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Leukemia Research Feb 2024Patients with acute myeloid leukemia (AML) may experience extramedullary involvement when disease is present outside of the blood and bone marrow. In particular, the... (Meta-Analysis)
Meta-Analysis
Patients with acute myeloid leukemia (AML) may experience extramedullary involvement when disease is present outside of the blood and bone marrow. In particular, the presence of central nervous system (CNS) involvement has traditionally been thought of as a poor prognostic factor. In the presently available literature, there is a paucity of conclusive data surrounding CNS AML given its rarity and lack of unified screening practices. Thus, we performed a systematic review and meta-analysis in order to more definitively characterize survival outcomes in this patient population. In this meta-analysis, we evaluated survival outcomes and response rates from clinical studies on patients with AML stratified by the presence of CNS involvement. Twelve studies were included in the meta-analysis with a resulting hazard ratio (HR) for overall survival (OS) of 1.34 with a 95 % CI of 1.14 to 1.58. These findings suggest that CNS involvement in adult patients with AML is associated with an increased hazard of mortality compared to those patients without CNS involvement. As such, CNS involvement should be viewed as negative prognostic marker, and attention should be made to ensure prompt identification and treatment of patients who experience this complication.
Topics: Adult; Humans; Leukemia, Myeloid, Acute; Central Nervous System Neoplasms; Bone Marrow; Proportional Hazards Models; Central Nervous System; Prognosis
PubMed: 38335816
DOI: 10.1016/j.leukres.2024.107452 -
Zhurnal Voprosy Neirokhirurgii Imeni N.... 2024The main problem in microsurgical resection of spinal cord tumors is excessive surgical aggression. The last one often leads to unsatisfactory clinical and neurological...
UNLABELLED
The main problem in microsurgical resection of spinal cord tumors is excessive surgical aggression. The last one often leads to unsatisfactory clinical and neurological outcomes. Laser fluorescence spectroscopy is a modern neurosurgical approach to distinguish tumor boundaries even if standard visible fluorescence techniques are ineffective.
OBJECTIVE
To evaluate the effectiveness of laser fluorescence spectroscopy alone or in combination with visual 5-ALA fluorescence for improvement of safety and quality of resection, as well as intraoperative diagnosis.
MATERIAL AND METHODS
Searching for literature data was carried out in accordance with the PRISMA recommendations. The authors reviewed articles independently of each other. These data were systematized.
RESULTS
Laser fluorescence spectroscopy is valuable to identify fragments of intramedullary ependyomas in 86% of cases, while visual fluorescence only in 81% of cases. Advisability of this technique for low-grade astrocytomas is still unclear and requires further study. Its effectiveness is 87.5% for extramedullary meningiomas. Neuromas do not accumulate 5-ALA. In addition, this method can be used to determine the boundaries of intradural metastatic lesions.
CONCLUSION
5-ALA fluorescence is a safe and useful intraoperative method for identifying tumor tissue and resection margins in patients with intramedullary or infiltrative extramedullary spinal cord tumors. Visual fluorescence combined with laser spectroscopy is a perspective method for intraoperative visualization of tumor remnants. This approach can improve safety and postoperative outcomes while maintaining resection quality.
Topics: Humans; Spinal Neoplasms; Spectrometry, Fluorescence; Spinal Cord Neoplasms; Neurosurgical Procedures; Lasers
PubMed: 38334738
DOI: 10.17116/neiro202488011109 -
Zhurnal Voprosy Neirokhirurgii Imeni N.... 2024Planar hyperostotic meningiomas account for 2-9% of intracranial meningiomas. They are characterized by planar node following the contours of the inner surface of the...
BACKGROUND
Planar hyperostotic meningiomas account for 2-9% of intracranial meningiomas. They are characterized by planar node following the contours of the inner surface of the skull. Hyperostosis is present in most cases. Timely diagnosis of skull base tumors is usually simple due to early involvement of the cranial nerves. However, convexity meningiomas en plaque usually reach large dimensions that complicates surgery and radiotherapy.
OBJECTIVE
To analyze the current state of diagnosis, molecular biology and surgical treatment of hyperostotic meningiomas en plaque.
MATERIAL AND METHODS
A systematic review was performed in accordance with the PRISMA guidelines. Searching for literature data included the following keywords: «planar meningioma», «hyperostotic meningioma», «meningioma en plaque», «infiltrative meningioma». We reviewed the PubMed and Google Scholar databases until May 2023 and enrolled only full-text Russian-, English- or French-language reports.
RESULTS AND DISCUSSION
Among primary 332 reports, 35 references met the inclusion criteria. We found less severity or absence of focal neurological symptoms, comparable incidence of intracranial hypertension and no histological differences between planar and nodular meningiomas. Analysis of molecular biological features of planar meningiomas, including cell cultures, is feasible. There is no consensus regarding surgical treatment and radiotherapy. Most publications are case reports.
CONCLUSION
The results of treatment of planar hyperostotic meningiomas, especially large and giant ones, are unsatisfactory. There is no a generally accepted algorithm for treating patients in the literature. This problem requires further research.
Topics: Humans; Meningioma; Skull; Hyperostosis; Skull Base Neoplasms; Meningeal Neoplasms
PubMed: 38334737
DOI: 10.17116/neiro202488011103 -
La Radiologia Medica Feb 2024The percutaneous thermal ablation techniques (pTA) are radiofrequency ablation, cryoablation, and microwave ablation, suitable for the treatment of bone oligometastases.... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The percutaneous thermal ablation techniques (pTA) are radiofrequency ablation, cryoablation, and microwave ablation, suitable for the treatment of bone oligometastases. Magnetic resonance-guided focused ultrasound (MRgFUS) is a noninvasive ablation technique.
OBJECTIVES
To compare the effectiveness and safety of MRgFUS and pTA for treating bone oligometastases and their complications.
METHODS
Studies were selected with a PICO/PRISMA protocol: pTA or MRgFUS in patients with bone oligometastases; non-exclusive curative treatment. Exclusion criteria were: primary bone tumor; concurrent radiation therapy; palliative therapy; and absence of imaging at follow-up. PubMed, BioMed Central, and Scopus were searched. The modified Newcastle-Ottawa Scale assessed articles quality. For each treatment (pTA and MRgFUS), we conducted two separate random-effects meta-analyses to estimate the pooled effectiveness and safety. The effectiveness was assessed by combining the proportions of treated lesions achieving local tumor control (LTC); the safety by combining the complications rates of treated patients. Meta-regression analyses were performed to identify any outcome predictor.
RESULTS
A total of 24 articles were included. Pooled LTC rate for MRgFUS was 84% (N = 7, 95% CI 66-97%, I = 74.7%) compared to 65% of pTA (N = 17, 95% CI 51-78%, I = 89.3%). Pooled complications rate was similar, respectively, 13% (95% CI 1-32%, I = 81.0%) for MRgFUS and 12% (95% CI 8-18%, I = 39.9%) for pTA, but major complications were recorded with pTA only. The meta-regression analyses, including technique type, study design, tumor, and follow-up, found no significant predictors.
DISCUSSION
The effectiveness and safety of the two techniques were found comparable, even though MRgFUS is a noninvasive treatment that did not cause any major complication. Limited data availability on MRgFUS and the lack of direct comparisons with pTA may affect these findings.
CONCLUSIONS
MRgFUS can be a valid, safe, and noninvasive treatment for bone oligometastases. Direct comparison studies are needed to confirm its promising benefits.
Topics: Humans; High-Intensity Focused Ultrasound Ablation; Bone Neoplasms; Palliative Care; Ablation Techniques; Magnetic Resonance Spectroscopy; Treatment Outcome
PubMed: 38302831
DOI: 10.1007/s11547-024-01780-4 -
Journal of Medical Imaging and... Mar 2024Interventional radiology employs minimally invasive image-guided procedures for diagnosing and treating various conditions. Among these procedures, alcohol and thermal... (Review)
Review
BACKGROUND
Interventional radiology employs minimally invasive image-guided procedures for diagnosing and treating various conditions. Among these procedures, alcohol and thermal ablation techniques have shown high efficacy. However, these procedures present challenges such as increased procedure time, radiation dose, and risk of tissue injury. This scoping review aims to explore how augmented reality (AR) can mitigate these challenges and improve the accuracy, precision, and efficiency of image-guided tumor ablation while improving patient outcomes.
METHODS
A scoping review of the literature was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guideline to identify published literature investigating AR in image-guided tumor ablations. We conducted our electronic searches using PubMed, Scopus, Web of Sciences and CINAHL from inception to April 27th, 2023. The following Boolean terms were used for the search: ("augmented reality" OR "AR" OR "navigation system" OR "head mounted device" OR "HMD") AND ("tumor ablation" OR "radiofrequency tumor ablation" OR "microwave tumor ablation" OR "cryoablation"). We considered articles eligible for our scoping review if they met the following conditions: (1) published in English only, (2) focused on image-guided tumour ablations, (3) incorporated AR techniques in their methodology, (4) employed an aspect of AR in image-guided tumour ablations, and (5) exclusively involved human subjects. Publications were excluded if there was no mention of applying AR, or if the study investigated interventions other than image-guided tumour ablations.
RESULTS
Our search results yielded 1,676 articles in our initial search of the databases. Of those, 409 studies were removed as duplicates. 1,243 studies were excluded during the title and abstract screening. 24 studies were assessed for eligibility in the full-text stage. 19 studies were excluded, resulting in a final selection of only five studies that satisfied our inclusion criteria. The studies aimed to assess AR's efficacy in tumor ablations. Two studies compared an optical-based AR system with CT guidance. Two studies used a head-mounted AR device, while one used a dual-camera setup. Various tumor types were examined, including bone, abdominal soft tissue, breast, hepatic, renal, colorectal, and lung lesions. All studies showed positive results, including reduced radiation exposure, shorter procedures, and improved navigation, and targeting assistance.
CONCLUSION
AR systems enhance image-guided tumor ablations by improving the accuracy of ablation probe placements and increasing efficiency. They offer real-time guidance, enhanced visualization, and improved navigation, resulting in optimal needle placement. AR reduces radiation exposure and shortens procedure times compared to traditional CT-guided techniques. However, limitations like small sample sizes and technical challenges require further research. Despite this, AR shows potential benefits and larger, diverse studies are needed for validation.
Topics: Humans; Augmented Reality; Neoplasms; Liver
PubMed: 38290953
DOI: 10.1016/j.jmir.2023.12.006 -
Current Oncology (Toronto, Ont.) Jan 2024Dedifferentiated chondrosarcoma (DDCS) is a high-grade subtype of chondrosarcoma with the bimorphic histological appearance of a conventional chondrosarcoma component... (Review)
Review
Dedifferentiated chondrosarcoma (DDCS) is a high-grade subtype of chondrosarcoma with the bimorphic histological appearance of a conventional chondrosarcoma component with abrupt transition to a high-grade, non-cartilaginous sarcoma. DDCS can be radiographically divided into central and peripheral types. Wide resection is currently the main therapeutic option for localized DDCS. Moreover, the effectiveness of adjuvant chemotherapy remains controversial. Therefore, we performed a systematic review of available evidence to evaluate the effect of adjuvant chemotherapy on localized DDCS. The purpose was to compare the 5-year survival rate among patients treated with surgery plus adjuvant chemotherapy or surgery alone for localized DDCS. The search was conducted in PubMed, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) databases. Of the 217 studies shortlisted, 11 retrospective non-randomized studies (comprising 556 patients with localized DDCS) were selected. The 5-year survival rates were similar between the two treatment groups (28.2% (51/181) vs. 24.0% (90/375), respectively). The overall pooled odds ratio was 1.25 (95% confidence interval: 0.80-1.94; = 0.324), and heterogeneity I was 2%. However, when limited to peripheral DDCS, adjuvant chemotherapy was associated with prolonged survival ( = 0.03). Due to the paucity of included studies and the absence of prospective comparative studies, no conclusions can be drawn regarding the effectiveness or ineffectiveness of adjuvant chemotherapy for localized DDCS.
Topics: Humans; Retrospective Studies; Prospective Studies; Chemotherapy, Adjuvant; Chondrosarcoma; Sarcoma; Bone Neoplasms
PubMed: 38275833
DOI: 10.3390/curroncol31010040 -
Nutrients Jan 2024Older adults are prone to vitamin D3 (VD3) deficiency, which may impair their health. A high dose of VD3 (HDVD3 = 100,000 IU) could improve their 25-hydroxyvitamin D3... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Older adults are prone to vitamin D3 (VD3) deficiency, which may impair their health. A high dose of VD3 (HDVD3 = 100,000 IU) could improve their 25-hydroxyvitamin D3 [25(OH)D] level and health outcomes. However, evidence for such a beneficial effect of HDVD3 in older adults coming from clinical trials is mixed.
OBJECTIVE
To review the literature on the efficacy of a single dose of 100,000 IU of VD3 in older people.
METHODS
We searched PubMed/Medline, Science Direct, and NIH's clinical trials registry for clinical studies on the effect of a single high dose of VD3 on various health outcomes in older people. We also performed a meta-analysis using the standardized mean difference to assess the effect of VD3 on its blood level. Due to expected high heterogeneity, its amount (i.e., tau) was estimated using the DerSimonian-Laird estimator. To estimate tau, the Q-test for heterogeneity and the statistic were calculated.
RESULTS
Search results identify 13 studies that reported diverse health outcomes, such as lung and cardiovascular function, skin cancer progression, intensive care unit mortality, immune system response, and bone density. The meta-analysis showed a significant increase in 25(OH)D blood levels after treatment in 10 studies, with an average standardized mean difference of 2.60 ng/mL (95% CI: 2.07 to 3.13). Their results suggested that a single high dose of VD3 may benefit intensive care unit patients and skin cancer patients in remission. However, evidence for other beneficial health effects of HDVD3 was mixed due to high heterogeneity among studies.
CONCLUSIONS
A single high dose of VD3 may positively affect some health outcomes in older people, possibly due to its pleiotropic and immunomodulatory effects. However, the evidence needs to be more extensive and consistent, and more rigorous studies are required to confirm the benefits and safety of VD3 high doses in older patients.
Topics: Humans; Aged; Cholecalciferol; Skin Neoplasms; Bone Density; Calcifediol; Critical Care
PubMed: 38257146
DOI: 10.3390/nu16020252 -
World Neurosurgery Apr 2024The current meta-analysis was performed to gather available evidence regarding the incidence and risk factors of cement leakage (CL) in patients undergoing surgical... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
The current meta-analysis was performed to gather available evidence regarding the incidence and risk factors of cement leakage (CL) in patients undergoing surgical procedures for spinal metastasis.
METHODS
Two authors independently searched the PubMed, Embase, and CENTRAL databases. Clinical studies reporting the incidence or risk factors of CL were included for analysis. The primary outcome analyzed was the incidence of various types of CL. Random-effects or fixed-effects single-proportion meta-analyses were conducted to pool the available evidence, based on the heterogeneity test. Subgroup analyses were conducted based on surgical procedures (percutaneous vertebroplasty, percutaneous kyphoplasty, and others). Risk factors of CL were synthesized narratively to identify the most commonly accepted factors.
RESULTS
A total of 26 studies, involving 2551 patients, were included. The number of operated spine segments was reported in 23 studies, accounting for 4101 vertebrae. The pooled incidences of general, intradiscal, paravertebral, spinal canal, and intravascular CLs were 0.18 (95% confidence interval [CI], 0.11-0.28), 0.14 (95% CI, 0.08-0.21), 0.13 (95% CI, 0.06-0.21), 0.11 (95% CI, 0.05-0.19), and 0.12 (95% CI, 0.08-0.17), respectively. Subgroup analyses revealed significantly different incidences of general CL (0.37 vs. 0.06 vs. 0.09, P < 0.01), intradiscal CL (0.22 vs. 0.06 vs. 0.12, P < 0.01), paravertebral CL (0.25 vs. 0.03 vs. 0.06, P < 0.01), and vascular CL (0.14 vs. 0.03 vs. 0.15, P < 0.01) among the three groups. Posterior wall disruption, pathologic fracture, and the number of treated vertebral levels were the most commonly identified independent risk factors for general CL. Posterior wall disruption was determined as a common significant risk factor for spinal canal CL.
CONCLUSIONS
This review provides insights into the incidence and risk factors associated with CL in surgical procedures for spinal metastasis. Understanding these risk factors can contribute to the development of tailored strategies aimed at minimizing CL occurrence and optimizing surgical outcomes for patients undergoing spinal metastatic surgery.
Topics: Humans; Vertebroplasty; Incidence; Spinal Neoplasms; Spinal Fractures; Fractures, Compression; Bone Cements; Kyphoplasty; Risk Factors; Osteoporotic Fractures; Treatment Outcome
PubMed: 38246530
DOI: 10.1016/j.wneu.2024.01.065 -
International Journal of Radiation... Jul 2024There are limited data available on clinical outcomes after stereotactic body radiation therapy (SBRT) for nonspinal bone metastases. We performed a systematic review... (Meta-Analysis)
Meta-Analysis Review
There are limited data available on clinical outcomes after stereotactic body radiation therapy (SBRT) for nonspinal bone metastases. We performed a systematic review and meta-analysis to characterize local control (LC), overall survival (OS), pain response rates, and toxicity after SBRT. The primary outcomes were 1-year LC, incidence of acute and late grade 3 to 5 toxicities, and overall pain response rate at 3 months. The secondary outcome was 1-year OS. The Newcastle-Ottawa scale was used for assessment of study bias, with a median score of 5 for included studies (range, 4-8). Weighted random-effects meta-analyses were conducted to estimate effect sizes. We identified 528 patients with 597 nonspinal bone lesions in 9 studies (1 prospective study and 8 retrospective observational studies) treated with SBRT. The estimated 1-year LC rate was 94.6% (95% CI, 87.0%-99.0%). The estimated 3-month combined partial and complete pain response rate after SBRT was 87.7% (95% CI, 55.1%-100.0%). The estimated combined acute and late grade 3 to 5 toxicity rate was 0.5% (95% CI, 0%-5.0%), with an estimated pathologic fracture rate of 3.1% (95% CI, 0.2%-9.1%). The estimated 1-year OS rate was 71.0% (95% CI, 51.7%-87.0%). SBRT results in excellent LC and palliation of symptoms with minimal related toxicity. Prospective investigations are warranted to further characterize long-term outcomes of SBRT for patients with nonspinal bone metastases.
Topics: Humans; Radiosurgery; Bone Neoplasms; Treatment Outcome; Cancer Pain; Male; Aged; Female; Observational Studies as Topic
PubMed: 38220068
DOI: 10.1016/j.ijrobp.2023.12.051 -
International Journal of Clinical... Apr 2024To conduct a systematic review and meta-analysis of publications to evaluate the analgesic efficacy and safety of percutaneous thermal ablation (PTA) plus percutaneous... (Meta-Analysis)
Meta-Analysis
PURPOSE
To conduct a systematic review and meta-analysis of publications to evaluate the analgesic efficacy and safety of percutaneous thermal ablation (PTA) plus percutaneous cementoplasty (PCP) (PTA + PCP) for painful bone metastases.
METHODS
We searched PubMed, Cochrane Library and Embase for articles published up to October 2022. Outcomes were a 10-point pain scale, morphine equivalents daily dose (MEDD) and complications. A subgroup confined to spinal bone metastases was analyzed.
RESULTS
Twenty-one articles were selected for the analysis. The 21 selected articles involved a total of 661 cases. The pooled pain scales at pre-PTA + PCP, 1 day, 1 week and 1-, 3-, and 6 months post-PTA + PCP were 7.60 (95% confidence interval [CI], 7.26-7.95, I = 89%), 3.30 (95% CI, 2.25-4.82, I = 98%), 2.58 (95% CI, 1.99-3.35, I = 94%), 2.02 (95% CI, 1.50-2.71, I = 93%), 1.78 (95% CI, 1.26-2.53, I = 95%), and 1.62 (95% CI, 1.14-2.31, I = 88%), and in the subgroup, 7.97 (95% CI, 7.45-8.52, I = 86%), 3.01 (95% CI, 1.43-6.33, I = 98%), 2.95 (95% CI, 1.93-4.51, I = 95%), 2.34 (95% CI, 1.82-3.01, I = 68%), 2.18 (95% CI, 1.57-3.03, I = 78%), and 2.01 (95% CI, 1.16-3.48, I = 86%). Mean MEDD decreased up to 3 months post-PTA + PCP in 4 articles. The overall pooled major complication rate was 4% (95% CI, 2-6%, I = 2%).
CONCLUSIONS
The updated systematic review and meta-analysis indicates that PTA + PCP for painful bone metastases is safe, and can lead to rapid and sustained pain reduction.
Topics: Humans; Treatment Outcome; Pain; Bone Neoplasms; Cementoplasty; Analgesics; Catheter Ablation
PubMed: 38217754
DOI: 10.1007/s10147-023-02458-z