RFA May Have Role in Treating Secondary Hyperparathyroidism

Researchers caution that radiofrequency ablation should only be considered for patients ineligible for parathyroid surgery.
Researchers caution that radiofrequency ablation should only be considered for patients ineligible for parathyroid surgery.

Ultrasound-guided radiofrequency ablation (RFA) of hyperplastic parathyroid glands may be a feasible option for treating selected patients with secondary hyperparathyroidism (SHPT) associated with chronic kidney disease, according to a new study.

Based on their findings, investigators concluded that, given the risk profile and limited effectiveness of the procedure, “it should only be considered as a possible alternative in patients who are not eligible for parathyroid surgery.”

The study involved 34 CKD patients with refractory SHPT who underwent ultrasound-guided radiofrequency ablation (RFA) of some or all parathyroid glands. Of these patients, 15 underwent RFA of all 4 glands, 10 had 3 glands ablated, and 9 had 1 or 2 glands ablated.

Following RFA, intact parathyroid hormone (iPTH), calcium, and phosphorus levels decreased in all groups. One year after RFA, these parameters remained significantly lower in the 4-gland ablation group compared with the 3-gland and 1- to 2-gland groups.

One year after RFA, 15 patients had iPTH levels in the reasonable range (less than 477 pg/mL) and 19 had excessive iPTH levels (477 pg/mL or higher). The researchers noted that, based on Kidney Disease: Improving Global Outcomes guidelines, PTH levels 2 to 9 times the upper limit of normal (106–477 pg/mL) is considered reasonable for patients with CKD stage 5.

Of the 15 patients with iPTH in the reasonable range, 12 (80%) had all 4 glands ablated whereas 3 had 1 to 3 glands ablated, Chengzhong Peng, MS, of Hangzhou Hospital of Traditional Chinese Medicine in Hangzhou, China, and colleagues reported online in Head & Neck. In addition, compared with the patients who had excessive PTH levels (477 pg/mL or higher) 1 year after RFA, the PTH levels on the first day after RFA were significant lower in the reasonable PTH group (138 vs. 903 pg/mL). 

In addition, use of 272 pg/mL as a cutoff for PTH levels 1 day after ablation can predict PTH levels in the reasonable range 1 year after ablation with 89.5% sensitivity and 100% specificity.

“In order to achieve a good ablation effect, all hyperplastic parathyroid glands found on ultrasound should be ablated,” Peng's group wrote. “PTH levels 1 day after ablation might be a good indicator to assess the therapeutic effect.”

Reference

1. Peng C, Zhang Z, Liu J, et al. Efficacy and safety of ultrasound-guided radiofrequency ablation of hyperplastic parathyroid gland for secondary hyperparathyroidism associated with chronic kidney disease. Head Neck 2016; published online ahead of print.

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