-
European Radiology May 2021To systematically review microwave ablation (MWA) protocols, safety, and clinical efficacy for treating bone tumors. (Review)
Review
AIM
To systematically review microwave ablation (MWA) protocols, safety, and clinical efficacy for treating bone tumors.
MATERIALS AND METHODS
A systematic literature search was conducted using PubMed, the Cochrane Library, EMBASE, and Web of Science database. Data concerning patient demographics, tumor characteristics, procedure, complications, and clinical outcomes were extracted and analyzed.
RESULTS
Seven non-comparative studies (6 retrospective, 1 prospective) were included accounting for 249 patients and 306 tumors (244/306 [79.7%] metastases; 25/306 [8.2%] myelomas, and 37/306 [12.1%] osteoid osteomas [OO]). In malignant tumors, MWA power was 30-70 W (except in one spinal tumors series where a mean power of 13.3 W was used) with pooled mean ablation time of 308.3 s. With OO, MWA power was 30-60 W with mean ablation time of 90-102 s. Protective measures were very sporadically used in 5 studies. Additional osteoplasty was performed in 199/269 (74.0%) malignant tumors. Clinically significant complications were noted in 10/249 (4.0%) patients. For malignant tumors, estimated pain reduction on the numerical rating scale was 5.3/10 (95% confidence intervals [95%CI] 4.6-6.1) at 1 month; and 5.3/10 (95% CI 4.3-6.3) at the last recorded follow-up (range 20-24 weeks in 4/5 studies). For OO, at 1-month follow-up, effective pain relief was noted in 92.3-100% of patients.
CONCLUSION
MWA is effective in achieving pain relief at short- (1 month) and mid-term (4-6 months) for painful OO and malignant bone tumors, respectively. Although MWA seems safe, further prospective studies are warranted to further assess this aspect, and to standardize MWA protocols.
KEY POINTS
• Large heterogeneity exists across literature about ablation protocols used with microwave ablation applied for the treatment of benign and malignant bone tumors. • Although microwave ablation of bone tumors appears safe, further studies are needed to assess this aspect, as current literature does not allow definitive conclusions. • Nevertheless, microwave ablation is effective in achieving pain relief at short- (1 month) and mid-term (4-6 months) for painful osteoid osteomas and malignant bone tumors, respectively.
Topics: Ablation Techniques; Bone Neoplasms; Catheter Ablation; Humans; Microwaves; Prospective Studies; Radiofrequency Ablation; Retrospective Studies; Treatment Outcome
PubMed: 33155107
DOI: 10.1007/s00330-020-07382-8 -
Supportive Care in Cancer : Official... Dec 2023Bones are frequent sites of metastatic disease, observed in 30-75% of advanced cancer patients. Quality of life (QoL) is an important endpoint in studies evaluating the... (Review)
Review
INTRODUCTION
Bones are frequent sites of metastatic disease, observed in 30-75% of advanced cancer patients. Quality of life (QoL) is an important endpoint in studies evaluating the treatments of bone metastases (BM), and many patient-reported outcome tools are available. The primary objective of this systematic review was to compile a list of QoL issues relevant to BM and its interventions. The secondary objective was to identify common tools used to assess QoL in patients with BM, and the QoL issues they fail to address.
METHODS
A search was conducted on Ovid MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials databases between 1946 and 27 January 2023 with the keywords "bone metastases", "quality of life", and "patient reported outcomes". Specific QoL issues in original research studies and the QoL tools used were extracted.
RESULTS
The review identified the QoL issues most prevalent to BM in the literature. Physical and functional issues observed in patients included pain, interference with ambulation and daily activities, and fatigue. Psychological symptoms, such as helplessness, depression, and anxiety were also common. These issues interfered with patients' relationships and social activities. Items not mentioned in existing QoL tools were related to newer treatments of BM, such as pain flare, flu-like symptoms, and jaw pain due to osteonecrosis.
CONCLUSIONS
This systematic review highlights that QoL issues for patients with BM have expanded over time due to advances in BM-directed treatments. If they are relevant, additional treatment-related QoL issues identified need to be validated prospectively by patients and added to current assessment tools.
Topics: Humans; Quality of Life; Bone Neoplasms; Emotions; Anxiety; Pain
PubMed: 38091116
DOI: 10.1007/s00520-023-08241-0 -
American Journal of Rhinology & Allergy Sep 2023Leiomyomas are benign smooth muscle tumors that are rarely diagnosed in the nasal cavity and paranasal sinuses. (Review)
Review
BACKGROUND
Leiomyomas are benign smooth muscle tumors that are rarely diagnosed in the nasal cavity and paranasal sinuses.
OBJECTIVE
This systematic review summarizes the histopathologic and clinical tumor characteristics, surgical management, and follow-up of sinonasal leiomyomas.
METHODS
A systematic review of the literature on sinonasal leiomyoma was performed by applying the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Studies that met the inclusion criteria were assessed for level of evidence. Patient demographics, clinical and pathological tumor characteristics, primary intervention, and results of follow-up were evaluated.
RESULTS
Forty studies including 84 patients with sinonasal leiomyoma were identified. The tumor was most often located in the nasal cavity (47/84, 56%) originating from the inferior turbinate (32/84, 38%). Patients mostly presented with symptoms originating from an intranasal mass, including recurrent epistaxis (41/84, 49%), nasal obstruction (43/84, 51.2%), and localized facial or head pain (25/84, 29.8%). Surgery was performed in all cases. An endoscopic approach was most frequently chosen. Recurrence occurred only twice (2.4%). Morbidity was noted in 2 cases (2.4%) following postoperative bleeding and 1 (1.2%) case following a CSF leak.
CONCLUSION
Sinonasal leiomyomas are neoplasms of the smooth muscle manifesting clinically with recurrent epistaxis and nasal obstruction. Management goal is total resection with clear margins to avoid local recurrence.
Topics: Humans; Paranasal Sinus Neoplasms; Nasal Obstruction; Epistaxis; Follow-Up Studies; Leiomyoma; Nose Neoplasms
PubMed: 37093753
DOI: 10.1177/19458924231170464 -
The British Journal of Oral &... Jul 2023To investigate the relation between periodontal disease (PD) and oral squamous cell carcinoma (OSCC) we systematically searched records published up to August 2022. Odds... (Meta-Analysis)
Meta-Analysis Review
To investigate the relation between periodontal disease (PD) and oral squamous cell carcinoma (OSCC) we systematically searched records published up to August 2022. Odds ratios (OR) and relative risk (RR) with 95% confidence intervals (95% CI) were estimated to evaluate this relation, then sensitivity analysis was performed accordingly. Begg's test and Egger's test were used to detect publication bias. Out of 970 papers from several databases, 13 studies were included. Summary estimates showed that PD was positively associated with the prevalence of OSCC (OR = 3.28, 95% CI: 1.87 to 5.74), especially for severe PD (OR = 4.23, 95% CI: 2.92 to 6.13). No evident publication bias was revealed. No increased OSCC risk among patients with PD was shown according to the combined results (RR = 1.50, 95% CI: 0.93 to 2.42). Patients with OSCC exhibited significant differences in alveolar bone loss, clinical attachment loss, and bleeding on probing, when compared with controls. The systematic review and meta-analysis suggested that there was a positive association between PD and prevalence of OSCC. However, according to the current evidence, a causal relation is unclear.
Topics: Humans; Carcinoma, Squamous Cell; Squamous Cell Carcinoma of Head and Neck; Mouth Neoplasms; Periodontal Diseases; Head and Neck Neoplasms
PubMed: 37308334
DOI: 10.1016/j.bjoms.2023.05.004 -
Blood Reviews Nov 2023Despite recent advancements, treatment of cytopenia due to bone marrow failures (BMF) and myeloid neoplasms remains challenging. Androgens promote renewal and maturation... (Review)
Review
Despite recent advancements, treatment of cytopenia due to bone marrow failures (BMF) and myeloid neoplasms remains challenging. Androgens promote renewal and maturation of blood cells and may be beneficial in these forms. Here we report a systematic review of androgens use as single agent in hematologic conditions. Forty-six studies, mainly retrospective with various androgen types and doses, were included: 12 on acquired aplastic anemia (AA), 11 on inherited BMF, 17 on myelodysplastic syndromes (MDS), and 7 on myelofibrosis. Responses ranged from 50 to 70% in inherited BMF, 40-50% in acquired AA and MDS, while very limited evidence emerged for myelofibrosis. In acquired AA, response was associated with presence of non-severe disease; in MDS androgens were more effective on thrombocytopenia or mild to moderate anemia, whilst limited benefit was observed for transfusion dependent anemia. Toxicity profile mainly consisted of virilization and liver enzyme elevation, whilst the risk of leukemic evolution remains controversial.
Topics: Humans; Androgens; Primary Myelofibrosis; Retrospective Studies; Neoplasms; Anemia, Aplastic; Myelodysplastic Syndromes; Bone Marrow Failure Disorders; Pancytopenia; Myeloproliferative Disorders; Thrombocytopenia
PubMed: 37709654
DOI: 10.1016/j.blre.2023.101132 -
Orthopaedics & Traumatology, Surgery &... Jun 2022Benign and pseudo-neoplastic bone lesions are usually treated by curettage and filling of the cavity. This filling is usually achieved with the use of autologous bone... (Review)
Review
BACKGROUND
Benign and pseudo-neoplastic bone lesions are usually treated by curettage and filling of the cavity. This filling is usually achieved with the use of autologous bone grafts, bone cement, allografts, xenografts, or synthetic bone substitutes. Recently, some authors have suggested that these defects do not require filling for consolidation but the respective rate of complications of each method is not well defined. Therefore, we did a systematic review aiming to answer: (1) Not filling bone cavities after benign bone tumour curettage may increase the rate of fractures? (2) Can the volume of the bone defect in itself be a specific or reliable predictor of fracture? (3) Does the mean functional outcome, recurrence, non-weight bearing time, other postoperative complications or bone consolidation time vary between the methods of filling?
PATIENTS AND METHODS
The PubMed (2407 articles) and Latin American and Caribbean Health Sciences Literature (LILACS) (50 articles) databases were reviewed, without restriction considering publication date. After exclusion criteria, 62 articles were selected for data collection. Filling or not filling (UN), methods of filling, fracture rate, bone defect size, mean functional outcome, recurrence, non-weight bearing time, other postoperative complications, consolidation time were the data of interest.
RESULTS
The number of patients was 2555 distributed among the different filling methods. Unfilled cavities were associated with higher fracture rate [20/302 (6.62%)] versus 4/189 (2.12%) for allografts, 14/343 (4.08%) for cement filling, 4/247 for autograft (1.62%), and 12/580 (2.07%) for bone substitute. The volume of the bone defect alone is not a specific or reliable predictor of fracture. All filling methods were similar regarding the mean functional outcome, recurrence rate and consolidation time. The bone cement allowed early weight bearing time (mean of weeks): UN: 9.67; autologous bone grafts: 9.8; bone cement: 0.5; allografts: 9.0; synthetic bone substitutes: 9.96.
CONCLUSION
Not filling the bone cavity after benign bone tumour curettage is an alternative, but can increase fracture rate, even in small volume bone defects. The use of prophylactic fixation drastically reduces the fracture rate. Filling with cement reduces weight bearing time. There are little differences between the methods used to fill, even compared to not filling the cavity.
LEVEL OF EVIDENCE
III; systematic review.
Topics: Bone Cements; Bone Neoplasms; Bone Substitutes; Bone Transplantation; Curettage; Humans; Postoperative Complications; Retrospective Studies
PubMed: 34033919
DOI: 10.1016/j.otsr.2021.102966 -
JAMA Network Open Feb 2024Conventional external beam radiotherapy (cEBRT) and stereotactic body radiotherapy (SBRT) are commonly used treatment options for relieving metastatic bone pain. The... (Meta-Analysis)
Meta-Analysis
IMPORTANCE
Conventional external beam radiotherapy (cEBRT) and stereotactic body radiotherapy (SBRT) are commonly used treatment options for relieving metastatic bone pain. The effectiveness of SBRT compared with cEBRT in pain relief has been a subject of debate, and conflicting results have been reported.
OBJECTIVE
To compare the effectiveness associated with SBRT vs cEBRT for relieving metastatic bone pain.
DATA SOURCES
A structured search was performed in the PubMed, Embase, and Cochrane databases on June 5, 2023. Additionally, results were added from a new randomized clinical trial (RCT) and additional unpublished data from an already published RCT.
STUDY SELECTION
Comparative studies reporting pain response after SBRT vs cEBRT in patients with painful bone metastases.
DATA EXTRACTION AND SYNTHESIS
Two independent reviewers extracted data from eligible studies. Data were extracted for the intention-to-treat (ITT) and per-protocol (PP) populations. The study is reported following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline.
MAIN OUTCOMES AND MEASURES
Overall and complete pain response at 1, 3, and 6 months after radiotherapy, according to the study's definition. Relative risk ratios (RRs) with 95% CIs were calculated for each study. A random-effects model using a restricted maximum likelihood estimator was applied for meta-analysis.
RESULTS
There were 18 studies with 1685 patients included in the systematic review and 8 RCTs with 1090 patients were included in the meta-analysis. In 7 RCTs, overall pain response was defined according to the International Consensus on Palliative Radiotherapy Endpoints in clinical trials (ICPRE). The complete pain response was reported in 6 RCTs, all defined according to the ICPRE. The ITT meta-analyses showed that the overall pain response rates did not differ between cEBRT and SBRT at 1 (RR, 1.14; 95% CI, 0.99-1.30), 3 (RR, 1.19; 95% CI, 0.96-1.47), or 6 (RR, 1.22; 95% CI, 0.96-1.54) months. However, SBRT was associated with a higher complete pain response at 1 (RR, 1.43; 95% CI, 1.02-2.01), 3 (RR, 1.80; 95% CI, 1.16-2.78), and 6 (RR, 2.47; 95% CI, 1.24-4.91) months after radiotherapy. The PP meta-analyses showed comparable results.
CONCLUSIONS AND RELEVANCE
In this systematic review and meta-analysis, patients with painful bone metastases experienced similar overall pain response after SBRT compared with cEBRT. More patients had complete pain alleviation after SBRT, suggesting that selected subgroups will benefit from SBRT.
Topics: Humans; Bone Neoplasms; Pain; Radiosurgery; Cancer Pain; Pain Management; Pathologic Complete Response; Randomized Controlled Trials as Topic
PubMed: 38345820
DOI: 10.1001/jamanetworkopen.2023.55409 -
Dermatologic Surgery : Official... Oct 2022Bone invasion has long been recognized as a poor prognostic indicator for cutaneous squamous cell carcinoma (SCC). Survival analyses of factors associated with SCC with...
BACKGROUND
Bone invasion has long been recognized as a poor prognostic indicator for cutaneous squamous cell carcinoma (SCC). Survival analyses of factors associated with SCC with bone invasion have not been published.
OBJECTIVE
To analyze all published demographic, clinical, and treatment data for SCC with bone invasion and assess the impact of prognostic variables on disease progression, disease-specific death, and overall mortality.
MATERIALS AND METHODS
A systematic review and pooled-survival analysis was performed using individual patient data from case reports. Progression-free survival (PFS), disease-specific survival (DSS), and overall survival (OS) were estimated by Kaplan-Meier analysis.
RESULTS
The study included 76 cases of SCC with bone invasion from 49 publications. Recurrent tumors and nonsurgical treatment modality were predictors of disease progression in univariable analysis and tumors of the trunk, head, and neck were predictors of disease progression in multivariable analysis. At 5 years from bone invasion diagnosis, patients had a PFS, DSS, and OS rate of 66.7%, 71.7%, and 66.2%, respectively.
CONCLUSION
Cases of SCC with bone invasion had poor DFS, DSS, and OS rates, with worse outcomes imparted to tumors of the trunk, head, and neck.
Topics: Carcinoma, Squamous Cell; Disease Progression; Disease-Free Survival; Humans; Neoplasm Recurrence, Local; Prognosis; Retrospective Studies; Skin Neoplasms; Survival Analysis; Survival Rate
PubMed: 35862674
DOI: 10.1097/DSS.0000000000003553 -
Journal of the American Academy of... Mar 2022Although basal cell carcinoma (BCC) tends to follow an indolent course, some tumors can exhibit locally aggressive behavior and invade into bone.
BACKGROUND
Although basal cell carcinoma (BCC) tends to follow an indolent course, some tumors can exhibit locally aggressive behavior and invade into bone.
OBJECTIVE
To analyze all published demographic, clinical, and treatment data on recurrence patterns, disease progression, disease-specific death, and overall mortality of BCC with bone invasion.
METHODS
A systematic review and pooled-survival analysis was performed, including case reports and case series of BCC with bone invasion.
RESULTS
The study included 101 patients from 70 publications. BCC tumors invading into bone were most often large, neglected tumors located in high-risk face areas. At 5 years, patients had a 30% risk probability of disease recurrence (after negative margins), a 72.1% risk of disease progression or death (with ambiguous margin status), an 18.2% risk of BCC-related death, and a 20.7% overall probability of death.
LIMITATIONS
Limitations include the reliance on case reports and series for individual patient data, which has the potential to introduce selection bias.
CONCLUSION
The high rate of disease progression and suboptimal 5-year survival rate highlights the poor prognosis of BCC with bone invasion and further underscores the importance of early detection and treatment.
Topics: Carcinoma, Basal Cell; Disease Progression; Humans; Neoplasm Recurrence, Local; Skin Neoplasms; Survival Analysis
PubMed: 34273459
DOI: 10.1016/j.jaad.2021.06.889 -
Neurosurgical Review Sep 2023Endoscopic transsphenoidal surgery is a novel surgical technique requiring specific training. Different models and simulators have been recently suggested for it, but no... (Review)
Review
Endoscopic transsphenoidal surgery is a novel surgical technique requiring specific training. Different models and simulators have been recently suggested for it, but no systematic review is available. To provide a systematic and critical literature review and up-to-date description of the training models or simulators dedicated to endoscopic transsphenoidal surgery. A search was performed on PubMed and Scopus databases for articles published until February 2023; Google was also searched to document commercially available. For each model, the following features were recorded: training performed, tumor/arachnoid reproduction, assessment and validation, and cost. Of the 1199 retrieved articles, 101 were included in the final analysis. The described models can be subdivided into 5 major categories: (1) enhanced cadaveric heads; (2) animal models; (3) training artificial solutions, with increasing complexity (from "box-trainers" to multi-material, ct-based models); (4) training simulators, based on virtual or augmented reality; (5) Pre-operative planning models and simulators. Each available training model has specific advantages and limitations. Costs are high for cadaver-based solutions and vary significantly for the other solutions. Cheaper solutions seem useful only for the first stages of training. Most models do not provide a simulation of the sellar tumor, and a realistic simulation of the suprasellar arachnoid. Most artificial models do not provide a realistic and cost-efficient simulation of the most delicate and relatively common phase of surgery, i.e., tumor removal with arachnoid preservation; current research should optimize this to train future neurosurgical generations efficiently and safely.
Topics: Humans; Animals; Endoscopy; Cadaver; Computer Simulation; Databases, Factual; Skull Base Neoplasms
PubMed: 37725193
DOI: 10.1007/s10143-023-02149-3