International journal of hyperthermia : the official journal of European Society for Hyperthermic Oncology, North American Hyperthermia Group | 2021
Microwave ablation versus parathyroidectomy for severe secondary hyperparathyroidism in patients on hemodialysis: a retrospective multicenter study.
Abstract
BACKGROUND\nMicrowave ablation is effective for severe secondary hyperparathyroidism, but the difference in efficacy between microwave ablation and parathyroidectomy remains unclear. In this multicenter retrospective cohort study, we compared the long-term clinical efficacy of microwave ablation and parathyroidectomy for severe secondary hyperparathyroidism undergoing hemodialysis.\n\n\nMATERIALS AND METHODS\nThe patients were divided into microwave ablation and parathyroidectomy groups. The primary endpoint was the proportion of patients with intact parathyroid hormone (iPTH) concentrations within the target range (100-600\u2009pg/mL) during the efficacy assessment phase. The secondary endpoints were (i) differences in iPTH concentrations over time between the two groups, and (ii) decreases in iPTH concentrations over time in the two groups.\n\n\nRESULTS\nMicrowave ablation was performed in 47/92 patients and parathyroidectomy in 45/92. Primary endpoint: iPTH concentrations within the target range were achieved during the efficacy assessment phase in 26/47 patients (55.3%) and in 14/45 (31.1%) patients in the microwave ablation and parathyroidectomy groups, respectively (p\u2009=\u2009.02). Secondary endpoints: (i) Mean iPTH concentrations during the efficacy assessment phase were significantly higher in the microwave ablation versus parathyroidectomy groups (649\u2009±\u2009519\u2009pg/mL versus 136\u2009±\u2009228\u2009pg/mL, respectively; p\u2009<\u2009.01). (ii) Mean decrease in iPTH concentration from baseline was 725\u2009±\u2009605\u2009pg/mL versus 1369\u2009±\u2009478\u2009pg/mL in the MWA versus parathyroidectomy groups, respectively (p\u2009<\u2009.01).\n\n\nCONCLUSIONS\nUltrasound-guided percutaneous microwave ablation provides higher iPTH target-achieving rates than parathyroidectomy in patients with severe secondary hyperparathyroidism undergoing hemodialysis.