Efficacy and safety of radiofrequency ablation (RFA) for recurrent metastatic thyroid carcinoma to the lateral neck: a systematic review

Abstract Aim To evaluate the efficacy and safety of radiofrequency ablation (RFA) for lateral cervical recurrence of metastatic thyroid carcinoma compared to revision surgery (after a primary thyroidectomy and selective neck dissection) and RFA in the central compartment or thyroid bed. This review focuses on studies that differentiate between lateral and central neck RFA, as lesion location might influence outcomes and complication rates. Methods A systematic review was conducted using the PRISMA guidelines, looking at articles that address management of thyroid cancer recurrence in the lateral neck. Data on tumor volume reduction, thyroglobulin (Tg) levels, recurrence rates, and complications were analyzed. Results Eight studies were include in this review. Across 252 patients treated with RFA, complete nodule disappearance was reported in up to 97% of cases, with therapeutic success rates ranging from 92 to 100%. Volume reduction rates (VRR) reached 93–100% at 24–60 months. Thyroglobulin levels consistently decreased post-treatment, with reductions from baseline values as high as 37 ng/mL to < 1 ng/mL. Recurrence-free survival was 90.8–96% at 1–3 years, and up to 94.5% at 6 years in long-term follow-up. Radiofrequency ablation demonstrated a favorable safety profile: transient voice changes occurred in 3.7–8.6% of patients, mainly in central lesions, with no reported cases of hypocalcemia. Surgery showed higher complication rates, including hypocalcemia (8.7–30%) and permanent voice changes. Comparative studies showed that while surgery may offer more frequent biochemical remission, RFA remains effective with fewer complications. Conclusion RFA is an effective, minimally invasive alternative for lateral cervical recurrence of thyroid cancer. Its high efficacy and superior safety profile make it a valuable option, particularly for patients avoiding revision surgery. Differentiating lateral and central RFA is important, as both show comparable efficacy, though central RFA has a higher complication risk.