Local ablation of liver tumors matured during the recent years and is now proven to be an effective tool in the treatment of malignant liver lesions. Advances focus on the improvement of local tumor control by technic...Local ablation of liver tumors matured during the recent years and is now proven to be an effective tool in the treatment of malignant liver lesions. Advances focus on the improvement of local tumor control by technical innovations, individual selection of imaging modalities, more accurate needle placement and the free choice of access to the liver. Considering data found in the current literature for conventional local ablative treatment strategies, virtually no single technology is able to demonstrate an unequivocal superiority. Hints at better performance of microwave compared to radiofrequency ablation regarding local tumor control, duration of the procedure and potentially achievable larger size of ablation areas favour the comparably more recent treatment modality; image fusion enables more patients to undergo ultrasound guided local ablation; magnetic resonance guidance may improve primary success rates in selected patients; navigation and robotics accelerate the needle placement and reduces deviation of needle positions; laparoscopic thermoablation results in larger ablation areas and therefore hypothetically better local tumor control under acceptable complication rates, but seems to be limited to patients with no, mild or moderate adhesions following earlier surgical procedures. Apart from that, most techniques appear technically feasible, albeit demanding. Which technology will in the long run become accepted, is subject to future work.展开更多
Background:Percutaneous local tumor ablation(LTA)and stereotactic body radiotherapy(SBRT)have been regarded as viable treatments for early-stage lung cancer patients.The purpose of this study was to compare the effica...Background:Percutaneous local tumor ablation(LTA)and stereotactic body radiotherapy(SBRT)have been regarded as viable treatments for early-stage lung cancer patients.The purpose of this study was to compare the efficacy and safety of LTA with SBRT for early-stage non-small cell lung cancer(NSCLC).Methods:PubMed,Embase,Cochrane library,Ovid,Google scholar,CNKI,and CBMdisc were searched to identify potential eligible studies comparing the efficacy and safety of LTA with SBRT for early-stage NSCLC published between January 1,1991,and May 31,2021.Hazard ratios(HRs)or odds ratios(ORs)with 95%confidence intervals(CIs)were applied to estimate the effect size for overall survival(OS),progression-free survival(PFS),locoregional progression(LP),and adverse events.Results:Five studies with 22,231 patients were enrolled,including 1443 patients in the LTA group and 20,788 patients in the SBRT group.The results showed that SBRT was not superior to LTA for OS(HR=1.03,95%CI:0.87-1.22,P=0.71).Similar results were observed for PFS(HR=1.09,95%CI:0.71-1.67,P=0.71)and LP(HR=0.66,95%CI:0.25-1.77,P=0.70).Subgroup analysis showed that the pooled HR for OS favored SBRT in patients with tumors sized>2 cm(HR=1.32,95%CI:1.14-1.53,P=0.0003),whereas there was no significant difference in patients with tumors sized≤2 cm(HR=0.93,95%CI:0.64-1.35,P=0.70).Moreover,no significant differences were observed for the incidence of severe adverse events(≥grade 3)(OR=1.95,95%CI:0.63-6.07,P=0.25)between the LTA group and SBRT group.Conclusions:Compared with SBRT,LTA appears to have similar OS,PFS,and LP.However,for tumors>2 cm,SBRT is superior to LTA in OS.Prospective randomized controlled trials are required to determine such findings.展开更多
文摘Local ablation of liver tumors matured during the recent years and is now proven to be an effective tool in the treatment of malignant liver lesions. Advances focus on the improvement of local tumor control by technical innovations, individual selection of imaging modalities, more accurate needle placement and the free choice of access to the liver. Considering data found in the current literature for conventional local ablative treatment strategies, virtually no single technology is able to demonstrate an unequivocal superiority. Hints at better performance of microwave compared to radiofrequency ablation regarding local tumor control, duration of the procedure and potentially achievable larger size of ablation areas favour the comparably more recent treatment modality; image fusion enables more patients to undergo ultrasound guided local ablation; magnetic resonance guidance may improve primary success rates in selected patients; navigation and robotics accelerate the needle placement and reduces deviation of needle positions; laparoscopic thermoablation results in larger ablation areas and therefore hypothetically better local tumor control under acceptable complication rates, but seems to be limited to patients with no, mild or moderate adhesions following earlier surgical procedures. Apart from that, most techniques appear technically feasible, albeit demanding. Which technology will in the long run become accepted, is subject to future work.
基金supported by Shenzhen Key Medical Discipline Construction Fund(No.SZXK013).
文摘Background:Percutaneous local tumor ablation(LTA)and stereotactic body radiotherapy(SBRT)have been regarded as viable treatments for early-stage lung cancer patients.The purpose of this study was to compare the efficacy and safety of LTA with SBRT for early-stage non-small cell lung cancer(NSCLC).Methods:PubMed,Embase,Cochrane library,Ovid,Google scholar,CNKI,and CBMdisc were searched to identify potential eligible studies comparing the efficacy and safety of LTA with SBRT for early-stage NSCLC published between January 1,1991,and May 31,2021.Hazard ratios(HRs)or odds ratios(ORs)with 95%confidence intervals(CIs)were applied to estimate the effect size for overall survival(OS),progression-free survival(PFS),locoregional progression(LP),and adverse events.Results:Five studies with 22,231 patients were enrolled,including 1443 patients in the LTA group and 20,788 patients in the SBRT group.The results showed that SBRT was not superior to LTA for OS(HR=1.03,95%CI:0.87-1.22,P=0.71).Similar results were observed for PFS(HR=1.09,95%CI:0.71-1.67,P=0.71)and LP(HR=0.66,95%CI:0.25-1.77,P=0.70).Subgroup analysis showed that the pooled HR for OS favored SBRT in patients with tumors sized>2 cm(HR=1.32,95%CI:1.14-1.53,P=0.0003),whereas there was no significant difference in patients with tumors sized≤2 cm(HR=0.93,95%CI:0.64-1.35,P=0.70).Moreover,no significant differences were observed for the incidence of severe adverse events(≥grade 3)(OR=1.95,95%CI:0.63-6.07,P=0.25)between the LTA group and SBRT group.Conclusions:Compared with SBRT,LTA appears to have similar OS,PFS,and LP.However,for tumors>2 cm,SBRT is superior to LTA in OS.Prospective randomized controlled trials are required to determine such findings.
