Thyroid Cancer
Conditions
Keywords
Radiofrequency ablation, Hemithyroidectomy, thyroid cancer, Differentiated thyroid carcinoma
Brief summary
This is a multicenter randomized controlled trial including patients with small (\<2 cm) suspected or confirmed thyroid cancers. Patients are included after informed consent and randomized to one of two treatments. One treatment is a standard henithyroidectomy and the second treatment is radiofrequency ablation (RFA) of the specific tumor. The investigators will evaluate initial outcome of the allocated treatment, thyroid hormonal function, oncologic safety, quality of life, and treatment costs in a follow-up period of five years after treatment. The overall aim of the study is to improve patient's health by reducing the number of operations on small thyroid cancers. In patients with these small tumors, the long-term adverse outcome may be higher than possible benefits from the operation. For participants undergoing surgical treatment with HT, the investigators will measure final histology and both beneficial and adverse outcome from the operation. For participants undergoing RFA, the investigators expect to reduce the need for thyroid hormonal substitutions, reduce the surgical adverse outcomes, reduce treatment costs and increase QoL without a reduction in oncologic safety and outcome.
Interventions
PROCEDURERadiofrequency ablation alone
RFA of a cancer in the thyroid gland.
PROCEDURESurgery
Hemithyroidectomy of the thyroid lobe with cancer
Sponsors
University of Aarhus
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
30 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Single tumor in the thyroid gland with a FNAB suspecious of cancer or diagnostic of cancer (category V or VI in the Bethesda system) * tumor size of less than 2 cm in all dimensions.
Exclusion criteria
* suspicion of disseminated disease because of PET-positive lymph nodes ; suspect lymph-nodes by ultrasonography (US); or signs of capsular invasion of the tumor OR * tumor not eligible for RFA treatment because of high-risk location; previous thyroid surgery; concomitant hyperparathyroidism (ionized calcium \> 1.32 mmol/L and PTH \> 6 pmol//L ) OR * if the patient is pregnant OR * If the patient is unable to give informed consent.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Uncomplicated initial treatment (yes/no) | One month after randomization. | Uncomplicated treatment is defined as a composite endpoint (dichotomous; yes/no) with none of the following adverse outcomes within the first month after treatment/surgery: 1. short or long-term affection of the recurrent laryngeal nerve (RLN) based on laryngoscopy, 2. infection with a need for surgical treatment, 3. capsule rupture or bleeding with a need for operation, 4. prolonged hospital stay (more than one night), 5. any other reason for a secondary surgical intervention on the neck. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Oncologic | 5 years after randomization. | Any oncologic events with either recurrence of disease in the thyroid gland or lymph node metastasis are included (dichotomous; yes/no). Developing disease in the contralateral side of the thyroid gland will also be described and evaluated and possibly treated. However, contralateral disease will not be classified as adverse outcome after initial treatment but rather classified as new disease (dichotomous; yes/no). |
| Endocrinological 1 | At three months, 1, 2, 3, 4 and 5 years after randomization. | The need for substitutional treatment with thyroid hormones (dichotomous; yes/no) is included as secondary endpoint. |
| Health economics | At 5 years after randomization. | Collective costs for treatment with a HT operation in general anesthesia and an in-hospital stay is much more expensive than RFA treatment in the outpatient clinic. The relation between total costs for HT versus RFA are close to 5:1 and all treatment related costs will be collected during the trial. |
| Patient-reported outcome 2 | At randomization (baseline), and at three months, 1, 2, 3, 4, and 5 years after randomization. | A patient reported outcome is collected with use of the thyroid specific questionnaire Voice Related QoL (V-RQoL) (continuous outcome). |
| Patient-reported outcome 1 | At randomization (baseline), and at three months, 1, 2, 3, 4, and 5 years after randomization. | A patient reported outcome is collected with use of the thyroid specific questionnaire ThyPRO-39 (continuous outcome). |
Other
| Measure | Time frame | Description |
|---|---|---|
| Endocrinological 2 | At randomization (baseline), and at three months, 1, 2, 3, 4 and 5 years after randomization. | Thyroid hormones are evaluated by biochemical measurements (mU/L). |
Countries
Denmark
Contacts
Primary ContactSofie Louise Rygaard, MD, PhD
Backup ContactLars Rolighed, MD, PhD
Outcome results
None listed