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Medicine Jul 2022Hepatocellular carcinoma (HCC) is one of the most common malignant tumors. Surgical resection is often only possible in the early stages of HCC and among those with... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Hepatocellular carcinoma (HCC) is one of the most common malignant tumors. Surgical resection is often only possible in the early stages of HCC and among those with limited cirrhosis. Radiofrequency ablation and Microwave ablation are 2 main types of percutaneous thermal ablation for the treatment of HCC. The efficacy and safety between these 2 therapy methods are still under a debate.
OBJECTIVE
To compare the efficacy and safety of Radiofrequency ablation and Microwave ablation in treating HCC.
METHODS
PubMed, EMBASE, the Cochrane databases and Web of Science were systematically searched. We included randomized controlled trials and cohort studies comparing the efficacy and safety of Radiofrequency ablation and Microwave ablation in HCC patients. Outcome measures on local tumor progression, complete ablation, disease-free survival, overall survival, or major complications were compared between the 2 groups. The random effect model was used when there was significant heterogeneity between studies, otherwise the fixed effect model was used.
RESULTS
A total of 33 studies, involving a total of 4589 patients were identified, which included studies comprised 7 RCTs, 24 retrospective observational trials, and 2 prospective observational trial. Microwave ablation had a lower local tumor progression than Radiofrequency ablation in cohort studies (OR = 0.78, 95% CI 0.64-0.96, P = .02). Complete ablation rate of Microwave ablation was higher than that of Radiofrequency ablation in cohort studies (OR = 1.54, 95% CI 1.05-2.25, P = .03). There was no significant difference in overall survival and disease-free survival between the 2 groups. Meta-analysis showed that there was no significant difference in the main complications between Microwave ablation and Radiofrequency ablation.
CONCLUSIONS
Microwave ablation has higher complete ablation and lower local tumor progression than Radiofrequency ablation in the ablation treatment of HCC nodules. There was no significant difference in overall survival between the 2 therapy methods.
Topics: Carcinoma, Hepatocellular; Catheter Ablation; Humans; Liver Neoplasms; Microwaves; Observational Studies as Topic; Radiofrequency Ablation; Retrospective Studies; Treatment Outcome
PubMed: 35905207
DOI: 10.1097/MD.0000000000029321 -
Medicine Nov 2018Robot-assisted partial nephrectomy (RPN) and focal therapy (FT) have both been successfully employed in the management of small renal masses. However, despite this being... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Robot-assisted partial nephrectomy (RPN) and focal therapy (FT) have both been successfully employed in the management of small renal masses. However, despite this being the era of minimally invasive surgery, few comparative studies exist on RPN and FT. The aim of our study is to review perioperative, renal functional and oncologic outcomes of FT and RPN in cT1 renal masses.
METHODS
Literature published in Medline, EMBASE, and Cochrane Library databases up to April 22, 2018, was systematically searched. We included literature comparing outcomes of FT (radiofrequency ablation, cryoablation, microwave ablation, and irreversible electroporation) and RPN. Studies that reported only on laparoscopic partial nephrectomy or open partial nephrectomy, and review articles, editorials, letters, or cost analyses were excluded. In total, data from 1166 patients were included.
RESULTS
From 858 total articles, 7 nonrandomized, observational studies were included. Compared with RPN, FT was associated with a significantly lower decrease of estimated glomerular filtration rate (weighted mean difference [WMD] -8.06 mL/min/1.73 m; confidence interval [CI] -15.85 to -0.26; P = .04), and lower estimated blood loss (WMD -49.61 mL; CI -60.78 to -38.45; P < .001). However, patients who underwent FT had a significantly increased risk of local recurrence (risk ratio [RR] 9.89; CI 4.24-23.04; P < .001) and distant metastasis (RR 6.42; CI 1.70-24.33; P = .006). However, operative times, lengths of stay, and complication rates were revealed to be similar between FT and RPN.
CONCLUSION
RPN has a substantial advantage in preventing cancer recurrence. However, in the era of minimally invasive surgery, FT has advantages in renal function preservation and less bleeding. Long-term follow-up for survival rates and comparative analysis of microwave ablation and irreversible electroporation are needed to extend FT for patients with significant morbidities and for those who need sufficient renal function preservation with minimal bleeding.
Topics: Ablation Techniques; Electrochemotherapy; Glomerular Filtration Rate; Humans; Kidney; Kidney Neoplasms; Length of Stay; Neoplasm Recurrence, Local; Nephrectomy; Operative Time; Postoperative Complications; Robotic Surgical Procedures; Survival Rate; Treatment Outcome
PubMed: 30407321
DOI: 10.1097/MD.0000000000013102 -
Abdominal Radiology (New York) Nov 2021Contrast-enhanced ultrasound (CEUS) is a useful tool to assess treatment response after percutaneous ablation or transarterial chemoembolization (TACE) of hepatocellular... (Meta-Analysis)
Meta-Analysis
PURPOSE
Contrast-enhanced ultrasound (CEUS) is a useful tool to assess treatment response after percutaneous ablation or transarterial chemoembolization (TACE) of hepatocellular carcinoma (HCC). Here, we performed a systematic review and meta-analysis to evaluate the usefulness of CEUS in identifying residual tumor after locoregional therapy.
METHODS
PubMed, Scopus, and Cochrane library databases were searched from their inception until March 8, 2021, for diagnostic test accuracy studies comparing CEUS to a reference standard for identifying residual tumors after locoregional therapy of HCC. The pooled sensitivity, specificity, accuracy, and diagnostic odds ratio (DOR) were obtained using a bivariate random effects model. Subgroup analyses were performed by stratifying the studies based on study design, type of locoregional therapy, CEUS criteria for residual tumor, timing of CEUS follow up, and type of standard reference.
RESULTS
Two reviewers independently evaluated 1479 publications. After full-text review, 142 studies were found to be relevant, and 43 publications (50 cohorts) were finally included. The overall sensitivity of CEUS in detection of residual disease estimated from the bivariate random effects model was 0.85 (95% CI 0.80-0.89). Similarly, the overall specificity was 0.94 (95% CI 0.91-0.96). The diagnostic accuracy was 93.5%. The DOR was 70.1 (95% CI 62.2-148), and the AUROC was 0.95. Importantly, subgroup analysis showed no apparent differences in the diagnostic performance between locoregional therapy (TACE vs. ablation) and criteria used to define residual enhancement, timing of performing CEUS, study design, or type of reference standard.
CONCLUSION
CEUS is a highly accurate method to identify HCC residual tumor after TACE or percutaneous ablation.
Topics: Carcinoma, Hepatocellular; Chemoembolization, Therapeutic; Contrast Media; Humans; Liver Neoplasms; Treatment Outcome; Ultrasonography
PubMed: 34410432
DOI: 10.1007/s00261-021-03248-9 -
Health Technology Assessment... Dec 2023A wide range of ablative and non-surgical therapies are available for treating small hepatocellular carcinoma in patients with very early or early-stage disease and... (Meta-Analysis)
Meta-Analysis
BACKGROUND
A wide range of ablative and non-surgical therapies are available for treating small hepatocellular carcinoma in patients with very early or early-stage disease and preserved liver function.
OBJECTIVE
To review and compare the effectiveness of all current ablative and non-surgical therapies for patients with small hepatocellular carcinoma (≤ 3 cm).
DESIGN
Systematic review and network meta-analysis.
DATA SOURCES
Nine databases (March 2021), two trial registries (April 2021) and reference lists of relevant systematic reviews.
REVIEW METHODS
Eligible studies were randomised controlled trials of ablative and non-surgical therapies, versus any comparator, for small hepatocellular carcinoma. Randomised controlled trials were quality assessed using the Cochrane Risk of Bias 2 tool and mapped. The comparative effectiveness of therapies was assessed using network meta-analysis. A threshold analysis was used to identify which comparisons were sensitive to potential changes in the evidence. Where comparisons based on randomised controlled trial evidence were not robust or no randomised controlled trials were identified, a targeted systematic review of non-randomised, prospective comparative studies provided additional data for repeat network meta-analysis and threshold analysis. The feasibility of undertaking economic modelling was explored. A workshop with patients and clinicians was held to discuss the findings and identify key priorities for future research.
RESULTS
Thirty-seven randomised controlled trials (with over 3700 relevant patients) were included in the review. The majority were conducted in China or Japan and most had a high risk of bias or some risk of bias concerns. The results of the network meta-analysis were uncertain for most comparisons. There was evidence that percutaneous ethanol injection is inferior to radiofrequency ablation for overall survival (hazard ratio 1.45, 95% credible interval 1.16 to 1.82), progression-free survival (hazard ratio 1.36, 95% credible interval 1.11 to 1.67), overall recurrence (relative risk 1.19, 95% credible interval 1.02 to 1.39) and local recurrence (relative risk 1.80, 95% credible interval 1.19 to 2.71). Percutaneous acid injection was also inferior to radiofrequency ablation for progression-free survival (hazard ratio 1.63, 95% credible interval 1.05 to 2.51). Threshold analysis showed that further evidence could plausibly change the result for some comparisons. Fourteen eligible non-randomised studies were identified ( ≥ 2316); twelve had a high risk of bias so were not included in updated network meta-analyses. Additional non-randomised data, made available by a clinical advisor, were also included ( = 303). There remained a high level of uncertainty in treatment rankings after the network meta-analyses were updated. However, the updated analyses suggested that microwave ablation and resection are superior to percutaneous ethanol injection and percutaneous acid injection for some outcomes. Further research on stereotactic ablative radiotherapy was recommended at the workshop, although it is only appropriate for certain patient subgroups, limiting opportunities for adequately powered trials.
LIMITATIONS
Many studies were small and of poor quality. No comparative studies were found for some therapies.
CONCLUSIONS
The existing evidence base has limitations; the uptake of specific ablative therapies in the United Kingdom appears to be based more on technological advancements and ease of use than strong evidence of clinical effectiveness. However, there is evidence that percutaneous ethanol injection and percutaneous acid injection are inferior to radiofrequency ablation, microwave ablation and resection.
STUDY REGISTRATION
PROSPERO CRD42020221357.
FUNDING
This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment (HTA) programme (NIHR award ref: NIHR131224) and is published in full in ; Vol. 27, No. 29. See the NIHR Funding and Awards website for further award information.
Topics: Humans; Carcinoma, Hepatocellular; Ethanol; Liver Neoplasms; Network Meta-Analysis; Prospective Studies; Randomized Controlled Trials as Topic; Ablation Techniques
PubMed: 38149643
DOI: 10.3310/GK5221 -
International Journal of Dental Hygiene Feb 2021The aim of this systematic review was to evaluate the effectiveness of removable complete denture disinfection using microwaves for the treatment of denture stomatitis. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
The aim of this systematic review was to evaluate the effectiveness of removable complete denture disinfection using microwaves for the treatment of denture stomatitis.
METHODS
This review identified studies comparing the efficacy of microwave prosthesis disinfection (I) to topical antifungal therapy (C) in the treatment of denture stomatitis (O), which included only individuals who used complete dentures and presented with denture stomatitis (P). The search was performed in six databases and identified 1524 records; after the removal of duplicates, 816 articles remained. Three articles were selected for qualitative synthesis and two for meta-analysis. Random-effects meta-analysis estimated the polled effects of microwave disinfection and antifungal therapy on the Candida counts and clinical manifestation of denture stomatitis. The GRADE approach was used to estimate the certainty of evidence.
RESULTS
All included studies reported significant reductions in Candida counts and the frequency of denture stomatitis of groups subjected to microwave disinfection of dentures and topical antifungal therapy with nystatin. Significative differences between treatments were only detected for Candida quantification in the palate, within 90 days follow-up period (SMD = 0.47, 95% CI = 0.02-0.91). Meta-analyses did not show any further differences between treatments (p > .05), considering the Candida quantification in dentures and the frequency of clinical signs of denture stomatitis. The certainty of the evidence was considered as low, according to GRADE approach.
CONCLUSION
Microwave disinfection of complete dentures can be considered as efficient as antifungal therapy for the treatment of denture stomatitis. However, further well-designed studies are necessary to confirm such evidence.
Topics: Candida; Denture, Complete; Disinfection; Humans; Microwaves; Stomatitis, Denture
PubMed: 33022878
DOI: 10.1111/idh.12477 -
Journal of Cosmetic and Laser Therapy :... Feb 2017Primary focal axillary hyperhidrosis is a disorder of excessive sweating that can strongly impact quality of life. (Comparative Study)
Comparative Study Review
BACKGROUND
Primary focal axillary hyperhidrosis is a disorder of excessive sweating that can strongly impact quality of life.
OBJECTIVE
The objective if this study was to compare microwave ablation (MA), botulinum toxin (BT) injection, and liposuction-curettage (LC) in the treatment of primary axillary hyperhidrosis based on subjective and objective criteria.
METHODS
A systematic review of the literature published in French or English between 1 January 1991 and 1 February 2015 was completed using PubMed and Embase databases.
RESULTS
16 of 775 articles were selected based on relevance and criteria of inclusion and exclusion. The three methods proved to be efficient and safe; however, MA and BT had better results when compared to LC in the short term. Both MA and LC showed longer lasting results when compared to BT. However, in the long term, MA was superior to LC.
CONCLUSION
MA, LC, and BT injections are safe and efficient minimally invasive alternatives for the treatment of axillary hyperhidrosis. Well-designed randomized controlled trials are needed to further compare the efficacy of these techniques.
Topics: Ablation Techniques; Axilla; Botulinum Toxins; Curettage; Humans; Hyperhidrosis; Injections, Intralesional; Lipectomy; Microwaves
PubMed: 27782761
DOI: 10.1080/14764172.2016.1248438 -
Animals : An Open Access Journal From... Dec 2022Electrotherapy modalities are currently used in the treatment of animals, but the evidence base supporting their use has not yet been systematically reviewed. Cochrane... (Review)
Review
Electrotherapy modalities are currently used in the treatment of animals, but the evidence base supporting their use has not yet been systematically reviewed. Cochrane guidelines, as adapted by the Swedish Agency for Health Technology Assessment and Assessment of Social Services, were followed for this systematic review. A literature search regarding all currently known electrotherapy modalities applied to horses, dogs, and cats was conducted for the years 1980-2020 using three databases: CABI, PubMed, and Web of Science Core Collection. Of the 5385 references found, 41 articles were included in the review: 13 papers on pulsed electromagnetic field therapy (PEMFT), 7 on neural electrical muscle stimulation (NEMS), 5 on transcutaneous electrical nerve stimulation (TENS), 4 on static magnets, 3 on interference, 2 each on percutaneous electrical neural stimulation (PENS), bioelectricity, and diathermy, and 1 each on micro-pulsed stimulation, capacitive coupled electrical stimulation, and microwave therapy. The literature per modality was limited in quantity (mean 3.7 papers). Half of the articles were assessed to have a high risk of bias (20 high, 7 moderate, and 14 low). The existing literature used a spectrum of indications and treatment parameters, which makes comparisons and drawing conclusions to support the use of these modalities in clinical practice challenging. The current scientific evidence is not sufficient to support the clinical effects of electrotherapies for any clinical indication in horses, dogs or cats. The selected suggestive results warrant further high-quality research on PEMFT, NEMS, TENS, and PENS.
PubMed: 36611674
DOI: 10.3390/ani13010064 -
Endocrine Nov 2018To evaluate the effectiveness and safety of microwave ablation (MWA), including cooled MWA (cMWA) and uncooled MWA (uMWA), for the treatment of benign thyroid nodules... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
To evaluate the effectiveness and safety of microwave ablation (MWA), including cooled MWA (cMWA) and uncooled MWA (uMWA), for the treatment of benign thyroid nodules (BTNs).
METHODS
The databases of MEDLINE, EMBASE and Cochrane library were searched up to 3 Jun, 2018. In this meta-analysis, data of volume reduction rates (VRRs) at the 3-, 6- and 12-month follow-up, and complications are obtained to evaluate the effectiveness and safety of cMWA and uMWA for the treatment of BTNs.
RESULTS
Nine studies involving 1461 patients with 1845 BTNs were included. The pooled VRR at the 3-month follow-up after MWA therapy reached 54.3% (95% CI: 45.3-63.3%, I = 97.6%), 73.5% (95% CI: 66.7-80.3%, I = 94.9%) at the 6-month follow-up, and 88.6% (95% CI: 84.9-92.4%, I = 92.7%) at the 12-month follow-up. The pooled proportions of overall, major and minor complications were 52.4% (95% CI: 29.8-74.9%; I = 99.5%), 4.8% (95% CI: 2.7-7.0%; I = 55.9%) and 48.3% (95% CI: 31.2-65.4%; I = 99.7%). Both cMWA and uMWA achieved similar pooled VRR at the 3-month follow-up (58.4 vs 45.3%, P = 0.07) and pooled proportion of major complications (4.9 vs 5.0%, P = 0.49), while uMWA had higher pooled proportions of overall and minor complications than cMWA (97.8 vs 29.7%, P < 0.01; 97.8 vs 21.0%, P < 0.01), with more patients suffering pain and skin burn after uMWA (100 vs 5.5%, P < 0.01; 47.2 vs 0.2%, P < 0.01).
CONCLUSION
MWA is an effective treatment modality for BTNs. When considering the patient's comfort, cMWA would be a more preferable procedure with less complications.
Topics: Combined Modality Therapy; Humans; Hypothermia, Induced; Microwaves; Radiofrequency Ablation; Thyroid Nodule; Treatment Outcome
PubMed: 30073455
DOI: 10.1007/s12020-018-1693-2 -
The Cochrane Database of Systematic... Oct 2007Cervical ectropion is considered as one of the most common types of chronic cervicitis in China. Topical treatments for cervical ectropion including microwave tissue... (Review)
Review
BACKGROUND
Cervical ectropion is considered as one of the most common types of chronic cervicitis in China. Topical treatments for cervical ectropion including microwave tissue coagulation, are widely used in many hospitals in China. Nowadays, the necessary intervention for inflammatory cervical ectopy is controversial.
OBJECTIVES
To compare the efficacy and potential side effects of microwave tissue coagulation with other interventions or no intervention in the treatment of cervical ectropion.
SEARCH STRATEGY
We searched the Cochrane Menstrual Disorders and Subfertility Group Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library 2006, Issue 1), MEDLINE (1966 to 2005), EMBASE (1974 to 2005); The Chinese Biomedical Database (CBM, 1978 to 2005), The Chinese Medical Current Contents (CMCC, 1994 to 2005), CAJ Full-text Database (1994 to 2005) and Chinese Scientific Journals Database (1989 to 2005). We also searched related literature on the Internet with search engines such as Google, searched the reference lists of articles and hand searched relevant Chinese journals.
SELECTION CRITERIA
Only authentic randomized controlled trials (RCTs) were included.
DATA COLLECTION AND ANALYSIS
Two authors independently interviewed the original authors of claimed RCTs published in China and then assessed the quality of the three included RCTs and extracted data.
MAIN RESULTS
No studies were found that met the participant inclusion criteria of the protocol. Although three studies were identified as authentic RCTs from 92 potential RCTs, it was not possible to confirm that the participants were symptomatic prior to treatment. Of these three studies two trials compared microwave therapy with laser and one compared microwave therapy with interferon-alpha suppository therapy. Microwave therapy showed a better effect on cervical appearance over laser therapy in the women with grade II and III and also improved cervical appearance over interferon-alpha suppository therapy. There was no difference in grade I women. Microwave therapy showed less adverse bleeding than laser therapy during the treatment. However, the methodological quality of the three RCTs was generally low. No trial compared treatment to no intervention and most trials didn't assess relief of symptoms or quality of life and satisfaction, which are very important to women.
AUTHORS' CONCLUSIONS
There are no RCTs comparing microwave therapy with other treatments or no treatment in symptomatic women with cervical ectropion. Although microwave therapy improved the appearance of the cervix over both laser therapy and interferon-alpha suppository therapy it is not clear if there is any other benefit for women.
Topics: Chronic Disease; Female; Humans; Microwaves; Randomized Controlled Trials as Topic; Uterine Cervicitis
PubMed: 17943899
DOI: 10.1002/14651858.CD006227.pub2 -
Frontiers in Oncology 2022Microwave ablation (MWA) for hepatocellular carcinomas (HCCs) in the elderly has been the subject of new research in recent years. However, there are currently no strong...
BACKGROUND
Microwave ablation (MWA) for hepatocellular carcinomas (HCCs) in the elderly has been the subject of new research in recent years. However, there are currently no strong lines of evidence for the prognosis following MWA treatment for HCC in the elderly. Therefore, we conducted a systematic review to assess the safety and feasibility of MWA for HCC in elderly patients.
METHODS
Up until August 15, 2021, a comprehensive literature search was undertaken in PubMed, Scopus, CENTRAL (Cochrane Central Register of Controlled Trials), and Google Scholar databases for all published articles. Observational studies reporting the safety and feasibility of MWA for HCC in elderly patients were included. The Newcastle-Ottawa Scale (NOS) was used to measure the quality assessment.
RESULTS
Our review, composed of 7 observational studies, including a total of 7,683 HCC patients, looked at the safety and feasibility of MWA for HCC in the elderly. Current lines of evidence on the risks and outcomes of MWA of HCC treatments in elderly patients are discussed.
CONCLUSIONS
According to our findings, elderly patients, even those with a high comorbidity index, benefited from MWA of HCC similar to younger patients. More clinical data are needed to determine selection criteria for elderly HCC patients to increase the possibility of receiving MWA as a potential lifesaving option. As such, further studies evaluating the outcomes of MWA for HCC treatment modalities in elderly patients are warranted.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/, identifier CRD42021273091.
PubMed: 35677153
DOI: 10.3389/fonc.2022.855909