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The Oncologist Oct 2019This article provides an overview of radiofrequency ablation (RFA) and microwave ablation (MWA) for treatment of primary liver tumors and hepatic metastasis. Only... (Review)
Review
This article provides an overview of radiofrequency ablation (RFA) and microwave ablation (MWA) for treatment of primary liver tumors and hepatic metastasis. Only studies reporting RFA and MWA safety and efficacy on liver were retained. We found 40 clinical studies that satisfied the inclusion criteria. RFA has become an established treatment modality because of its efficacy, reproducibility, low complication rates, and availability. MWA has several advantages over RFA, which may make it more attractive to treat hepatic tumors. According to the literature, the overall survival, local recurrence, complication rates, disease-free survival, and mortality in patients with hepatocellular carcinoma (HCC) treated with RFA vary between 53.2 ± 3.0 months and 66 months, between 59.8% and 63.1%, between 2% and 10.5%, between 22.0 ± 2.6 months and 39 months, and between 0% and 1.2%, respectively. According to the literature, overall survival, local recurrence, complication rates, disease-free survival, and mortality in patients with HCC treated with MWA (compared with RFA) vary between 22 months for focal lesion >3 cm (vs. 21 months) and 50 months for focal lesion ≤3 cm (vs. 27 months), between 5% (vs. 46.6%) and 17.8% (vs. 18.2%), between 2.2% (vs. 0%) and 61.5% (vs. 45.4%), between 14 months (vs. 10.5 months) and 22 months (vs. no data reported), and between 0% (vs. 0%) and 15% (vs. 36%), respectively. According to the literature, the overall survival, local recurrence, complication rates, and mortality in liver metastases patients treated with RFA (vs. MWA) are not statistically different for both the survival times from primary tumor diagnosis and survival times from ablation, between 10% (vs. 6%) and 35.7% (vs. 39.6), between 1.1% (vs. 3.1%) and 24% (vs. 27%), and between 0% (vs. 0%) and 2% (vs. 0.3%). MWA should be considered the technique of choice in selected patients, when the tumor is ≥3 cm in diameter or is close to large vessels, independent of its size. IMPLICATIONS FOR PRACTICE: Although technical features of the radiofrequency ablation (RFA) and microwave ablation (MWA) are similar, the differences arise from the physical phenomenon used to generate heat. RFA has become an established treatment modality because of its efficacy, reproducibility, low complication rates, and availability. MWA has several advantages over RFA, which may make it more attractive than RFA to treat hepatic tumors. The benefits of MWA are an improved convection profile, higher constant intratumoral temperatures, faster ablation times, and the ability to use multiple probes to treat multiple lesions simultaneously. MWA should be considered the technique of choice when the tumor is ≥3 cm in diameter or is close to large vessels, independent of its size.
Topics: Female; Humans; Liver Neoplasms; Male; Microwaves; Radiofrequency Ablation; Survival Analysis
PubMed: 31217342
DOI: 10.1634/theoncologist.2018-0337 -
Techniques in Vascular and... Jun 2020
Topics: Ablation Techniques; Cryosurgery; Electroporation; Humans; Medical Oncology; Microwaves; Neoplasms; Radiofrequency Ablation; Radiology, Interventional
PubMed: 32591187
DOI: 10.1016/j.tvir.2020.100671 -
Advanced Drug Delivery Reviews 2020Local application of hyperthermia has a myriad of effects on the tumor microenvironment as well as the host's immune system. Ablative hyperthermia... (Review)
Review
Local application of hyperthermia has a myriad of effects on the tumor microenvironment as well as the host's immune system. Ablative hyperthermia (typically > 55 °C) has been used both as monotherapy and adjuvant therapy, while mild hyperthermia treatment (39-45 °C) demonstrated efficacy as an adjuvant therapy through enhancement of both chemotherapy and radiation therapy. Clinical integration of hyperthermia has especially great potential in pediatric oncology, where current chemotherapy regimens have reached maximum tolerability and the young age of patients implies significant risks of late effects related to therapy. Furthermore, activation of both local and systemic immune response by hyperthermia suggests that hyperthermia treatments could be used to enhance the anticancer effects of immunotherapy. This review summarizes the state of current applications of hyperthermia in pediatric oncology and discusses the use of hyperthermia in the context of other available treatments and promising pre-clinical research.
Topics: DNA Repair-Deficiency Disorders; Drug Delivery Systems; High-Intensity Focused Ultrasound Ablation; Humans; Hyperthermia, Induced; Immune System; Liposomes; Microsatellite Instability; Microwaves; Neoplasms; Pediatrics; Tumor Microenvironment; Ultrasonography
PubMed: 33203538
DOI: 10.1016/j.addr.2020.10.016 -
Techniques in Vascular and... Jun 2020Renal cell carcinoma is most commonly diagnosed in the sixth or seventh decade of life. Historically, surgical extirpation was the gold standard treatment option for... (Review)
Review
Renal cell carcinoma is most commonly diagnosed in the sixth or seventh decade of life. Historically, surgical extirpation was the gold standard treatment option for small renal masses. However, given the comorbidities in this elderly population, not all patients are candidates for surgery. The development of minimally invasive ablative therapies has solved the surgical dilemma in this patient population. Furthermore, the 2017 American Urological Association guidelines recommends consideration of percutaneous image guided thermal ablation as a treatment option for masses smaller than 3 cm even in healthy individuals. Percutaneous image guided thermal ablation is an attractive treatment option providing excellent local tumor control, fewer complications, better preservation of the renal functions, faster recovery and shorter hospital stay. Various ablative modalities are available in clinical practice. This includes radiofrequency ablation, cryoablation, microwave ablation, irreversible electroporation, high intensity focused ultrasound, and laser ablation. In this review, we focus on the most commonly used modalities including radiofrequency ablation and cryoablation and to a lesser extent microwave ablation and irreversible electroporation.
Topics: Carcinoma, Renal Cell; Cryosurgery; Electroporation; Humans; Kidney Neoplasms; Microwaves; Postoperative Complications; Radiofrequency Ablation; Risk Factors; Surgery, Computer-Assisted; Treatment Outcome; Tumor Burden
PubMed: 32591194
DOI: 10.1016/j.tvir.2020.100674 -
International Journal of Molecular... Jun 2020Hepatocellular carcinoma (HCC) is one of the most common causes of cancer-related deaths worldwide and its incidence is rising. Percutaneous locoregional therapies, such... (Review)
Review
Hepatocellular carcinoma (HCC) is one of the most common causes of cancer-related deaths worldwide and its incidence is rising. Percutaneous locoregional therapies, such as radiofrequency ablation and microwave ablation, are widely used as curative treatment options for patients with small HCC, but their effectiveness remains restricted because of the associated high rate of recurrence, occurring in about 70% of patients at five years. These thermal ablation techniques have the particularity to induce immunomodulation by destroying tumours, although this is not sufficient to raise an effective antitumour immune response. Ablative therapies combined with immunotherapies could act synergistically to enhance antitumour immunity. This review aims to understand the different immune changes triggered by radiofrequency ablation and microwave ablation as well as the interest in using immunotherapies in combination with thermal ablation techniques as a tool for complementary immunomodulation.
Topics: Carcinoma, Hepatocellular; Clinical Trials as Topic; Combined Modality Therapy; Humans; Immunotherapy; Liver Neoplasms; Microwaves; Neoplasm Recurrence, Local; Radiofrequency Ablation; Treatment Outcome
PubMed: 32575734
DOI: 10.3390/ijms21124398 -
Abdominal Radiology (New York) Apr 2016Surveillance programs and widespread use of medical imaging have increased the detection of hepatic tumors. When feasible, surgical resection is widely accepted as the... (Review)
Review
Surveillance programs and widespread use of medical imaging have increased the detection of hepatic tumors. When feasible, surgical resection is widely accepted as the curative treatment of choice, but surgical morbidity and mortality has spurred the development of minimally invasive ablative technologies over the last 2 decades. Microwave ablation has emerged as a promising thermal ablation modality with improving oncologic efficacy due to technical improvements and image guidance strategies. This article provides an overview of microwave application in liver tumors, and we discuss currently available equipment, clinical efficacy, and safety and provide comparisons with other commonly used therapies. This article also introduces advanced ablative techniques and combination therapies that may help achieve precise ablation and further enhance the efficacy of microwave ablation.
Topics: Catheter Ablation; Diagnostic Imaging; Equipment Safety; Humans; Imaging, Three-Dimensional; Liver Neoplasms; Microwaves; Patient Safety; Radiography, Interventional; Surgery, Computer-Assisted
PubMed: 26880177
DOI: 10.1007/s00261-016-0662-6 -
Critical Reviews in Biomedical... 2018Microwave (MW) ablation has emerged as a minimally invasive therapeutic modality and is in clinical use for treatment of unresectable tumors and cardiac arrhythmias,... (Review)
Review
Microwave (MW) ablation has emerged as a minimally invasive therapeutic modality and is in clinical use for treatment of unresectable tumors and cardiac arrhythmias, neuromodulation, endometrial ablation, and other applications. Components of image-guided MW ablation systems include high-power MW sources, ablation applicators that deliver power from the generator to the target tissue, cooling systems, energy-delivery control algorithms, and imaging guidance systems tailored to specific clinical indications. The applicator incorporates a MW antenna that radiates MW power into the surrounding tissue. A variety of antenna designs have been developed for MW ablation with the objective of efficiently transferring MW power to tissue, with a radiation pattern well matched to the size and shape of the targeted tissue. Here, we survey advances in percutaneous, endocavitary, and endoscopic antenna designs as an integral element of MW ablation applicators for a diverse set of clinical applications.
Topics: Catheter Ablation; Equipment Design; Humans; Hyperthermia, Induced; Microwaves; Radiofrequency Ablation
PubMed: 30806212
DOI: 10.1615/CritRevBiomedEng.2018028554 -
Journal of Cancer Research and... Dec 2022Spinal metastases are the most common source of morbidity in patients with cancer. Recently, microwave ablation has produced satisfactory results in the management of... (Review)
Review
Spinal metastases are the most common source of morbidity in patients with cancer. Recently, microwave ablation has produced satisfactory results in the management of spinal metastases. However, there is still controversy in terms of clinical treatment, such as indication, power, time, and temperature. To standardize the application of microwave ablation technology and reduce the risk of surgical-related complications in spinal metastases, in this report, we aimed to summarize the current evidence and clinical experience of microwave ablation and developed a clinical guideline, initiated by the Musculoskeletal Tumor Group of the Committee for Minimally Invasive Therapy in Oncology of the Chinese Anti-Cancer Association. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used in to rate the quality of evidence and the strength of recommendations, and the Reporting Items for Practice Guidelines in Healthcare (RIGHT) checklist was strictly followed to report the guideline. Finally, 15 evidence-based recommendations were formulated based on the 15 most concerned clinical questions among orthopedic surgeons, oncologists, and interventional radiologists in China. This guideline aims to promote the science-based normalization of microwave ablation for the treatment of spinal metastases.
Topics: Humans; Catheter Ablation; Microwaves; Radiofrequency Ablation; Spinal Neoplasms
PubMed: 36647941
DOI: 10.4103/jcrt.jcrt_655_22 -
Journal of Evidence-based Medicine May 2015To assess the efficacy and safety of focused ultrasound therapy (FU) and microwave therapy (MW) for cervical ectopy (CE). (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
To assess the efficacy and safety of focused ultrasound therapy (FU) and microwave therapy (MW) for cervical ectopy (CE).
METHODS
We searched PubMed, EMbase, the Cochrane Library, Chinese Biomedical Literature Database (CBM), Chinese Scientific Journals Database (VIP), China Academic Journals Full-text Database (CNKI), and WanFang Data for randomized controlled trials (RCTs) comparing FU with MW for women with symptomatic CE from inception to 30 August 2014. Two review authors (Tang XL and Gao Z) independently screened for eligible studies according to the inclusion and exclusion criteria, extracted data and assessed risk of bias of included RCTs. Then, meta-analysis was performed using the RevMan 5.2 software. Funnel plots were used to evaluate publication bias.
RESULTS
A total of 33 RCTs with 11,759 participants were included. All studies had high risk of bias. The results of meta-analysis indicated that compared to MW, FU significantly reduced the risk of vaginal bleeding (RR = 0.09, 95%CI 0.05 to 0.17, P < 0.00001) and vaginal discharge (RR = 0.10, 95%CI 0.04 to 0.24, P < 0.00001), increased the cure rate (RR = 1.10, 95%CI 1.05 to 1.15, P < 0.0001) and the total effectiveness rate (RR = 1.04, 95%CI 1.02 to 1.06, P = 0.0005), and decreased the recurrence rate (RR = 0.13, 95%CI 0.02 to 1.00, P = 0.05); however, this last difference was not statistically significant.
CONCLUSION
Current available evidence suggests that FU is safer and more effective than MW for treating CE. However, some limitations will reduce the reliability of our results. Further well-designed clinical trials are needed to provide further clarification.
Topics: Endometriosis; Female; Humans; Microwaves; Ultrasonic Therapy; Uterine Cervical Diseases
PubMed: 25954850
DOI: 10.1111/jebm.12150 -
Surgical Technology International Nov 2020Hepatocellular carcinoma (HCC) and secondary hepatic malignancies, most often arising from colorectal cancer, are a leading cause of morbidity and cancer-related deaths... (Review)
Review
Hepatocellular carcinoma (HCC) and secondary hepatic malignancies, most often arising from colorectal cancer, are a leading cause of morbidity and cancer-related deaths worldwide. In lieu of first-line surgical resection, which is precluded in more than 75% of cases due to underlying comorbid conditions or locally advanced disease, several minimally-invasive transarterial and thermal ablation procedures have emerged as safe and effective alternative therapies in select patients. Among the thermal ablative techniques, microwave ablation (MWA) has become the preferred treatment modality because of its operational convenience and superior heating profile, allowing for larger ablation zones and reduced treatment times while maintaining high technical success rates. To date, MWA has been demonstrated to provide equivalent, and in some cases improved, clinical outcomes compared to radiofrequency ablation (RFA) in patients with inoperable HCC or oligometastatic disease. Active areas of investigation include the comparison of MWA and transarterial therapies, such as transarterial chemoembolization (TACE), as well as combined multimodality therapies. Here we review the emerging topic of MWA for the treatment of hepatic malignancies by examining staging and treatment strategies, available technologies, procedural protocol and technique, and clinical outcomes.
Topics: Carcinoma, Hepatocellular; Catheter Ablation; Chemoembolization, Therapeutic; Humans; Liver Neoplasms; Microwaves; Radiofrequency Ablation; Treatment Outcome
PubMed: 32681731
DOI: No ID Found