Efficacy and safety of radiofrequency ablation for hyperparathyroidism: a meta-analysis and systematic review.

Abstract

Objective: Radiofrequency ablation (RFA) is increasingly being investigated as a treatment for parathyroid lesions, with favorable outcomes, especially in patients who are ineligible for surgery or decline surgery. We aimed to assess the efficacy and safety of RFA in treating hyperparathyroidism.

Materials and methods: PubMed and Embase were searched for original literature published on or before July 18, 2024. We included 14 eligible studies with 593 patients (241 with primary hyperparathyroidism [PHPT], 310 with secondary hyperparathyroidism [SHPT], and 42 with tertiary hyperparathyroidism [THPT]). Serial pooled means of biochemical indexes (parathyroid hormone [PTH], calcium, phosphorus), volume reduction ratio (VRR) after RFA, and complication rate were calculated.

Results: In PHPT, the pooled mean baseline PTH value of 158.7 pg/mL and serum calcium value of 10.96 mg/dL significantly decreased to 57.3 pg/mL and 9.55 mg/dL, respectively, at 12 months (both p < 0.001), with both being within normal ranges. The pooled mean VRR gradually increased, reaching 95.6% at 12 months. In SHPT, the pooled mean baseline PTH value of 1683.7 pg/mL significantly decreased to 267.2 pg/mL at 12 months (p < 0.001), which was within the target reference level (PTH ≤ 585 pg/mL). In THPT, the mean baseline PTH value of 1284.9 pg/mL decreased to 161.6 pg/mL at 1 year (p < 0.001). The pooled incidence rates of total, major, and minor complications were 27.9%, 7.5%, and 20.0%, respectively.

Conclusions: RFA showed promising effectiveness and safety profiles, particularly for patients who are ineligible for surgery or decline surgical intervention.

Key points: Question What is the efficacy and safety of RFA in treating hyperparathyroidism? Findings In PHPT, pooled mean values of biochemical indexes (serum PTH, calcium) were normal throughout 12-month follow-up. In SHPT and THPT, pooled mean PTH stayed within target ranges throughout 12-month follow-up. Clinical relevance RFA showed efficacy and safety in treating hyperparathyroidism, maintaining biochemical indexes within normal or target ranges throughout 12-month follow-ups. RFA would be a valuable treatment option for patients who are ineligible for surgery or who decline surgical intervention.