UNASSIGNED:射频消融(RFA)和消融性外束放疗(消融性RT)通常用于治疗小的肝内恶性肿瘤。我们对肿瘤学结果进行了荟萃分析,并系统地回顾了肿瘤位置和大小的临床考虑。
未经授权:PubMed,Medline,Embase,和Cochrane图书馆数据库在2022年2月24日进行了搜索。比较RFA和消融性RT的研究,提供其中一个终点(局部控制或生存),包括每组≥5名患者。
UNASSIGNED:纳入21项研究,涉及4,638例患者。关于生存,比值比(OR)为1.204(p=0.194,有利于RFA,在所有研究中没有统计学意义),1.253(p=0.153)在肝细胞癌(HCC)研究中,和1.002(p=0.996)在结直肠癌转移研究中。关于本地控制,在所有研究中,OR为0.458(p<0.001,有利于消融RT),在肝癌研究中,0.452(p<0.001)有利于消融RT臂,和0.649(p=0.484)在结直肠癌转移研究中。RFA后,HCC研究的1年和2年生存率分别为91.8%和77.7%,消融RT后89.0%和76.0%,对于转移研究,RFA后分别为88.2%和66.4%,RT后分别为82.7%和60.6%,分别。文献分析表明,对于大于2-3厘米的肿瘤或肝脏中的特定亚位置(例如,膈下或血管周围部位),消融性RT比RFA更有效。具有中等质量的证据(参考美国放射肿瘤学会原发性肝癌临床指南的分级系统)。RFA和消融性RT组合并≥3级并发症发生率分别为2.9%和2.8%,分别(p=0.952)。
UNASSIGNED:我们的研究表明,消融性RT可以产生与RFA相似的肿瘤结局,并表明它可以更有效地治疗难以进行RFA的肿瘤或大型肿瘤。
未经授权:本研究在PROSPERO注册(方案号:CRD42022332997)。
UNASSIGNED:射频消融(RFA)和消融性放疗(RT)是治疗小的肝内恶性肿瘤的非手术方式。消融RT显示肿瘤结果至少与RFA相似,并且在特定位置(例如血管周围或膈下位置)更有效。
UNASSIGNED: Radiofrequency ablation (RFA) and ablative external beam radiotherapy (ablative RT) are commonly used to treat small intrahepatic malignancies. We meta-analysed oncologic outcomes and systematically reviewed the clinical consideration of tumour location and size.
UNASSIGNED: PubMed, Medline, Embase, and Cochrane Library databases were searched on February 24, 2022. Studies comparing RFA and ablative RT, providing one of the endpoints (local control or survival), and encompassing ≥5 patients in each arm were included.
UNASSIGNED: Twenty-one studies involving 4,638 patients were included. Regarding survival, the odds ratio (OR) was 1.204 (p = 0.194, favouring RFA, not statistically significant) among all studies, 1.253 (p = 0.153) among hepatocellular carcinoma (HCC) studies, and 1.002 (p = 0.996) among colorectal cancer metastasis studies. Regarding local control, the OR was 0.458 (p <0.001, favouring ablative RT) among all studies, 0.452 (p <0.001) among HCC studies, favouring the ablative RT arm, and 0.649 (p = 0.484) among colorectal cancer metastasis studies. Pooled 1- and 2-year survival rates for HCC studies were 91.8% and 77.7% after RFA, and 89.0% and 76.0% after ablative RT, respectively; and for metastasis studies were 88.2% and 66.4% after RFA and 82.7% and 60.6% after RT, respectively. Literature analysis suggests that ablative RT can be more effective than RFA for tumours larger than 2-3 cm or for specific sublocations in the liver (e.g. subphrenic or perivascular sites), with moderate quality of evidence (reference to the grading system of the American Society for Radiation Oncology Primary Liver Cancer Clinical Guidelines). The pooled grade ≥3 complication rates were 2.9% and 2.8% in the RFA and ablative RT arms, respectively (p = 0.952).
UNASSIGNED: Our study shows that ablative RT can yield oncologic outcomes similar to RFA, and suggests that it can be more effective for the treatment of tumours in locations where RFA is difficult to perform or for large-sized tumours.
UNASSIGNED: This study was registered with PROSPERO (Protocol No: CRD42022332997).
UNASSIGNED: Radiofrequency ablation (RFA) and ablative radiotherapy (RT) are non-surgical modalities for the treatment of small intrahepatic malignancies. Ablative RT showed oncologic outcomes at least similar to those of RFA, and was more effective at specific locations (e.g. perivascular or subphrenic locations).