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Prostate Cancer and Prostatic Diseases Jul 2023Focal therapy (FT) is a promising alternative with curative intent for Low- to Intermediate-risk localized Prostate Cancer (PCa), claiming better functional outcomes and... (Review)
Review
INTRODUCTION
Focal therapy (FT) is a promising alternative with curative intent for Low- to Intermediate-risk localized Prostate Cancer (PCa), claiming better functional outcomes and safety profile than standard whole-gland treatments. Ten different FT modalities have been described in the literature. The objective of our narrative review is to evaluate the safety profile and functional outcomes of these different modalities and the current most used tools of assessment for those outcomes.
MATERIAL AND METHODS
Literature search was performed on 21st February 2023 using PubMed, EMBASE, and Scopus, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA). Articles reporting whole-gland treatments were excluded. All articles reporting functional outcomes were included.
RESULTS
One-hundred-seven studies, reporting data on 6933 patients, were included (26 on High Intensity Focal Ultrasound, 22 on Focal Cryotherapy, 14 on Irreversible Electroporation, 11 on Focal brachytherapy, 10 on Focal Laser Ablation, 8 on Photodynamic Therapy, 3 on Microwave ablation, 3 on Robotic Partial Prostatectomy, 2 on bipolar Radio Frequency Ablation, 1 on Prostatic Artery Embolization, and 7 studies comparing different FTs). Post-operative pad-free rate ranged between 92.3-100%. Greater heterogeneity exists considering the Change in Erectile Function, with Changing in Erectile function- rates ranging between 0-94.4% (Cryotherapy). The most used Patient-Reported Outcome Measures (PROMs) were the International Prostate Symptom Score and the International Index of Erectile Function for incontinence/urinary function and potency, respectively. The most common reported complications were hematuria, infections, and urethral strictures, with rates widely ranging among different treatments. The Clavien-Dindo Classification was the most used (40/88 papers) to describe adverse events.
CONCLUSION
FT is a promising treatment for localized PCa, achieving excellent results in terms of safety and functional outcomes. There is a wide heterogeneity in the definition of PROMS and time of collection between studies. High quality comparative studies with standard treatments are needed to reinforce these findings.
PubMed: 37491432
DOI: 10.1038/s41391-023-00698-8 -
BMJ Clinical Evidence Jul 2011Chronic prostatitis can cause pain and urinary symptoms, and usually occurs without positive bacterial cultures from prostatic secretions (known as chronic abacterial... (Review)
Review
INTRODUCTION
Chronic prostatitis can cause pain and urinary symptoms, and usually occurs without positive bacterial cultures from prostatic secretions (known as chronic abacterial prostatitis or chronic pelvic pain syndrome [CP/CPPS]). Bacterial infection can result from urinary tract instrumentation, but the cause and natural history of CP/CPPS are unknown.
METHODS AND OUTCOMES
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of treatments for chronic bacterial prostatitis? What are the effects of treatments for chronic abacterial prostatitis/chronic pelvic pain syndrome? We searched: Medline, Embase, The Cochrane Library, and other important databases up to August 2010 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS
We found 33 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS
In this systematic review, we present information relating to the effectiveness and safety of the following interventions: 5 alpha-reductase inhibitors, allopurinol, alpha-blockers, biofeedback, local injections of antimicrobial drugs, mepartricin, non-steroidal anti-inflammatory drugs (NSAIDs), oral antimicrobial drugs, pentosan polysulfate, prostatic massage, quercetin, radical prostatectomy, sitz baths, transurethral microwave thermotherapy, and transurethral resection.
Topics: 5-alpha Reductase Inhibitors; Chronic Disease; Humans; Male; Mepartricin; Pentosan Sulfuric Polyester; Prostatitis; Quercetin
PubMed: 21736764
DOI: No ID Found -
The Cochrane Database of Systematic... Jul 2021A variety of minimally invasive treatments are available as an alternative to transurethral resection of the prostate (TURP) for management of lower urinary tract... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
A variety of minimally invasive treatments are available as an alternative to transurethral resection of the prostate (TURP) for management of lower urinary tract symptoms (LUTS) in men with benign prostatic hyperplasia (BPH). However, it is unclear which treatments provide better results.
OBJECTIVES
Our primary objective was to assess the comparative effectiveness of minimally invasive treatments for lower urinary tract symptoms in men with BPH through a network meta-analysis. Our secondary objective was to obtain an estimate of relative ranking of these minimally invasive treatments, according to their effects.
SEARCH METHODS
We performed a comprehensive search of multiple databases (CENTRAL, MEDLINE, Embase, Scopus, Web of Science and LILACS), trials registries, other sources of grey literature, and conference proceedings, up to 24 February 2021. We had no restrictions on language of publication or publication status.
SELECTION CRITERIA
We included parallel-group randomized controlled trials assessing the effects of the following minimally invasive treatments, compared to TURP or sham treatment, on men with moderate to severe LUTS due to BPH: convective radiofrequency water vapor therapy (CRFWVT); prostatic arterial embolization (PAE); prostatic urethral lift (PUL); temporary implantable nitinol device (TIND); and transurethral microwave thermotherapy (TUMT).
DATA COLLECTION AND ANALYSIS
Two review authors independently screened the literature, extracted data, and assessed risk of bias. We performed statistical analyses using a random-effects model for pair-wise comparisons and a frequentist network meta-analysis for combined estimates. We interpreted them according to Cochrane methods. We planned subgroup analyses by age, prostate volume, and severity of baseline symptoms. We used risk ratios (RRs) with 95% confidence intervals (CIs) to express dichotomous data and mean differences (MDs) with 95% CIs to express continuous data. We used the GRADE approach to rate the certainty of evidence.
MAIN RESULTS
We included 27 trials involving 3017 men, mostly over age 50, with severe LUTS due to BPH. The overall certainty of evidence was low to very low due to concerns regarding bias, imprecision, inconsistency (heterogeneity), and incoherence. Based on the network meta-analysis, results for our main outcomes were as follows. Urologic symptoms (19 studies, 1847 participants): PUL and PAE may result in little to no difference in urologic symptoms scores (MD of International Prostate Symptoms Score [IPSS]) compared to TURP (3 to 12 months; MD range 0 to 35; higher scores indicate worse symptoms; PUL: 1.47, 95% CI -4.00 to 6.93; PAE: 1.55, 95% CI -1.23 to 4.33; low-certainty evidence). CRFWVT, TUMT, and TIND may result in worse urologic symptoms scores compared to TURP at short-term follow-up, but the CIs include little to no difference (CRFWVT: 3.6, 95% CI -4.25 to 11.46; TUMT: 3.98, 95% CI 0.85 to 7.10; TIND: 7.5, 95% CI -0.68 to 15.69; low-certainty evidence). Quality of life (QoL) (13 studies, 1459 participants): All interventions may result in little to no difference in the QoL scores, compared to TURP (3 to 12 months; MD of IPSS-QoL score; MD range 0 to 6; higher scores indicate worse symptoms; PUL: 0.06, 95% CI -1.17 to 1.30; PAE: 0.09, 95% CI -0.57 to 0.75; CRFWVT: 0.37, 95% CI -1.45 to 2.20; TUMT: 0.65, 95% CI -0.48 to 1.78; TIND: 0.87, 95% CI -1.04 to 2.79; low-certainty evidence). Major adverse events (15 studies, 1573 participants): TUMT probably results in a large reduction of major adverse events compared to TURP (RR 0.20, 95% CI 0.09 to 0.43; moderate-certainty evidence). PUL, CRFWVT, TIND and PAE may also result in a large reduction in major adverse events, but CIs include substantial benefits and harms at three months to 36 months; PUL: RR 0.30, 95% CI 0.04 to 2.22; CRFWVT: RR 0.37, 95% CI 0.01 to 18.62; TIND: RR 0.52, 95% CI 0.01 to 24.46; PAE: RR 0.65, 95% CI 0.25 to 1.68; low-certainty evidence). Retreatment (10 studies, 799 participants): We are uncertain about the effects of PAE and PUL on retreatment compared to TURP (12 to 60 months; PUL: RR 2.39, 95% CI 0.51 to 11.1; PAE: RR 4.39, 95% CI 1.25 to 15.44; very low-certainty evidence). TUMT may result in higher retreatment rates (RR 9.71, 95% CI 2.35 to 40.13; low-certainty evidence). Erectile function (six studies, 640 participants): We are very uncertain of the effects of minimally invasive treatments on erectile function (MD of International Index of Erectile Function [IIEF-5]; range 5 to 25; higher scores indicates better function; CRFWVT: 6.49, 95% CI -8.13 to 21.12; TIND: 5.19, 95% CI -9.36 to 19.74; PUL: 3.00, 95% CI -5.45 to 11.44; PAE: -0.03, 95% CI -6.38, 6.32; very low-certainty evidence). Ejaculatory dysfunction (eight studies, 461 participants): We are uncertain of the effects of PUL, PAE and TUMT on ejaculatory dysfunction compared to TURP (3 to 12 months; PUL: RR 0.05, 95 % CI 0.00 to 1.06; PAE: RR 0.35, 95% CI 0.13 to 0.92; TUMT: RR 0.34, 95% CI 0.17 to 0.68; low-certainty evidence). TURP is the reference treatment with the highest likelihood of being the most efficacious for urinary symptoms, QoL and retreatment, but the least favorable in terms of major adverse events, erectile function and ejaculatory function. Among minimally invasive procedures, PUL and PAE have the highest likelihood of being the most efficacious for urinary symptoms and QoL, TUMT for major adverse events, PUL for retreatment, CRFWVT and TIND for erectile function and PUL for ejaculatory function.
AUTHORS' CONCLUSIONS
Minimally invasive treatments may result in similar or worse effects concerning urinary symptoms and QoL compared to TURP at short-term follow-up. They may result in fewer major adverse events, especially in the case of PUL and PAE; resulting in better rankings for symptoms scores. PUL may result in fewer retreatments compared to other interventions, especially TUMT, which had the highest retreatment rates at long-term follow-up. We are very uncertain about the effects of these interventions on erectile function. There was limited long-term data, especially for CRFWVT and TIND. Future high-quality studies with more extended follow-up, comparing different, active treatment modalities, and adequately reporting critical outcomes relevant to patients, including those related to sexual function, could provide more information on the relative effectiveness of these interventions.
Topics: Humans; Lower Urinary Tract Symptoms; Male; Middle Aged; Network Meta-Analysis; Prostatic Hyperplasia; Quality of Life; Transurethral Resection of Prostate
PubMed: 34693990
DOI: 10.1002/14651858.CD013656.pub2 -
Surgical Endoscopy May 2023Primary hepatocellular carcinoma (HCC) and colorectal liver metastases (CRLM) represent the two most common malignant neoplasms of the liver. The objective of this study... (Meta-Analysis)
Meta-Analysis Review
Surgical approach to microwave and radiofrequency liver ablation for hepatocellular carcinoma and colorectal liver metastases less than 5 cm: a systematic review and meta-analysis.
BACKGROUND
Primary hepatocellular carcinoma (HCC) and colorectal liver metastases (CRLM) represent the two most common malignant neoplasms of the liver. The objective of this study was to assess outcomes of surgical approaches to liver ablation comparing laparoscopic versus percutaneous microwave ablation (MWA), and MWA versus radiofrequency ablation (RFA) in patients with HCC or CRLM lesions smaller than 5 cm.
METHODS
A systematic review was conducted across seven databases, including PubMed, Embase, and Cochrane, to identify all comparative studies between 1937 and 2021. Two independent reviewers screened for eligibility, extracted data for selected studies, and assessed study bias using the modified Newcastle Ottawa Scale. Random effects meta-analyses were subsequently performed on all available comparative data.
RESULTS
From 1066 records screened, 11 studies were deemed relevant to the study and warranted inclusion. Eight of the 11 studies were at high or uncertain risk for bias. Our meta-analyses of two studies revealed that laparoscopic MW ablation had significantly higher complication rates compared to a percutaneous approach (risk ratio = 4.66; 95% confidence interval = [1.23, 17.22]), but otherwise similar incomplete ablation rates, local recurrence, and oncologic outcomes. The remaining nine studies demonstrated similar efficacy of MWA and RFA, as measured by incomplete ablation, complication rates, local/regional recurrence, and oncologic outcomes, for both HCC and CRLM lesions less than 5 cm (p > 0.05 for all outcomes). There was no statistical subgroup interaction in the analysis of tumors < 3 cm.
CONCLUSION
The available comparative evidence regarding both laparoscopic versus percutaneous MWA and MWA versus RFA is limited, evident by the few studies that suffer from high/uncertain risk of bias. Additional high-quality randomized trials or statistically matched cohort studies with sufficient granularity of patient variables, institutional experience, and physician specialty/training will be useful in informing clinical decision making for the ablative treatment of HCC or CRLM.
Topics: Humans; Liver Neoplasms; Carcinoma, Hepatocellular; Microwaves; Catheter Ablation; Treatment Outcome; Radiofrequency Ablation; Colorectal Neoplasms
PubMed: 36542137
DOI: 10.1007/s00464-022-09815-5 -
Surgical Endoscopy Feb 2023Microwave ablation (MWA) has become the standard thermal-based treatment for hepatic malignancies in patients who have unresectable disease based on the biology of the... (Review)
Review
BACKGROUND
Microwave ablation (MWA) has become the standard thermal-based treatment for hepatic malignancies in patients who have unresectable disease based on the biology of the tumor, the patients' comorbidities, and certain disease sites. The technical effectiveness, ablation success, local recurrence rates of hepatic malignancies treated with the various commercial microwave ablation devices has not been previously published in the peer reviewed literature. The aim of this systematic review is to summarize the clinical outcomes for the various MWA devices in the use of a hepatic malignancies to best educate hepatic surgeons as well as interventional radiologists.
METHODS
A comprehensive review of the literature and instructions for use of each device that was published from 1/2013 to 12/2020 was performed. The main outcomes extracted were technical success, ablation success, major complications, local and new recurrence rates, recurrence-free survival, ablation volumes, time, and the number of antennas required. A qualitative review of the literature was performed.
RESULTS
In total, 29 studies reporting data on 3250 patients and 4500 tumors were included in this review. Median patient age was 60.5 years (range 3-91). 76.3% (2420 M/753 F) of patients were male. Hepatocellular carcinoma (55%) was the most common tumor pathology followed by colorectal liver metastasis (10%) and cholangiocarcinoma (4%). A majority of studies reported technical success (range, 91.6-100%) and ablation success (range, 73.1-100%), as well as major complications (range, 0-9.1%). Local recurrence (range, 0-50%) was reported by 21 of the studies; however, new recurrence (range, 12.2-64%) was reported less frequently (6 studies) and were further specified in 12, six, and four studies as intrahepatic distant recurrence (11.3-54.2%), extrahepatic distant recurrence (3.6-20%), and metastasis (1.1-36%). A total of three, six, and five studies report disease, progression, and recurrence-free survival rates, respectively.
CONCLUSION
Microwave ablation is frequently used for the treatment of hepatic malignancies. A thorough understanding of the clinical outcomes associated with different pathologies and MWA devices can improve surgeon awareness and help prepare for operative planning and patient management. More consistent reporting of key outcomes in the literature is needed to achieve such an understanding.
Topics: Humans; Male; Child, Preschool; Child; Adolescent; Young Adult; Adult; Middle Aged; Aged; Aged, 80 and over; Female; Microwaves; Liver Neoplasms; Carcinoma, Hepatocellular; Radiofrequency Ablation; Technology; Catheter Ablation; Treatment Outcome; Retrospective Studies
PubMed: 36076101
DOI: 10.1007/s00464-022-09567-2 -
Experimental Hematology & Oncology Apr 2023Surgical intervention is the first-line treatment in well-selected hepatocellular carcinoma (HCC) patients. However, only a few patients are suitable to receive radical...
Comparison of local ablative therapies, including radiofrequency ablation, microwave ablation, stereotactic ablative radiotherapy, and particle radiotherapy, for inoperable hepatocellular carcinoma: a systematic review and meta-analysis.
Surgical intervention is the first-line treatment in well-selected hepatocellular carcinoma (HCC) patients. However, only a few patients are suitable to receive radical surgery. We conducted a systematic review and meta-analysis to evaluate local control among four local ablative therapies in inoperable HCC patients, including radiofrequency ablation therapy (RFA), microwave ablation therapy (MWA), stereotactic ablative radiotherapy (SABR), and particle radiotherapy. The primary outcome was the local control rate and the secondary were regional and distant progression rates, overall survival rate, and adverse events. We included twenty-six studies from PubMed, EMBASE, and Cochrane Library databases. MWA (p < 0.001) and particle radiotherapy (p < 0.001) showed better performance of local control compared to RFA, while SABR (p = 0.276) showed a non-significant trend. However, SABR (p = 0.002) and particle radiotherapy (p < 0.001) showed better performance than RFA in HCCs of ≥ 30 mm in size. MWA showed a similar result to RFA while SABR and particle radiotherapy showed a lower survival rate in the 2-, 3-, and 4-year overall survival rates. Our results indicate that MWA, SABR and particle radiotherapy were safe and no inferior to RFA in local control rate. Besides, the local control rates of SABR and particle radiotherapy are better than RFA in HCC of ≥ 30 mm in size. As a result, we suggested that MWA, SABR and particle radiotherapy to be effective alternatives to RFA for inoperable HCC. Moreover, the tumor size should be taken into consideration for optimal treatment selection between local ablative therapies.
PubMed: 37046292
DOI: 10.1186/s40164-023-00400-7 -
BMJ Clinical Evidence May 2008Chronic prostatitis can cause pain and urinary symptoms, and usually occurs without positive bacterial cultures from prostatic secretions (known as chronic abacterial... (Review)
Review
INTRODUCTION
Chronic prostatitis can cause pain and urinary symptoms, and usually occurs without positive bacterial cultures from prostatic secretions (known as chronic abacterial prostatitis or chronic pelvic pain syndrome, CP/CPPS). Bacterial infection can result from urinary tract instrumentation, but the cause and natural history of CP/CPPS are unknown.
METHODS AND OUTCOMES
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of treatments for chronic bacterial prostatitis? What are the effects of treatments for chronic abacterial prostatitis/chronic pelvic pain syndrome? We searched: Medline, Embase, The Cochrane Library and other important databases up to August 2007 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS
We found 30 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS
In this systematic review we present information relating to the effectiveness and safety of the following interventions: 5 alpha-reductase inhibitors, allopurinol, alpha-blockers, biofeedback, local injections of antimicrobial drugs, mepartricin, non-steroidal anti-inflammatory drugs, oral antimicrobial drugs, pentosan polysulfate, prostatic massage, quercetin, radical prostatectomy, sitz baths, transurethral microwave thermotherapy, and transurethral resection.
Topics: Cholestenone 5 alpha-Reductase; Humans; Male; Prostatitis
PubMed: 19450305
DOI: No ID Found -
Journal of Endourology Dec 2023Percutaneous microwave ablation (MWA) has emerged as a new energy modality for percutaneous renal tumor ablation with potential advantages over radiofrequency and... (Meta-Analysis)
Meta-Analysis
Percutaneous microwave ablation (MWA) has emerged as a new energy modality for percutaneous renal tumor ablation with potential advantages over radiofrequency and cryoablation. The goal of our study was to determine MWA outcomes for suspicious renal masses, with a subset analysis for biopsy-proven renal cell carcinoma (RCC) and larger (T1b) tumors. Studies reporting outcomes of MWA for RCC were identified. Random-effects models with inverse-variance weighting were used to pool outcomes, including technical success rate (TSR), technical efficacy rate (TER), local recurrence rate (LRR), cancer-specific survival rate (CSSR), overall survival rate (OSR), and complications. Among 914 studies captured, 27 studies with 1584 patients (1683 malignant renal tumors) were included. The pooled TSR and TER were 99.6% (95% confidence interval [CI], 98.0%-100%) and 96.2% (95% CI, 93.8%-98.2%). The pooled LRR was 3.2% (95% CI, 1.9%-4.7%). At 1, 3, and 5 years, the pooled CSSRs were 100% (95% CI, 99.4%-100%), 100% (95% CI, 98.4%-100%), and 97.7% (95% CI, 94.5%-99.7%), while pooled OSRs were 99.0% (95% CI, 97.5%-99.9%), 96.0% (95% CI, 93.1%-98.3%), and 88.1% (95% CI, 80.3%-94.2%). The pooled minor and major complication rates were 10.3% (95% CI, 7.1%-13.9%) and 1.0% (95% CI, 0.3%-2.1%). In 204 patients with 208 T1b tumors, the pooled TSR and TER were 100% (95% CI, 96.6%-100%) and 85.2% (95% CI, 71.0%-95.8%). The pooled LRR was 4.2% (95% CI, 0.9%-8.9%). At 1, 3, and 5 years, the pooled CSSRs were 98.2% (95% CI, 88.7%-100%), 97.2% (95% CI, 78.5%-100%), and 98.1% (95% CI, 72.3%-100%). At 1 and 3 years, the pooled OSRs were 94.3% (95% CI, 85.7%-99.6%) and 89.3% (95% CI, 68.7%-100%). The pooled minor and major complication rates were 14.8% (95% CI, 7.4%-23.8%) and 2.6% (95% CI, 0%-7.8%). MWA demonstrated favorable short- to intermediate-term oncologic outcomes with low complication rates, including in the T1b subset, with moderate quality of data and heterogeneity of assessed outcomes. This supports MWA as a safe and effective treatment for RCC and a potential viable option for larger tumors.
Topics: Humans; Carcinoma, Renal Cell; Microwaves; Retrospective Studies; Kidney Neoplasms; Kidney; Treatment Outcome; Catheter Ablation
PubMed: 37819699
DOI: 10.1089/end.2023.0342 -
BJOG : An International Journal of... Jan 2005To compare the effectiveness of two second generation endometrial ablation techniques (microwave and thermal balloon endometrial ablation) with first generation... (Comparative Study)
Comparative Study Review
OBJECTIVE
To compare the effectiveness of two second generation endometrial ablation techniques (microwave and thermal balloon endometrial ablation) with first generation techniques of endometrial ablation to treat heavy menstrual bleeding in women.
SEARCH STRATEGY
We searched the Cochrane Library (issue 3, 2002), the National Research Register, MEDLINE (1966 to August 2002), Embase (1980 to August 2002) and Web of Science Proceedings (all years). We also searched reference lists and contacted experts and manufacturers in the field.
SELECTION CRITERIA
Randomised controlled trials and controlled trials of microwave endometrial ablation and thermal balloon endometrial ablation versus transcervical resection and rollerball ablation, alone or in combination, to treat heavy menstrual bleeding were included.
DATA COLLECTION AND ANALYSIS
Two reviewers independently selected studies for inclusion and extracted data. As there was considerable clinical and methodological heterogeneity among the studies, meta-analysis was not undertaken and results are presented descriptively.
RESULTS
Two randomised controlled trials of microwave endometrial ablation and eight trials (six randomised controlled trials) of thermal balloon endometrial ablation were included in the review. No significant differences were found between first and second generation techniques in terms of amenorrhoea, bleeding patterns, pre-menstrual symptoms, patient satisfaction or quality of life. Microwave endometrial ablation and thermal balloon endometrial ablation had significantly shorter operating and theatre times than first generation techniques. Adverse effects were few with all techniques, but there were fewer peri-operative adverse effects with second generation techniques.
CONCLUSION
Microwave endometrial ablation and thermal balloon endometrial ablation are alternatives to first generation techniques for treating heavy menstrual bleeding. No head-to-head trials of microwave endometrial ablation and thermal balloon endometrial ablation have been undertaken and there is not yet enough evidence of differences in clinical effectiveness between these two techniques.
Topics: Catheter Ablation; Catheterization; Clinical Trials as Topic; Female; Humans; Hyperthermia, Induced; Menorrhagia; Microwaves; Randomized Controlled Trials as Topic
PubMed: 15663392
DOI: 10.1111/j.1471-0528.2005.00449.x -
Current Oncology Reports Jun 2022Based on good local control rates and an excellent safety profile, guidelines consider thermal ablation the gold standard to eliminate small unresectable colorectal... (Meta-Analysis)
Meta-Analysis Review
Microwave Ablation, Radiofrequency Ablation, Irreversible Electroporation, and Stereotactic Ablative Body Radiotherapy for Intermediate Size (3-5 cm) Unresectable Colorectal Liver Metastases: a Systematic Review and Meta-analysis.
PURPOSE OF REVIEW
Based on good local control rates and an excellent safety profile, guidelines consider thermal ablation the gold standard to eliminate small unresectable colorectal liver metastases (CRLM). However, efficacy decreases exponentially with increasing tumour size. The preferred treatment for intermediate-size unresectable CRLM remains uncertain. This systematic review and meta-analysis compare safety and efficacy of local ablative treatments for unresectable intermediate-size CRLM (3-5 cm).
RECENT FINDINGS
We systematically searched for publications reporting treatment outcomes of unresectable intermediate-size CRLM treated with thermal ablation, irreversible electroporation (IRE) or stereotactic ablative body-radiotherapy (SABR). No comparative studies or randomized trials were found. Literature to assess effectiveness was limited and there was substantial heterogeneity in outcomes and study populations. Per-patient local control ranged 22-90% for all techniques; 22-89% (8 series) for thermal ablation, 44% (1 series) for IRE, and 67-90% (1 series) for SABR depending on radiation dose. Focal ablative therapy is safe and can induce long-term disease control, even for intermediate-size CRLM. Although SABR and tumuor-bracketing techniques such as IRE are suggested to be less susceptible to size, evidence to support any claims of superiority of one technique over the other is unsubstantiated by the available evidence. Future prospective comparative studies should address local-tumour-progression-free-survival, local control rate, overall survival, adverse events, and quality-of-life.
Topics: Colorectal Neoplasms; Electroporation; Humans; Liver Neoplasms; Microwaves; Radiofrequency Ablation
PubMed: 35298796
DOI: 10.1007/s11912-022-01248-6