Wien, 28 - Repository of the LBI-HTA - Ludwig Boltzmann Gesellschaft

Radiofrequenzablation bei benignen und malignen Vera¨nderungen endokriner OrganeExecutive SummaryRFA: minimallyinvasive,thermaldestruction ofnodules/tumorsliterature search + infosfrom manufacturersbest available evidenceare prospective caseseriesquality of evidenceaccording to GRADEbenign and malignantthyroid nodules: 4 caseseriesadrenocortical adenomaand adrenal metastases:2 case seriesvery low quality ofevidenceBackground and research questionRadiofrequency ablation (RFA) is a relatively new, minimally-invasive ablationmethod that destroys tumors by local application of heat. This systematicreview evaluates the following indications of RFA for the treatment ofbenign and malignant lesions of endocrine organs: benign thyroid nodulesand throid cancer as well as adrenocortical adenomas and adrenal metastases.MethodsA systematic literature search in various databases was supplemented by ahandsearch (manually and by using Scopus). Additionally, RFAmanufacturerswere contacted for further information. Two review authorsindependently screened and selected the literature and included eligiblestudies. In cases of disagreement, consensus was achieved through discussionor by involving a third person. The data was extracted by one authorand checked by a second author. In the absence of (randomised) controlledtrials, prospective (uncontrolled) case-series were included as best availableevidence and assessed the quality of evidence according to the GRADE(Grading of Recommendations Assessment, Development and Evaluation)approach.ResultsThree case series were identified of RFA for the treatment of benign thyroidnodules and one case series of RFA for the treatment of thyroid cancer. Thestudies indicate that RFA is efficient and safe.For the RFA-treatment of adrenal tumors, two case series, one of which wasconcerned with the treatment of benign aldosteron-producing adrenocorticaladenomas and the other one was concerned with the treatment of adrenalmetastases were identified. The reported efficacy outcomes in the includedcase series were limited to the recurrence rate associated with RFA of adrenalmetastases. The low complication rate indicates that RFA for the treatmentof adrenal tumors is safe.Conclusion and recommendationAccording to GRADE, the quality of evidence is very low due to the uncontrolledstudy design of the included case series. Overall, the available evidenceis insufficient to assess the efficacy and safety of RFA compared to therespective standard therapy for the treatment of benign and malignant lesionsof endocrine organs. Currently, the inclusion into the hospital benefitcatalogue is not recommended.6 LBI-HTA | 2012