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Korean Journal of Radiology Mar 2024The current body of evidence lacks clarity regarding the comparative efficacy and safety of radiofrequency ablation (RFA) and microwave ablation (MWA) as minimally... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
The current body of evidence lacks clarity regarding the comparative efficacy and safety of radiofrequency ablation (RFA) and microwave ablation (MWA) as minimally invasive treatments for benign thyroid nodules. The primary objective of this study is to clarify these concerns.
MATERIALS AND METHODS
A comprehensive search was conducted using the Cochrane Library, Scopus, Europe PMC, and Medline databases until October 10th, 2023, using a combination of relevant keywords. This study incorporated literature that compared RFA and MWA for benign thyroid nodules. The primary outcome was the volume reduction ratio (VRR) from baseline to follow-up. Secondary outcomes were symptom score, cosmetic score, ablation time, major complications rate, hemorrhage, hoarseness, skin burn, cough, and sympathetic nerve injury. We used Risk of Bias in Non-randomized Studies - of Interventions (ROBINS-I) tool to assess the risk of bias in the included studies. We employed random effects models to analyze the standardized mean difference (SMD) and odds ratio for the presentation of outcomes.
RESULTS
Nine studies with 2707 nodules were included. The results of our meta-analysis indicated similar efficacy between RFA and MWA in terms of VRR during the 1 (SMD 0.06; 95% confidence interval [CI]: -0.13 to 0.26; = 0.52) and 3 (SMD 0.11; 95% CI: -0.03 to 0.25; = 0.12) months of follow-up. VRR was significantly higher in RFA than in MWA at the 6 (SMD 0.25; 95% CI: 0.06-0.43; = 0.008) and 12 month of follow-up (SMD 0.38; 95% CI: 0.17 to 0.59; < 0.001). There were no significant differences between RFA and MWA in symptom scores, cosmetic scores, or the incidence of complications, including hemorrhage, hoarseness, skin burn, cough, and sympathetic nerve injury.
CONCLUSION
RFA showed a higher VRR than MWA at 6 and 12-month follow-ups, with a comparable safety profile.
Topics: Humans; Catheter Ablation; Thyroid Nodule; Microwaves; Hoarseness; Radiofrequency Ablation; Cough; Hemorrhage; Burns; Treatment Outcome; Retrospective Studies
PubMed: 38413114
DOI: 10.3348/kjr.2023.1004 -
Urologic Oncology Jul 2022To assess the differential clinical outcomes of patients treated with partial nephrectomy (PN) vs. those treated with ablation therapy (AT) such as radiofrequency... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
To assess the differential clinical outcomes of patients treated with partial nephrectomy (PN) vs. those treated with ablation therapy (AT) such as radiofrequency ablation, cryoablation and microwave ablation for cT1b compared to cT1a renal tumors.
MATERIALS AND METHODS
Multiple databases were searched for articles published before August 2021. Studies were deemed eligible if they compared clinical outcomes in patients who underwent PN with those who underwent AT for cT1a and/or cT1b renal tumors.
RESULTS
Overall, 27 studies comprising 13,996 patients were eligible for this meta-analysis. In both cT1a and cT1b renal tumors, there was no significant difference in the percent decline of estimated glomerular filtration rates or in the overall/severe complication rates between PN and AT. Compared to AT, PN was associated with a lower risk of local recurrence in both patients with cT1a and cT1b tumors (cT1a: pooled risk ratio [RR]; 0.43, 95% confidence intervals [CI]; 0.28-0.66, cT1b: pooled RR; 0.41, 95%CI; 0.23-0.75). Subgroup analyses regarding the technical approach revealed no statistical difference in local recurrence rates between percutaneous AT and PN in patients with cT1a tumors (pooled RR; 0.61, 95%CI; 0.32-1.15). In cT1b, however, PN was associated with a lower risk of local recurrence (pooled RR; 0.45, 95%CI; 0.23-0.88). There was no difference in distant metastasis or cancer mortality rates between PN and AT in patients with cT1a, or cT1b tumors.
CONCLUSIONS
AT has a substantially relevant disadvantage with regards to local recurrence compared to PN, particularly in cT1b renal tumors. Despite the limitations inherent to the nature of retrospective and unmatched primary cohorts, percutaneous AT could be used as a reasonable alternative treatment for well-selected patients with cT1a renal tumors.
Topics: Carcinoma, Renal Cell; Humans; Kidney Neoplasms; Neoplasm Staging; Nephrectomy; Retrospective Studies; Treatment Outcome
PubMed: 35562311
DOI: 10.1016/j.urolonc.2022.04.002 -
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 -
International Journal of Hyperthermia :... 2022Radiofrequency ablation (RFA) and microwave ablation (MWA) are widely used in combination with transarterial chemoembolization (TACE) for intermediate-stage... (Meta-Analysis)
Meta-Analysis
Combined radiofrequency ablation or microwave ablation with transarterial chemoembolization can increase efficiency in intermediate-stage hepatocellular carcinoma without more complication: a systematic review and meta-analysis.
OBJECTIVES
Radiofrequency ablation (RFA) and microwave ablation (MWA) are widely used in combination with transarterial chemoembolization (TACE) for intermediate-stage hepatocellular carcinoma (HCC) in clinical practice. We aim to compare the efficacy and safety of TACE combined with RFA or MWA versus TACE monotherapy for intermediate-stage HCC.
METHODS
We searched PubMed, Embase, Web of Science, and the Cochrane Library for relevant studies. The outcomes included overall survival (OS), progression-free survival (PFS), local tumor control (LTC) rate, and major complication. Subgroup analysis for different TACE combination therapies was performed.
RESULTS
Ten studies with 1799 patients with intermediate-stage HCC were included. The pooled hazard ratio (HR) for OS was in favor of TACE combination therapy (HR, 0.50, 95% confidence interval [CI], 0.40-0.62). Specifically, the TACE combination therapy was associated with higher 1-, 3-, and 5-year OS rates. Regarding tumor progression, the TACE combination therapy showed significantly better PFS (HR, 0.47, 95% CI, 0.37-0.61) and higher 1-, 2- and 3-year PFS rates than TACE monotherapy. The pooled odds ratio (OR) for the LTC was also in favor of TACE combination therapy (OR, 0.36, 95% CI, 0.24-0.53). No significant difference was found between the two groups regarding the major complication rate (OR, 1.26, 95% CI, 0.74-2.16). These results were consistent across subgroups of TACE + RFA versus TACE and TACE + MWA versus TACE.
CONCLUSION
TACE combined with RFA or MWA can provide significantly better OS, PFS and LTC than TACE monotherapy for patients with intermediate-stage HCC, without increasing the risk of major complications.
Topics: Carcinoma, Hepatocellular; Catheter Ablation; Chemoembolization, Therapeutic; Combined Modality Therapy; Humans; Liver Neoplasms; Microwaves; Radiofrequency Ablation; Retrospective Studies; Treatment Outcome
PubMed: 35271786
DOI: 10.1080/02656736.2022.2048095 -
International Journal of Hyperthermia :... May 2016Radiofrequency ablation (RFA) and microwave ablation (MWA) are the two main percutaneous techniques for the treatment of unresectable hepatocellular carcinoma (HCC).... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Radiofrequency ablation (RFA) and microwave ablation (MWA) are the two main percutaneous techniques for the treatment of unresectable hepatocellular carcinoma (HCC). However, to date, studies comparing the two therapies have provided discordant results. The aim of this meta-analysis is to evaluate the efficacy and safety of the two treatments for HCC patients.
MATERIALS AND METHODS
A computerised bibliographic search was performed on PubMed/MEDLINE, Embase, Google Scholar and Cochrane library databases. The rates of complete response (CR), local recurrence (LRR), 3-year survival (SR) and major complications were compared between the two treatment groups by using the Mantel-Haenszel test in cases of low heterogeneity or the DerSimonian and Laird test in cases of high heterogeneity. Sources of heterogeneity were investigated using subgroup analyses. In order to confirm our finding, sensitivity analysis was performed restricting the analysis to high-quality studies.
RESULTS
One randomised controlled trial (RCT) and six retrospective studies with 774 patients were included in the meta-analysis. A non-significant trend of higher CR rates in the patients treated with MWA was found (odds ratio (OR) = 1.12, 95% confidence interval (CI) 0.67-1.88, p = 0.67]. Overall LRR was similar between the two treatment groups (OR 1.01, 95% CI 0.53-1.87, p = 0.98) but MWA outperformed RFA in cases of larger nodules (OR 0.46, 95% CI 0.24-0.89, p = 0.02). 3-year SR was higher after RFA without statistically significant difference (OR 0.95, 95% CI 0.58-1.57, p = 0.85). Major complications were more frequent, although not significantly, in MWA patients (OR 1.63, 95% CI 0.88-3.03, p = 0.12).
CONCLUSIONS
Our results indicate a similar efficacy between the two percutaneous techniques with an apparent superiority of MWA in larger neoplasms.
Topics: Carcinoma, Hepatocellular; Catheter Ablation; Humans; Liver Neoplasms; Microwaves; Neoplasm Recurrence, Local; Treatment Outcome
PubMed: 26794414
DOI: 10.3109/02656736.2015.1127434 -
Oral Diseases Apr 2016The objective of this study is to assess the efficacy and safety of miconazole for treating oral candidiasis. Twelve electronic databases were searched for randomized... (Meta-Analysis)
Meta-Analysis Review
The objective of this study is to assess the efficacy and safety of miconazole for treating oral candidiasis. Twelve electronic databases were searched for randomized controlled trials evaluating treatments for oral candidiasis and complemented by hand searching. The clinical and mycological outcomes, as well as adverse effects, were set as the primary outcome criteria. Seventeen trials were included in this review. Most studies were considered to have a high or moderate level of bias. Miconazole was more effective than nystatin for thrush. For HIV-infected patients, there was no significant difference in the efficacy between miconazole and other antifungals. For denture wearers, microwave therapy was significantly better than miconazole. No significant difference was found in the safety evaluation between miconazole and other treatments. The relapse rate of miconazole oral gel may be lower than that of other formulations. This systematic review and meta-analysis indicated that miconazole may be an optional choice for thrush. Microwave therapy could be an effective adjunct treatment for denture stomatitis. Miconazole oral gel may be more effective than other formulations with regard to long-term results. However, future studies that are adequately powered, large-scale, and well-designed are needed to provide higher-quality evidence for the management of oral candidiasis.
Topics: AIDS-Related Opportunistic Infections; Antifungal Agents; Candidiasis, Oral; Chewing Gum; Gels; Humans; Miconazole; Microwaves
PubMed: 26456226
DOI: 10.1111/odi.12380 -
Clinical Endocrinology Jul 2021To compare the effectiveness and safety of radiofrequency ablation (RFA) and microwave ablation (MWA) for the treatment of benign thyroid nodules (BTNs). (Meta-Analysis)
Meta-Analysis
PURPOSE
To compare the effectiveness and safety of radiofrequency ablation (RFA) and microwave ablation (MWA) for the treatment of benign thyroid nodules (BTNs).
METHODS
PubMed, Embase and Cochrane databases were searched up to September 11, 2020. Volume reduction rate (VRR), symptomatic and cosmetic scores analysed by standardized mean difference (SMD), and complications analysed by risk difference (RD) were performed to evaluate the efficacy and safety of RFA and MWA for treating BTNs.
RESULTS
Five eligible studies were included. 899 patients with 956 BTNs and 869 patients with 938 BTNs received RFA and MWA, respectively. RFA and MWA have the similar pooled 3-month (56.0% vs. 53.9%, p = .668) and 6-month (80.8% vs. 74.9%, p = .080) VRRs. But RFA showed a significantly higher VRR than MWA after 12 months (86.2% vs. 80.0%, p = .036). The pooled symptomatic and cosmetic scores decreased significantly after 6 and 12 months in both RFA and MWA. The improvements of symptoms were equivalent between two groups at 6 (SMD: 1.17 vs. 1.12, p = .930) and 12 (SMD: 1.46 vs. 1.45, p = .930) months. No significant differences in cosmetic scores were found between two groups at 6 (SMD: 0.87 vs. 0.94, p = 0. 334) and 12 (SMD: 1.21 vs. 1.15, p = 0. 872) months. Major (RD = -0.02, P = .107) and minor (RD = 0.00, p = .661) complications did not significantly differ between RFA and MWA.
CONCLUSIONS
RFA and MWA are effective and safe treatment modalities for BTNs. But RFA showed a superior 12-month VRR. RFA may have a better long-term effect on volume reduction of nodules compared with MWA.
Topics: Catheter Ablation; Humans; Microwaves; Radiofrequency Ablation; Retrospective Studies; Thyroid Nodule; Treatment Outcome
PubMed: 33556187
DOI: 10.1111/cen.14438 -
Hepatobiliary & Pancreatic Diseases... Aug 2021Gold standard for colorectal liver metastases (CRLM) remains hepatic resection (HR). However, patients with severe comorbidities, unresectable or deep-situated... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Gold standard for colorectal liver metastases (CRLM) remains hepatic resection (HR). However, patients with severe comorbidities, unresectable or deep-situated resectable CRLM are candidates for ablation. The aim of the study was to compare recurrence rate and survival benefit of the microwave ablation (MWA), radiofrequency ablation (RFA) and HR by conducting the first network meta-analysis.
DATA SOURCES
Systematic search of the literature was conducted in the electronic databases. Both updated traditional and network meta-analyses were conducted and the results were compared between them.
RESULTS
HR cohort demonstrated significantly less local recurrence rate and better 3- and 5-year disease-free (DFS) and overall survival (OS) compared to MWA and RFA cohorts. HR cohort included significantly younger patients and with significantly lower preoperative carcinoembryonic antigen (CEA) by 10.28 ng/mL compared to RFA cohort. Subgroup analysis of local recurrence and OS of solitary and ≤ 3 cm CRLMs did not demonstrate any discrepancies when compared with the whole sample.
CONCLUSIONS
For resectable CRLM the treatment of choice still remains HR. MWA and RFA can be used as a single or adjunct treatment in patients with unresectable CRLM and/or prohibitive comorbidities.
Topics: Catheter Ablation; Colorectal Neoplasms; Hepatectomy; Humans; Liver Neoplasms; Microwaves; Network Meta-Analysis; Radiofrequency Ablation; Treatment Outcome
PubMed: 34127382
DOI: 10.1016/j.hbpd.2021.05.004 -
Minerva Ginecologica Apr 2016Endometrial ablation is a procedure that surgically destroys (ablates) the lining of the uterus (endometrium). The goal of endometrial ablation is to reduce menstrual... (Comparative Study)
Comparative Study Review
INTRODUCTION
Endometrial ablation is a procedure that surgically destroys (ablates) the lining of the uterus (endometrium). The goal of endometrial ablation is to reduce menstrual flow. In some women, menstrual flow may stop completely. In some cases, endometrial ablation may be an alternative to hysterectomy. There are several techniques used to perform endometrial ablation, including electrical or electrocautery ablation, in which an electric current travels through a wire loop or rollerball is applied to the endometrial lining to cauterize the tissue; hydrothermal ablation, in which heated fluid is pumped into the uterus and destroys the endometrial lining via high temperatures; balloon therapy ablation, in which a balloon at the end of a catheter is inserted into the uterus and filled with fluid, which is then heated to the point that the endometrial tissues are eroded away; radiofrequency ablation in which a triangular mesh electrode is expanded to fill the uterine cavity, at which point the electrode delivers an electrical current and destroys the endometrial lining; cryoablation (freezing), in which a probe uses extremely low temperatures to freeze and destroy the endometrial tissues; and microwave ablation, in which microwave energy is delivered through a slender probe inserted into the uterus and destroys the endometrial lining.
EVIDENCE ACQUISITION
The purpose of this systematic review was to evaluate the feasibility, safety, and efficacy of endometrial ablation performed with first- and second-generation techniques. A literature search in PubMed from January 2000 to September 2015 was performed using the keywords endometrial ablation, menorrhagia, and heavy menstrual bleeding. Results were restricted to systematic reviews, randomized control trials (RCT)/controlled clinical trials, and observational studies written in English from January 2000 to September 2015.
EVIDENCE SYNTHESIS
There is no evidence that either broad category is more effective than the other in reducing HMB, and there is no evidence that rates of satisfaction differ significantly.
CONCLUSIONS
The overall results of the presented studies suggest that endometrial ablation is an effective therapy for menorrhagia in women with bleeding disorders.
Topics: Catheter Ablation; Cryosurgery; Electrodes; Endometrial Ablation Techniques; Endometrium; Equipment Design; Female; Humans; Menorrhagia; Microwaves; Randomized Controlled Trials as Topic
PubMed: 26928420
DOI: No ID Found -
Clinical Oral Investigations Nov 2020To evaluate the effectiveness of microwave disinfection in treating Candida-associated denture stomatitis (CADS). (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To evaluate the effectiveness of microwave disinfection in treating Candida-associated denture stomatitis (CADS).
MATERIALS AND METHODS
The PubMed/MEDLINE, Embase, and Scopus databases were searched for reports on randomized clinical trials (RCTs) published in English until May 2020 (PROSPERO CRD42020192062) that evaluated the treatment of CADS by using microwave disinfection. The main outcomes were the improvement of clinical signs and/or the decrease in the residual yeast present on the dentures and palatal mucosa. The mean differences, standard deviations, risk ratio, and 95% confidence interval were calculated by using the random-effects model. Heterogeneity was assessed by using Cochran's Q test and I values. The level of significance was set at α = 0.05.
RESULTS
Five RCTs with 245 participants were included. The descriptive investigations demonstrated that microwave disinfection was as effective (p > 0.05) as 0.2% chlorhexidine, 0.02% sodium hypochlorite, and topical nystatin (100.000 IU/mL), and was superior to topical miconazole in treating CADS. The metaanalysis did not show a statistical difference between microwave disinfection and nystatin (100.000 IU/mL) treatment in terms of mycological counts, cure, and recurrence rates (p > 0.05).
CONCLUSION
Microwave disinfection showed comparable results with those of conventional therapies for treating CADS. In addition, treatment with 650 W for 3 min once a week for 14 days had better cost-effect results, indicating both the prevention and treatment of CADS.
CLINICAL RELEVANCE
Our findings provide evidence regarding the treatment of CADS using microwave disinfection, and also indicating the best cost-effective option for this treatment modality.
Topics: Candida; Disinfection; Humans; Microwaves; Nystatin; Stomatitis, Denture
PubMed: 32974776
DOI: 10.1007/s00784-020-03599-5