, particularly the recurrent nerve, is a major concern. To avoid thermal injury to these structures, refinement of RFA technique and RFA instrumentation are necessary. The effectiveness of the treatment should be assessed in both short term and long term. Especially for intraoperative assessment, contrast-enhanced color Doppler imaging would be valuable as reported by Dr Carrafiello. If incompletely ablated, hyperparathyroidism will recur; therefore, a long-term follow-up is essential after RFA treatment.
Finally, the exact indication for RFA as opposed to surgical resection needs to be established. Can RFA be a new treatment, potentially replacing surgical resection? Because this RFA procedure is performed under ultrasound guidance, hyperparathyroidism owing to 4-gland hyperplasia is not a good indication for RFA because of nonvisualization of hyperplasia by ultrasound. On the other hand, a single-gland adenoma may become an appropriate indication for RFA treatment. Postsurgical recurrent hyperparathyroidism may be a good indication due to difficulty in reoperation. RFA for the parathyroid gland at unusual or ectopic locations needs to be taken into consideration. Preferably, RFA treatment for hyperparathyroidism is studied under a randomized controlled protocol trial with parathyroidectomy.
As it is evolving and expanding rapidly, a new technology such as RFA should be carefully assessed in each application to define its exact role and to clarify its limitations in the improvement of patient care.
