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Integrative Cancer Therapies 2021Branched-chain amino acids (BCAAs; leucine, isoleucine, and valine) are essential amino acids involved in immune responses, and may have roles in protein malnutrition... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Branched-chain amino acids (BCAAs; leucine, isoleucine, and valine) are essential amino acids involved in immune responses, and may have roles in protein malnutrition and sarcopenia. Furthermore, certain liver diseases have been associated with a decreased Fischer's ratio (BCAAs to aromatic amino acids; phenylalanine, tyrosine, and tryptophan). We aimed to evaluate the safety and efficacy of BCAAs use in patients with cancer undergoing surgery.
METHODS
MEDLINE, Embase, and CENTRAL were searched (inception to July 24, 2020) for randomized controlled trials (RCTs) and comparative observational studies in English evaluating BCAAs (alone or in combinations) during the oncological peri-operative period. Study selection, data extraction, and quality appraisal were done in duplicate. RCT risk-of-bias was appraised using Cochrane Risk-of-Bias tool, and observational studies' quality assessment was conducted with Newcastle-Ottawa Scale. Meta-analyses were conducted when appropriate.
RESULTS
20 articles were included comprising 13 RCTs and 6 observational cohort studies in 7 reports and 2019 total participants overall. Among 13 RCTs, 77% involved liver cancer. Methodological study quality scored substantial risk-of-bias across most RCTs. Meta-analysis of RCTs found a 38% decreased risk of post-operative infections in BCAAs group compared to controls (RR = 0.62; 95% CI = 0.44 to 0.87; = .006; number of RCTs, = 6; total sample size, N = 389; = 0%). BCAAs were also found to be beneficial for ascites (RR = 0.55; 95% CI = 0.35 to 0.86; = .008; = 4; N = 296; = 0%), body weight (MD = 3.24 kg; 95% CI = 0.44 to 6.04; = .02; = 3; N = 196; = 24%), and hospitalization length (MD = -2.07 days; 95% CI = -3.97 to -0.17; = .03; = 5; N = 362; = 59%). No differences were found between BCAAs and controls for mortality, recurrence, other post-operative complications (liver failure, edema, pleural effusion), blood loss, quality of life, ammonia level, and prothrombin time. No serious adverse events were related to BCAAs; however, serious adverse events were reported due to intravenous catheters. No safety concerns from observational studies were identified.
CONCLUSIONS
Branched-chain amino acids during the oncological surgical period demonstrated promise in reducing important post-operative morbidity from infections and ascites compared to controls. Blinded, placebo-controlled confirmatory trials of higher methodological quality are warranted, especially using oral, short-term BCAAs-enriched supplements within the context of recent ERAS programs.
PROSPERO REGISTRATION
CRD42018086168.
Topics: Amino Acids, Branched-Chain; Dietary Supplements; Humans; Neoplasm Recurrence, Local; Postoperative Complications; Quality of Life
PubMed: 33648360
DOI: 10.1177/1534735421997551 -
The Cochrane Database of Systematic... Feb 2021Breast cancer is one of the most common cancers among women. Surgical removal of the cancer is the mainstay of treatment; however, tumour handling during surgery can... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Breast cancer is one of the most common cancers among women. Surgical removal of the cancer is the mainstay of treatment; however, tumour handling during surgery can cause microscopic dissemination of tumour cells and disease recurrence. The body's hormonal response to surgery (stress response) and general anaesthesia may suppress immunity, promoting tumour dissemination. Paravertebral anaesthesia numbs the site of surgery, provides good analgesia, and blunts the stress response, minimising the need for general anaesthesia.
OBJECTIVES
To assess the effects of paravertebral anaesthesia with or without sedation compared to general anaesthesia in women undergoing breast cancer surgery, with important outcomes of quality of recovery, postoperative pain at rest, and mortality.
SEARCH METHODS
On 6 April 2020, we searched the Specialised Register of the Cochrane Breast Cancer Group (CBCG); CENTRAL (latest issue), in the Cochrane Library; MEDLINE (via OvidSP); Embase (via OvidSP); the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) search portal; and ClinicalTrials.gov for all prospectively registered and ongoing trials.
SELECTION CRITERIA
We included randomised controlled trials (RCTs) conducted in adult women undergoing breast cancer surgery in which paravertebral anaesthesia with or without sedation was compared to general anaesthesia. We did not include studies in which paravertebral anaesthesia was given as an adjunct to general anaesthesia and then this was compared to use of general anaesthesia.
DATA COLLECTION AND ANALYSIS
Two review authors independently extracted details of trial methods and outcome data from eligible trials. When data could be pooled, analyses were performed on an intention-to-treat basis, and the random-effects model was used if there was heterogeneity. When data could not be pooled, the synthesis without meta-analysis (SWiM) approach was applied. The GRADE approach was used to assess the certainty of evidence for each outcome.
MAIN RESULTS
Nine studies (614 participants) were included in the review. All were RCTs of parallel design, wherein female patients aged > 18 years underwent breast cancer surgery under paravertebral anaesthesia or general anaesthesia. None of the studies assessed quality of recovery in the first three postoperative days using a validated questionnaire; most assessed factors affecting quality of recovery such as postoperative analgesic use, postoperative nausea and vomiting (PONV), hospital stay, ambulation, and patient satisfaction. Paravertebral anaesthesia may reduce the 24-hour postoperative analgesic requirement (odds ratio (OR) 0.07, 95% confidence interval (CI) 0.01 to 0.34; 5 studies, 305 participants; low-certainty evidence) compared to general anaesthesia. Heterogeneity (I² = 70%) was attributed to the fixed dose of opioids and non-steroidal analgesics administered postoperatively in one study (70 participants), masking a difference in analgesic requirements between groups. Paravertebral anaesthesia probably reduces the incidence of PONV (OR 0.16, 95% CI 0.08 to 0.30; 6 studies, 324 participants; moderate-certainty evidence), probably results in a shorter hospital stay (mean difference (MD) -79.39 minutes, 95% CI -107.38 to -51.40; 3 studies, 174 participants; moderate-certainty evidence), and probably reduces time to ambulation compared to general anaesthesia (SWiM analysis): percentages indicate vote counting based on direction of effect (100%, 95% CI 51.01% to 100%; P = 0.125; 4 studies, 375 participants; moderate-certainty evidence). Paravertebral anaesthesia probably results in higher patient satisfaction (MD 5.52 points, 95% CI 1.30 to 9.75; 3 studies, 129 participants; moderate-certainty evidence) on a 0 to 100 scale 24 hours postoperatively compared to general anaesthesia. Postoperative pain at rest and on movement was assessed at 2, 6, and 24 postoperative hours on a 0 to 10 visual analogue scale (VAS). Four studies (224 participants) found that paravertebral anaesthesia as compared to general anaesthesia probably reduced pain at 2 postoperative hours (MD -2.95, 95% CI -3.37 to -2.54; moderate-certainty evidence). Five studies (324 participants) found that paravertebral anaesthesia may reduce pain at rest at 6 hours postoperatively (MD -1.54, 95% CI -3.20 to 0.11; low-certainty evidence). Five studies (278 participants) found that paravertebral anaesthesia may reduce pain at rest at 24 hours postoperatively (MD -1.19, 95% CI -2.27 to -0.10; low-certainty evidence). Differences in the methods of two studies (119 participants) and addition of clonidine to the local anaesthetic in two studies (109 participants), respectively, contributed to the heterogeneity (I² = 96%) observed for these two outcomes. Two studies (130 participants) found that paravertebral anaesthesia may reduce pain on movement at 6 hours (MD-2.57, 95% CI -3.97 to -1.17) and at 24 hours (MD -2.12, 95% CI -4.80 to 0.55; low-certainty evidence). Heterogeneity (I² = 96%) was observed for both outcomes and could be due to methodological differences between studies. None of the studies reported mortality related to the anaesthetic technique. Eight studies (574 participants) evaluated adverse outcomes with paravertebral anaesthesia: epidural spread (0.7%), minor bleeding (1.4%), pleural puncture not associated with pneumothorax (0.3%), and Horner's syndrome (7.1%). These complications were self-limiting and resolved without treatment. No data are available on disease-free survival, chronic pain, and quality of life. Blinding of personnel or participants was not possible in any study, as a regional anaesthetic technique was compared to general anaesthesia. Risk of bias was judged to be serious, as seven studies had concerns of selection bias and three of detection bias.
AUTHORS' CONCLUSIONS
Moderate-certainty evidence shows that paravertebral anaesthesia probably reduces PONV, hospital stay, postoperative pain (at 2 hours), and time to ambulation and results in greater patient satisfaction on the first postoperative day compared to general anaesthesia. Paravertebral anaesthesia may also reduce postoperative analgesic use and postoperative pain at 6 and 24 hours at rest and on movement based on low-certainty evidence. However, RCTs using validated questionnaires are needed to confirm these results. Adverse events observed with paravertebral anaesthesia are rare.
Topics: Adult; Analgesia; Anesthesia Recovery Period; Anesthesia, General; Anesthesia, Spinal; Bias; Breast Neoplasms; Early Ambulation; Female; Horner Syndrome; Humans; Incidence; Intention to Treat Analysis; Length of Stay; Nerve Block; Pain Measurement; Pain, Postoperative; Patient Satisfaction; Postoperative Nausea and Vomiting; Randomized Controlled Trials as Topic; Stress, Physiological
PubMed: 33629404
DOI: 10.1002/14651858.CD012968.pub2 -
Biomedical Reports Dec 2020Fluoro-edenite (FE), asbestiform fiber found in Biancavilla (Sicily, Italy), presents various characteristics similar to the asbestos group, in particular two fibrous... (Review)
Review
Fluoro-edenite (FE), asbestiform fiber found in Biancavilla (Sicily, Italy), presents various characteristics similar to the asbestos group, in particular two fibrous phases tremolite and actinolite. Indeed, epidemiological studies have shown that FE fibers have similar effects to those of asbestos fibers. Such studies have reported a high incidence of malignant mesothelioma (MM), an aggressive neoplasm of the serosal membranes lining the pleural cavity, in individuals residing there due to FE exposure in Biancavilla related to environmental contamination. Evidence has led to the classification of FE as a Group 1 human carcinogen by the International Agency for Research on Cancer (IARC). The aim of this systematic review is to compare the results achieved in , and experimental studies involving FE in order to update the current knowledge on the pathogenesis and molecular mechanisms responsible for FE-mediated MM development as well as the availability of effective biomarkers for MM prevention and diagnosis. This review is focused on the pathophysiological mechanisms mediated by inflammation induced by FE fiber exposure and which are responsible for MM development. This review also discusses the discovery of new diagnostic and prognostic biomarkers for the management of this pathology. It is known that the risk of cancer development increases with chronic inflammation, arising from enhanced reactive oxygen species (ROS) and NO production stimulated by the body to remove exogenous agents, causing DNA damage and enhanced signal transduction that may lead to activation of oncogenes. Studies concerning MM biomarker discovery indicate that several biomarkers have been proposed for MM, but mesothelin is the only Food and Drug Administration (FDA)-approved biomarker for MM, with limitations. In recent studies, analysis to identify selected miRNAs highly deregulated in cancer samples when compared with normal control have been developed. This approach could represent an effort in the field of biomarker discovery for MM.
PubMed: 33149905
DOI: 10.3892/br.2020.1367 -
Journal of Cancer Research and... Sep 2020The purpose of this study is to study the clinical outcomes of different types of magnetic resonance (MR)-guided ablation for the treatment of liver tumors by performing... (Meta-Analysis)
Meta-Analysis
PURPOSE
The purpose of this study is to study the clinical outcomes of different types of magnetic resonance (MR)-guided ablation for the treatment of liver tumors by performing a systematic review and pooled analysis.
MATERIALS AND METHODS
A comprehensive literature search was performed for clinical trials published from January 1997 to October 2019 in PubMed, the Web of Science, Embase, and the Cochrane Library. Pooled analyses were performed to obtain the complete ablation (CA), complication, progression-free survival (PFS), and overall survival (OS) rates.
RESULTS
Thirty studies were eligible, including four studies on MR-guided microwave ablation (MWA); 14 studies on MR-guided radiofrequency ablation (RFA); one study on both MR-guided MWA and RFA; eight studies on MR-guided, laser-induced thermotherapy (LITT); two studies on MR-guided percutaneous cryoablation (PC); and one study on MR-guided percutaneous ethanol injection (PEI). The CA rates in patients who underwent RFA, MWA, LITT, PC, and PEI were 95.60%, 98.86%, 77.78%, 47.92%, and 85.71%, respectively. The most frequent complications were pain (27.66%, 13/47) and postablation syndrome (27.66%, 13/47) in the PC group; pleural effusion (8.11%, 119/1,468) and subcapsular hematoma (2.25%, 33/1,468) in the LITT group; pleural effusion (2.67%, 2/75) in the MWA group; and subcapsular hematoma (4.18%, 20/478) and post-ablation syndrome (2.93%, 14/478) in the RFA group. There were few studies reporting PFS and OS.
CONCLUSIONS
MR-guided ablation is a practicable alternative treatment for liver tumors, especially MR-guided RFA and MWA, which have high rates of CA and low occurrences of complications.
Topics: Ablation Techniques; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Prognosis; Surgery, Computer-Assisted; Survival Rate
PubMed: 33004753
DOI: 10.4103/jcrt.JCRT_1115_19 -
Radiotherapy and Oncology : Journal of... Oct 2020Prognosis prediction is central in treatment decision making and quality of life for non-small cell lung cancer (NSCLC) patients. However, conventional computed... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Prognosis prediction is central in treatment decision making and quality of life for non-small cell lung cancer (NSCLC) patients. However, conventional computed tomography (CT) related prognostic factors may not apply to the challenging stage III NSCLC group. The aim of this systematic review was therefore to identify and evaluate CT-related prognostic factors for overall survival (OS) of stage III NSCLC.
METHODS
The Medline, Embase, and Cochrane electronic databases were searched. After study selection, risk of bias was estimated for the included studies. Meta-analysis of univariate results was performed when sufficient data were available.
RESULTS
1595 of the 11,996 retrieved records were selected for full text review, leading to inclusion of 65 studies that reported data of 144,513 stage III NSCLC patients andcompromising 26 unique CT-related prognostic factors. Relevance and validity varied substantially, few studies had low relevance and validity. Only four studies evaluated the added value of new prognostic factors compared with recognized clinical factors. Included studies suggested gross tumor volume (meta-analysis: HR = 1.22, 95%CI: 1.05-1.42), tumor diameter, nodal volume, and pleural effusion, are prognostic in patients treated with chemoradiation. Clinical T-stage and location (right/left) were likely not prognostic within stage III NSCLC. Inconclusive are several radiomic features, tumor volume, atelectasis, location (pulmonary lobes, central/peripheral), interstitial lung abnormalities, great vessel invasion, pit-fall sign, and cavitation.
CONCLUSIONS
Tumor-size and nodal size-related factors are prognostic for OS in stage III NSCLC. Future studies should carefully report study characteristics and contrast factors with guideline recognized factors to improve evidence evaluation and validation.
Topics: Carcinoma, Non-Small-Cell Lung; Humans; Lung Neoplasms; Neoplasm Staging; Prognosis; Quality of Life; Tomography, X-Ray Computed
PubMed: 32710990
DOI: 10.1016/j.radonc.2020.07.030 -
BMC Pulmonary Medicine Jul 2020To systematically evaluate the correlation between percutaneous transthoracic needle biopsy (PTNB) and recurrence in stage I lung cancer. (Meta-Analysis)
Meta-Analysis
BACKGROUND
To systematically evaluate the correlation between percutaneous transthoracic needle biopsy (PTNB) and recurrence in stage I lung cancer.
METHODS
The databases of PubMed, EMbase, The Cochrane Library, CNKI, WanFang Data and China Biology Medicine disc were retrieved to collect relevant literatures about the correlation between PTNB and recurrence in stage I lung cancer. The retrieval time was limited from the time of their database establishment to April 30/2020.Screened the literature, extracted the data and assessed the quality of studies included. Then the meta-analysis was performed by using Stata l6.0 software.
RESULTS
A total of 8 cohort studies involving 2760 lung cancer patients were included. The results of meta-analysis showed that PTNB did not increase the risk of total recurrence and pleural recurrence in the patients with stage I lung cancer. The result of subgroup analysis is according to the tumor location. For stage I lung cancer, PTNB will increase the risk of pleural recurrence in patients with sub-pleural lesions but not in those without sub-pleural lesions.
CONCLUSIONS
To stage I lung cancer, PTNB is not associated with the total recurrence and pleural recurrence but PTNB will increase the risk of pleural recurrence in patients with sub-pleural lesions.
Topics: Biopsy, Needle; Humans; Lung; Lung Neoplasms; Neoplasm Recurrence, Local; Neoplasm Seeding; Neoplasm Staging; Pleural Neoplasms
PubMed: 32689974
DOI: 10.1186/s12890-020-01235-2 -
The European Respiratory Journal Jun 2020The European Respiratory Society (ERS)/European Society of Thoracic Surgeons (ESTS)/European Association for Cardio-Thoracic Surgery (EACTS)/European Society for...
The European Respiratory Society (ERS)/European Society of Thoracic Surgeons (ESTS)/European Association for Cardio-Thoracic Surgery (EACTS)/European Society for Radiotherapy and Oncology (ESTRO) task force brought together experts to update previous 2009 ERS/ESTS guidelines on management of malignant pleural mesothelioma (MPM), a rare cancer with globally poor outcome, after a systematic review of the 2009-2018 literature. The evidence was appraised using the Grading of Recommendations, Assessment, Development and Evaluation approach. The evidence syntheses were discussed and recommendations formulated by this multidisciplinary group of experts. Diagnosis: pleural biopsies remain the gold standard to confirm the diagnosis, usually obtained by thoracoscopy but occasionally image-guided percutaneous needle biopsy in cases of pleural symphysis or poor performance status. Pathology: standard staining procedures are insufficient in ∼10% of cases, justifying the use of specific markers, including and () for the separation of atypical mesothelial proliferation from MPM. Staging: in the absence of a uniform, robust and validated staging system, we advise using the most recent 2016 8th TNM (tumour, node, metastasis) classification, with an algorithm for pre-therapeutic assessment. Monitoring: patient's performance status, histological subtype and tumour volume are the main prognostic factors of clinical importance in routine MPM management. Other potential parameters should be recorded at baseline and reported in clinical trials. Treatment: (chemo)therapy has limited efficacy in MPM patients and only selected patients are candidates for radical surgery. New promising targeted therapies, immunotherapies and strategies have been reviewed. Because of limited data on the best combination treatment, we emphasise that patients who are considered candidates for a multimodal approach, including radical surgery, should be treated as part of clinical trials in MPM-dedicated centres.
Topics: Humans; Medical Oncology; Mesothelioma; Mesothelioma, Malignant; Pleural Neoplasms; Surgeons
PubMed: 32451346
DOI: 10.1183/13993003.00953-2019 -
BMC Cancer May 2020The CSC (cancer stem cell) markers often indicate poor prognosis and more cell invasion or migration of cancer patients. Podoplanin was assumed as a candidate CSC marker... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The CSC (cancer stem cell) markers often indicate poor prognosis and more cell invasion or migration of cancer patients. Podoplanin was assumed as a candidate CSC marker and predict poor prognosis among squamous cancers. Whereas, the prognostic value of podoplanin among lung squamous cancer (LUSC) patients remains controversial.
METHODS
A search of databases including PubMed, Embase and Web of Science was performed. Eligible articles studying the prognostic significance of podoplanin were selected. Odds ratio and HR (hazard ratio) were used to assess the relationships between podoplanin and clinical characteristics, as well as to quantify its prognostic role. The heterogeneity was estimated by I Statistic and P values from sensitivity analysis. Begg's funnel plots were used to estimate possible publication bias.
RESULTS
8 eligible studies containing 725 I-IV LUSC patients were included. Podoplanin expression showed no significant correlations with TNM stage, vascular invasion, lymphatic invasion, lymph node metastasis, pleural metastasis of tumor and gender of patients. However, podoplanin showed significant associations with better differentiation (pooled OR = 2.64, 95% CI 1.53-4.56, P = 0.0005, fixed effect) and better overall survival (HR = 2.14, 95% CI 1.45-3.15, P = 0.0001, fixed effect) and progression-free survival (HR = 1.73, 95% CI: 1.01-2.98, P = 0.05, fixed effect) of LUSC. Funnel plots illustrated no evidence of publication bias in our results.
CONCLUSIONS
Podoplanin could be a useful prognostic marker and indicates better differentiation for LUSC patients, and the value of PDPN expression as a marker for cancer stem cells in LUSC should be critically evaluated in future studies.
Topics: Biomarkers, Tumor; Carcinoma, Non-Small-Cell Lung; Carcinoma, Squamous Cell; Humans; Lung Neoplasms; Membrane Glycoproteins; Prognosis
PubMed: 32408907
DOI: 10.1186/s12885-020-06936-9 -
The Cochrane Database of Systematic... Apr 2020Malignant pleural effusion (MPE) is a common problem for people with cancer and usually associated with considerable breathlessness. A number of treatment options are... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Malignant pleural effusion (MPE) is a common problem for people with cancer and usually associated with considerable breathlessness. A number of treatment options are available to manage the uncontrolled accumulation of pleural fluid, including administration of a pleurodesis agent (via a chest tube or thoracoscopy) or placement of an indwelling pleural catheter (IPC). This is an update of a review published in Issue 5, 2016, which replaced the original, published in 2004.
OBJECTIVES
To ascertain the optimal management strategy for adults with malignant pleural effusion in terms of pleurodesis success and to quantify differences in patient-reported outcomes and adverse effects between interventions.
SEARCH METHODS
We searched CENTRAL, MEDLINE (Ovid), Embase (Ovid) and three other databases to June 2019. We screened reference lists from other relevant publications and searched trial registries.
SELECTION CRITERIA
We included randomised controlled trials of intrapleural interventions for adults with symptomatic MPE, comparing types of sclerosant, mode of administration and IPC use.
DATA COLLECTION AND ANALYSIS
Two review authors independently extracted data on study design, characteristics, outcome measures, potential effect modifiers and risk of bias. The primary outcome was pleurodesis failure rate. Secondary outcomes were adverse events, patient-reported breathlessness control, quality of life, cost, mortality, survival, duration of inpatient stay and patient acceptability. We performed network meta-analyses of primary outcome data and secondary outcomes with enough data. We also performed pair-wise meta-analyses of direct comparison data. If we deemed interventions not jointly randomisable, or we found insufficient available data, we reported results by narrative synthesis. For the primary outcome, we performed sensitivity analyses to explore potential causes of heterogeneity and to evaluate pleurodesis agents administered via a chest tube only. We assessed the certainty of the evidence using GRADE.
MAIN RESULTS
We identified 80 randomised trials (18 new), including 5507 participants. We found all except three studies at high or unclear risk of bias for at least one domain. Due to the nature of the interventions, most studies were unblinded. Pleurodesis failure rate We included 55 studies of 21 interventions in the primary network meta-analysis. We estimated the rank of each intervention's effectiveness. Talc slurry (ranked 6, 95% credible interval (Cr-I) 3 to 10) is an effective pleurodesis agent (moderate certainty for comparison with placebo) and may result in fewer pleurodesis failures than bleomycin and doxycycline (bleomycin versus talc slurry: odds ratio (OR) 2.24, 95% Cr-I 1.10 to 4.68; low certainty; ranked 11, 95% Cr-I 7 to 15; doxycycline versus talc slurry: OR 2.51, 95% Cr-I 0.81 to 8.40; low certainty; ranked 12, 95% Cr-I 5 to 18). There is little evidence of a difference between the pleurodesis failure rate of talc poudrage and talc slurry (OR 0.50, 95% Cr-I 0.21 to 1.02; moderate certainty). Evidence for any difference was further reduced when restricting analysis to studies at low risk of bias (defined as maximum one high risk domain in the risk of bias assessment) (pleurodesis failure talc poudrage versus talc slurry: OR 0.78, 95% Cr-I 0.16 to 2.08). IPCs without daily drainage are probably less effective at obtaining a definitive pleurodesis (cessation of pleural fluid drainage facilitating IPC removal) than talc slurry (OR 7.60, 95% Cr-I 2.96 to 20.47; rank = 18/21, 95% Cr-I 13 to 21; moderate certainty). Daily IPC drainage or instillation of talc slurry via IPC are likely to reduce pleurodesis failure rates. Adverse effects Adverse effects were inconsistently reported. We performed network meta-analyses for the risk of procedure-related fever and pain. The evidence for risk of developing fever was of low certainty, but suggested there may be little difference between interventions relative to talc slurry (talc poudrage: OR 0.89, 95% Cr-I 0.11 to 6.67; bleomycin: OR 2.33, 95% Cr-I 0.45 to 12.50; IPCs: OR 0.41, 95% Cr-I 0.00 to 50.00; doxycycline: OR 0.85, 95% Cr-I 0.05 to 14.29). Evidence also suggested there may be little difference between interventions in the risk of developing procedure-related pain, relative to talc slurry (talc poudrage: OR 1.26, 95% Cr-I 0.45 to 6.04; very-low certainty; bleomycin: OR 2.85, 95% Cr-I 0.78 to 11.53; low certainty; IPCs: OR 1.30, 95% Cr-I 0.29 to 5.87; low certainty; doxycycline: OR 3.35, 95% Cr-I 0.64 to 19.72; low certainty). Patient-reported control of breathlessness Pair-wise meta-analysis suggests there is likely no difference in breathlessness control, relative to talc slurry, of talc poudrage ((mean difference (MD) 4.00 mm, 95% CI -6.26 to 14.26) on a 100 mm visual analogue scale for breathlessness; studies = 1; participants = 184; moderate certainty) and IPCs without daily drainage (MD -6.12 mm, 95% CI -16.32 to 4.08; studies = 2; participants = 160; low certainty). Overall mortality There may be little difference between interventions when compared to talc slurry (bleomycin and IPC without daily drainage; low certainty) but evidence is uncertain for talc poudrage and doxycycline. Patient acceptability Pair-wise meta-analysis demonstrated that IPCs probably result in a reduced risk of requiring a repeat invasive pleural intervention (OR 0.25, 95% Cr-I 0.13 to 0.48; moderate certainty) relative to talc slurry. There is likely little difference in the risk of repeat invasive pleural intervention with talc poudrage relative to talc slurry (OR 0.96, 95% CI 0.59 to 1.56; moderate certainty).
AUTHORS' CONCLUSIONS
Based on the available evidence, talc poudrage and talc slurry are effective methods for achieving a pleurodesis, with lower failure rates than a number of other commonly used interventions. IPCs provide an alternative approach; whilst associated with inferior definitive pleurodesis rates, comparable control of breathlessness can probably be achieved, with a lower risk of requiring repeat invasive pleural intervention. Local availability, global experience of agents and adverse events (which may not be identified in randomised trials) and patient preference must be considered when selecting an intervention. Further research is required to delineate the roles of different treatments according to patient characteristics, such as presence of trapped lung. Greater attention to patient-centred outcomes, including breathlessness, quality of life and patient preference is essential to inform clinical decision-making. Careful consideration to minimise the risk of bias and standardise outcome measures is essential for future trial design.
Topics: Adult; Bleomycin; Doxycycline; Dyspnea; Fever; Humans; Iodine; Network Meta-Analysis; Pleural Effusion, Malignant; Pleurodesis; Quinacrine; Randomized Controlled Trials as Topic; Talc; Treatment Failure
PubMed: 32315458
DOI: 10.1002/14651858.CD010529.pub3 -
European Journal of Radiology Jun 2020To perform a systematic review and meta-analysis evaluating usefulness of high-risk CT features (HRFs) on follow-up CT in detecting local recurrence after stereotactic... (Meta-Analysis)
Meta-Analysis
PURPOSE
To perform a systematic review and meta-analysis evaluating usefulness of high-risk CT features (HRFs) on follow-up CT in detecting local recurrence after stereotactic body radiation therapy (SBRT) in lung cancer patients.
METHODS
Pubmed and EMBASE were searched up to January 11th, 2019. We included studies that differentiated local recurrence from post-SBRT changes after SBRT on follow-up CT in lung cancer patients. Methodological quality was assessed using QUADAS-2. The association between HRFs and local recurrence were pooled in the form of odds ratio (OR) using the random effects model. Heterogeneity was examined by the Inconsistency index (I).
RESULTS
Eight studies were included, consisting of 356 lung cancer patients. The overall prevalence of patients with local recurrence was 18.8 % (67/356). Compared with post-SBRT changes, local recurrence after SBRT more frequently demonstrated air-bronchogram disappearance (OR = 7.15), bulging margin (OR = 24.12), craniocaudal growth (OR = 26.07), enlargement after 12 months (OR = 28.11), enlarging opacity (OR = 7.92), linear margin disappearance (OR = 29.24), and sequential enlargement (OR = 83.23) (p ≤ 0.02). Pleural effusion appearance was not related with local recurrence (p = 0.82). Heterogeneity varied among HRFs (I = 0-91 %). The quality of the studies was considered moderate.
CONCLUSIONS
Several HRFs on follow-up CT after SBRT were useful in suggesting local recurrence. These HRFs may help raise clinical suspicion of local recurrence, initiate prompt additional test for confirmation and perform subsequent proper personalized salvage treatment.
Topics: Aged; Aged, 80 and over; Female; Humans; Lung; Lung Neoplasms; Male; Middle Aged; Neoplasm Recurrence, Local; Radiosurgery; Reproducibility of Results; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 32298960
DOI: 10.1016/j.ejrad.2020.108978