Percutaneous radiofrequency ablation of lung tumors: evaluation of the literature using evidence-based techniques.

Hdl Handle:
http://hdl.handle.net/10147/207598
Title:
Percutaneous radiofrequency ablation of lung tumors: evaluation of the literature using evidence-based techniques.
Authors:
Chan, Victoria O; McDermott, Shaunagh; Malone, Dermot E; Dodd, Jonathan D
Affiliation:
Department of Radiology, St Vincent's University Hospital, Dublin, Ireland.
Citation:
J Thorac Imaging. 2011 Feb;26(1):18-26.
Journal:
Journal of thoracic imaging
Issue Date:
1-Feb-2012
URI:
http://hdl.handle.net/10147/207598
DOI:
10.1097/RTI.0b013e3181e48d5e
PubMed ID:
20829720
Abstract:
PURPOSE: The aim of this study was to evaluate the literature for articles assessing radiofrequency ablation (RFA) for pulmonary malignancy. MATERIALS AND METHODS: The "bottom-up" approach to evidence-based practice was applied by 2 reviewers to the retrieval and appraisal of original research articles published on pulmonary RFA between 2002 and 2009. Primary lung cancer and pulmonary metastases data were analyzed separately. The relationship between the percentage of local recurrence rate and lesion size, patient age, follow-up duration, and time to local recurrence was assessed using Spearman's rank correlation. Discrete time series were used to evaluate time trends. RESULTS: Secondary evidence yielded 1 review of 26 observational studies. Primary evidence yielded 46 studies that seemed suitable for detailed appraisal. A total of 2905 ablations were performed in 1584 patients. Eight studies evaluated primary lung cancers alone, 11 evaluated pulmonary metastases alone, 25 evaluated both, and 2 did not specify the histology. Results revealed trends toward increasing use of conscious sedation over general anesthesia, increasing use of multitined probes, decreasing size of nodule selection, and use of positron emission tomography/computed tomography as the optimal follow-up tool. Mean morbidity was 24.6%. The most prevalent side effects included pneumothorax (28.3%), pleural effusions (14.8%), and pain (14.1%). Procedure-related mortality ranged from 0 to 5.6, with an overall procedure-related mortality rate of 0.21%. There were 282 (12.2%) local recurrences occurring at a mean of 13 months. The mean overall survival rate was 59.4%, and the cancer-specific survival rate was 82.6%. CONCLUSIONS: This evidence-based practice review of pulmonary RFA shows it to be a promising treatment for pulmonary malignancy in carefully selected patient populations. Studies with higher levels of evidence, including case-control, prospective nonrandomized and randomized trials, that compare RFA with alternative contemporary local treatments are urgently needed.
Language:
eng
MeSH:
*Catheter Ablation/statistics & numerical data; Databases as Topic; *Evidence-Based Medicine; Humans; Lung Neoplasms/*radiotherapy
ISSN:
1536-0237 (Electronic); 0883-5993 (Linking)

Full metadata record

DC FieldValue Language
dc.contributor.authorChan, Victoria Oen_GB
dc.contributor.authorMcDermott, Shaunaghen_GB
dc.contributor.authorMalone, Dermot Een_GB
dc.contributor.authorDodd, Jonathan Den_GB
dc.date.accessioned2012-02-01T10:32:28Z-
dc.date.available2012-02-01T10:32:28Z-
dc.date.issued2012-02-01T10:32:28Z-
dc.identifier.citationJ Thorac Imaging. 2011 Feb;26(1):18-26.en_GB
dc.identifier.issn1536-0237 (Electronic)en_GB
dc.identifier.issn0883-5993 (Linking)en_GB
dc.identifier.pmid20829720en_GB
dc.identifier.doi10.1097/RTI.0b013e3181e48d5een_GB
dc.identifier.urihttp://hdl.handle.net/10147/207598-
dc.description.abstractPURPOSE: The aim of this study was to evaluate the literature for articles assessing radiofrequency ablation (RFA) for pulmonary malignancy. MATERIALS AND METHODS: The "bottom-up" approach to evidence-based practice was applied by 2 reviewers to the retrieval and appraisal of original research articles published on pulmonary RFA between 2002 and 2009. Primary lung cancer and pulmonary metastases data were analyzed separately. The relationship between the percentage of local recurrence rate and lesion size, patient age, follow-up duration, and time to local recurrence was assessed using Spearman's rank correlation. Discrete time series were used to evaluate time trends. RESULTS: Secondary evidence yielded 1 review of 26 observational studies. Primary evidence yielded 46 studies that seemed suitable for detailed appraisal. A total of 2905 ablations were performed in 1584 patients. Eight studies evaluated primary lung cancers alone, 11 evaluated pulmonary metastases alone, 25 evaluated both, and 2 did not specify the histology. Results revealed trends toward increasing use of conscious sedation over general anesthesia, increasing use of multitined probes, decreasing size of nodule selection, and use of positron emission tomography/computed tomography as the optimal follow-up tool. Mean morbidity was 24.6%. The most prevalent side effects included pneumothorax (28.3%), pleural effusions (14.8%), and pain (14.1%). Procedure-related mortality ranged from 0 to 5.6, with an overall procedure-related mortality rate of 0.21%. There were 282 (12.2%) local recurrences occurring at a mean of 13 months. The mean overall survival rate was 59.4%, and the cancer-specific survival rate was 82.6%. CONCLUSIONS: This evidence-based practice review of pulmonary RFA shows it to be a promising treatment for pulmonary malignancy in carefully selected patient populations. Studies with higher levels of evidence, including case-control, prospective nonrandomized and randomized trials, that compare RFA with alternative contemporary local treatments are urgently needed.en_GB
dc.language.isoengen_GB
dc.subject.mesh*Catheter Ablation/statistics & numerical dataen_GB
dc.subject.meshDatabases as Topicen_GB
dc.subject.mesh*Evidence-Based Medicineen_GB
dc.subject.meshHumansen_GB
dc.subject.meshLung Neoplasms/*radiotherapyen_GB
dc.titlePercutaneous radiofrequency ablation of lung tumors: evaluation of the literature using evidence-based techniques.en_GB
dc.contributor.departmentDepartment of Radiology, St Vincent's University Hospital, Dublin, Ireland.en_GB
dc.identifier.journalJournal of thoracic imagingen_GB
dc.description.provinceLeinster-

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