Radiofrequency ablation treatment for recurrent parathyroid cancer in the neck

Radiofrequency Ablation For Recurrent Parathyroid Carcinoma

This trial will try ultrasound-guided radiofrequency ablation in adults with recurrent parathyroid carcinoma and uncontrolled high blood calcium to see if it lowers their calcium and parathyroid hormone (PTH) levels.

Quick facts

• Phase: Not applicable
• Study type: Interventional
• Enrollment: 20 (estimated)
• Ages: 18 Years and up
• Sex: All
• Sponsor: M.D. Anderson Cancer Center (Academic / other)
• Locations: 1 site (Houston, Texas)
• Trial ID: NCT07475780 on ClinicalTrials.gov

What this trial studies

This interventional study will enroll up to 20 adults with surgically proven recurrent parathyroid carcinoma and at least one ultrasound-visible neck lesion who have persistent or recurrent hypercalcemia. Participants will undergo ultrasound-guided radiofrequency ablation (RFA) of the recurrent lesion and be monitored longitudinally with serum calcium and PTH measurements. The study will also document sonographic changes after RFA, procedure-related complications, and time until recurrence of hypercalcemia. Patients will be recruited and treated at UT MD Anderson Cancer Center in Houston with scheduled follow-up visits to capture outcomes.

Who should consider this trial

Good fit: Adults with surgically proven recurrent parathyroid carcinoma, an ultrasound-visible recurrent lesion in the neck, and persistent or recurrent hypercalcemia who are not surgical candidates or prefer nonsurgical management.

Not a fit: Patients without ultrasound-visible lesions, with widespread metastatic disease, or whose hypercalcemia is already controlled by other treatments are unlikely to benefit from this localized RFA approach.

Why it matters

Potential benefit: If successful, RFA could lower blood calcium and PTH, relieve symptoms of hypercalcemia, and offer a less invasive local treatment option for patients who cannot or prefer not to have repeat surgery.

How similar studies have performed: Small case reports and case series have suggested that RFA can reduce calcium and control local parathyroid lesions in selected patients, but there are no large controlled trials establishing efficacy for recurrent parathyroid carcinoma.

Eligibility criteria

Inclusion Criteria:

Adult patients with recurrent parathyroid carcinoma that was previously resected and persistent or recurrent hypercalciemia. Patients are not surgical candidates or strongly desire nonsurgical intervention. Eligibility for enrollment will be based upon meeting inclusion and exclusion criteria as detailed in section 4.1 and 4.2.

The study will include 20 eligible patients or lesions. Utmost care will be taken to minimize risk to patients through careful selection of patients and scheduled assessments (Table 1). Patients will be recruited through the Endocrine, Endocrine surgery, Head and Neck Surgery Clinics, as well as Neuro-Interventional Radiology Ultrasound. All patients who meet the inclusion and exclusion criteria and agree to participate in the study will be consented and then enrolled into the study. No other criteria, apart from the eligibility criteria detailed below, will be used for subject selection. We anticipate enrolling approximately 1 patient every 2 months (0.5 patients/month), for a total accrual period of up to 40 months to reach the planned sample size of 20 patients. Each participant will be followed for 12 months after RFA, so the total study duration is estimated at approximately 52 months from first patient enrollment to last patient follow-up.

Candidates for this study must meet all of the following inclusion criteria:

1. Patient is older than 18 years, is not a surgical candidate or refuses to have surgery.
2. Patient is medically fit to undergo local anesthesia with or without conscious sedation.
3. Patient is able to understand and give consent to participation in the study.
4. Confirmed parathyroid carcinoma by prior surgery and histopathology.
5. Presence of local recurrence or implant in the neck visible on ultrasound.
6. Distant oligometastasis visible on ultrasound.
7. Solid nodule without macrocalcification or internal cystic degeneration
8. Patient who is off of Cinacalcet
9. Entirety of the selected nodule is visible on ultrasound without significant extension posterior to trachea or mediastinal component (ie Type A, E, or high F).
10. Selected nodule is amenable to medial or lateral approach.
11. Normal complete blood count, blood coagulation.
12. Patient agrees to participate in the clinical study and to complete all required visits and evaluations.
13. Negative serum or urine pregnancy test for females of childbearing potential at baseline pre-procedure evaluation.

Exclusion Criteria:

Candidates will be ineligible for enrollment in the study if any of the following conditions apply:

1. Patients with cardiac arrhythmia and/or implanted cardiac device
2. Surgically naïve parathyroid lesions, parathyroid adenoma or atypical parathyroid tumor.
3. Pregnancy
4. Allergies to medications for anesthesia.
5. Cystic nodules (\< 70% solid components)
6. Calcified nodules
7. Targeted nodule within 0.5 cm from the major vessels, vagus nerve, brachial plexus, and recurrent laryngeal nerve.
8. Patients with contralateral vocal cord paralysis.
9. Uncorrectable coagulopathy with PTT\>1.5 X ULN or INR \>1.5 or platelet count \<100,000 per mm3

Where this trial is running

Houston, Texas

• UT MD Anderson — Houston, Texas, United States (Recruiting)

Study contacts

• Principal investigator: Thinh Vu, MD — UT MD Anderson
• Study coordinator: Thinh Vu, MD

Conditions Recurrent Parathyroid Carcinoma