US-guided laser treatment of parathyroid adenomas. (1st January 2020)

• Record Type: Journal Article
• Authors: Appelbaum, Liat; Goldberg, Shraga Nahum; Ierace, Tiziana; Mauri, Giovanni; Solbiati, Luigi
• Is Part Of: International journal of hyperthermia. Volume 37:Number 1(2020)
• Page Start: 366
• Page End: 372
• Publication Date: 2020-01-01
• Subjects: Laser ablation -- parathyroid ablation -- parathyroid adenoma -- primary hyperparathyroidism; Thermotherapy -- Periodicals; 615.832
• DOI: 10.1080/02656736.2020.1750712
• Languages: English
• ISSNs: 0265-6736

Abstract

Abstract: 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.