Percutaneous Laser Ablation in Benign Thyroid Nodules.Long Term Results

Purpose

Thyroid nodule pathologies occur frequently and represent a clinical issue for the endocrinologists, surgeons, nuclear physicians as well as the general practitioners. The incidence of this pathology has been further highlighted by the introduction of the ultrasound examination into the clinical practice as 20% with impalpable thyroid nodules is now detected through ultrasound. The majority of nodules are benign and characterized by slow growth, and therefore treated with suppressive doses of levothyroxine. Long-term levothyroxine treatment has, however, several well-known side effects and limitations.

During the last years, number of controlled studies have demonstrated that ultrasound guided percutaneous laser treatment (PLA) is able to reach the target lesion within the thyroid with a high level of precision, and to destroy the thyroid tissue in a predictable and repeatable fashion, without side effects.

Aim of the study:

1. to assess 1-year and 3-year effect of laser ablation therapy on the volume of benign thyroid nodules and on nodule-related symptoms, and to compare these effects with findings in control group without active therapy;
2. to assess the eventual re-occurence of thyroid lesions (observed after other types of ablation treatment, like percutaneous ethanol injection) during a 3-year follow-up;
3. to demonstrate reproducibility of results within different environments and under different operators;
4. to validate eventual presence of major or minor side effects.

To this aim we shall randomized 200 patients either for PLA (100 pts) or standard follow-up. Patients will be recruited, treated and followed in 4 italian centers (Ospedale Regina Apostolorum - Roma, Arcispedale S. Maria Nuova - Reggio Emilia, Ospedale S. Maria della Misericordia - Perugia, Ospedale di Cisanello - Pisa) by physicians with experience in PLA.The scientific coordinator of this multicentre study is dr. Claudio Maurizio Pacella.

Criteria

Inclusion Criteria:

• The presence of a single nodule or dominating nodule;
• A solid or mixed echo-structure with less than 20% fluid volume;
• A lesion volume between 5 and 18 ml (greatest diameter > 3.0 cm and <= 4 cm);
• Thyroid hormone and TSH serum levels within the normalcy value;
• 2 cytologically negative examinations for suspected neoplasia (British Thyroid Association, Second class THY)within the last six months;
• Calcitonin values within the normalacy value;
• Anticoagulant treatment suspension and antiaggregation treatment suspended for at least 72 hours.

Exclusion Criteria:

• Hyperfunctioning lesion (99mTc scintigraph);
• Autoimmune thyreopathy or elevation of autoantibodies;
• Active anticoagulant treatment or antiaggregation treatment.

Locations

Italy, Roma
Ospedale Regina Apostolorum	Recruiting
Albano Laziale, Roma, Italy, 00041
Contact: Giancarlo Bizzarri, MD     06-93298824 ext +39     bizzarrigiancarlo@libero.it
Italy
Azienda Ospedaliera di Perugia - Osp. S.Maria della Misericordia	Recruiting
Perugia, Italy, 06126
Contact: Pierpaolo De Feo, MD     075-5783673 ext +39     defeo@dimisem.med.unipg.it
Azienda Ospedaliero-Universitaria di Pisa - Presidio di Cisanello	Recruiting
Pisa, Italy, 56124
Contact: Aldo Pinchera, MD     050-544723 ext +39     a.pinchera@endoc.med.unipi.it
Arcispedale S. Maria Nuova	Recruiting
Reggio Emilia, Italy, 42100
Contact: Roberto Valcavi, MD     0522-296630 ext +39     roberto.valcavi@asmn.re.it

Sponsors and Collaborators

Elesta S.R.L.

  More Information
Publications:

Pacella CM, Bizzarri G, Guglielmi R, Anelli V, Bianchini A, Crescenzi A, Pacella S, Papini E. Thyroid tissue: US-guided percutaneous interstitial laser ablation-a feasibility study. Radiology. 2000 Dec;217(3):673-7.

Døssing H, Bennedbaek FN, Karstrup S, Hegedüs L. Benign solitary solid cold thyroid nodules: US-guided interstitial laser photocoagulation--initial experience. Radiology. 2002 Oct;225(1):53-7.

Pacella CM, Bizzarri G, Spiezia S, Bianchini A, Guglielmi R, Crescenzi A, Pacella S, Toscano V, Papini E. Thyroid tissue: US-guided percutaneous laser thermal ablation. Radiology. 2004 Jul;232(1):272-80. Epub 2004 May 20.

Døssing H, Bennedbaek FN, Hegedüs L. Effect of ultrasound-guided interstitial laser photocoagulation on benign solitary solid cold thyroid nodules - a randomised study. Eur J Endocrinol. 2005 Mar;152(3):341-5.

Papini E, Guglielmi R, Bizzarri G, Graziano F, Bianchini A, Brufani C, Pacella S, Valle D, Pacella CM. Treatment of benign cold thyroid nodules: a randomized clinical trial of percutaneous laser ablation versus levothyroxine therapy or follow-up. Thyroid. 2007 Mar;17(3):229-35.

Responsible Party:	Elesta SRL ( Serse Pierotti )
ClinicalTrials.gov Identifier:	NCT00858104     History of Changes
Other Study ID Numbers:	IALT-07
Study First Received:	March 6, 2009
Last Updated:	March 6, 2009
Health Authority:	Italy: Ethics Committee

Additional relevant MeSH terms:

Thyroid Nodule Thyroid Neoplasms Endocrine Gland Neoplasms Neoplasms by Site

Neoplasms Head and Neck Neoplasms Endocrine System Diseases Thyroid Diseases