US-guided laser treatment of parathyroid adenomas

被引:22
作者
Appelbaum, Liat [1 ]
Goldberg, Shraga Nahum [1 ]
Ierace, Tiziana [2 ]
Mauri, Giovanni [3 ]
Solbiati, Luigi [2 ,4 ]
机构
[1] Hadassah Hebrew Univ, Dept Radiol, Med Ctr, Jerusalem, Israel
[2] Humanitas Clin & Res Hosp, Milan, Italy
[3] European Inst Oncol, Dept Intervent Radiol, Milan, Italy
[4] Humanitas Univ Pieve Emanuele, Dept Biomed Sci, Milan, Italy
关键词
Laser ablation; parathyroid ablation; parathyroid adenoma; primary hyperparathyroidism; PERCUTANEOUS MICROWAVE ABLATION; PRIMARY HYPERPARATHYROIDISM; RADIOFREQUENCY ABLATION; ETHANOL INJECTION; ULTRASOUND; FEASIBILITY; MANAGEMENT; THERAPY; TUMORS;
D O I
10.1080/02656736.2020.1750712
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Objective: To determine the clinical efficacy of laser ablation for the tredatment of primary hyperparathyroidism (pHPT). Materials and methods: Twelve patients with pHPT were treated with laser ablation. Energy was administered by means of 1.5 m optical fibers percutaneously placed into the target via 21 G needles. A laser ablation unit (EchoLaser X4, Esaote) applied 3 W power for 400-600 s/fiber/insertion to a total 3600-9000 Joules of energy. Patient serum parathyroid hormone (PTH) and calcium levels were checked at baseline and thereafter every 6 months. Patients were followed-up for 2 years with serologic and contrast-enhanced ultrasound. Therapeutic success was defined as normal PTH and calcium levels together with disappearance of nodule-related symptoms. Results: All procedures were performed in single session. Immediately following ablation, contrast enhanced ultrasound confirmed that all but one target had become avascular (technical success rate 11/12; 92%), remaining avascular at all follow-up ultrasound examinations, thereafter. The mean volume of parathyroid nodules decreased from 0.54 cc to 0.36 cc (72.0%). Serum PTH and calcium levels were significantly lower at 1, 12 and 24 m compared to baseline (p < 0.01). By 6 m, PTH and calcium returned to normal and were stable until 24 m in all successfully treated patients. All cases of hyperparathyroid-related symptoms resolved by 6 m (ostealgia [n = 5], repeated renal colic [n = 5], vomiting [n = 3]). Only one patient (8%) reported transient dysphonia as a minor complication. Conclusion: Laser ablation of enlarged, symptomatic parathyroid glands is safe and well-tolerated and can produce long-term, sustained reduction of serum PTH and calcium levels.
引用
收藏
页码:366 / 372
页数:7
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