Tsakok Maria Theresa, Jones Daniel, MacNeill Alice, Gleeson Fergus Vincent
Department of Radiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
Medical Sciences Division, University of Oxford, Oxford, UK.
Interact Cardiovasc Thorac Surg. 2019 Aug 1;29(2):283–286. doi: 10.1093/icvts/ivz044. Epub 2019 Mar 30.
A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was 'Is microwave ablation (MWA) more effective than radiofrequency ablation (RFA) in achieving local control for primary lung cancer?'. Altogether, 439 papers were found, of which 7 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Both are thermal ablative techniques, with microwave ablation (MWA) the newer technique and radiofrequency ablation (RFA) with a longer track record. Lack of consensus with regard to definitions of technical success and efficacy and heterogeneity of study inclusions limits studies for both. The only direct comparison study does not demonstrate a difference with either technique in achieving local control. The quality of evidence for MWA is very limited by retrospective nature and heterogeneity in technique, power settings and tumour type. Tumour size and late-stage cancer were shown to be associated with higher rates of local recurrence in 1 MWA study. RFA studies were generally of a higher level of evidence comprising prospective trials, systematic review and meta-analysis. The recurrence rates for MWA and RFA overlapped, and for the included studies ranged between 16% and 44% for MWA and 9% and 58% for RFA. The current evidence, therefore, does not clearly demonstrate a benefit of MWA over RFA in achieving local control in primary lung cancer.
一篇胸外科最佳证据主题文章是按照结构化方案撰写的。所探讨的问题是“在实现原发性肺癌的局部控制方面，微波消融（MWA）是否比射频消融（RFA）更有效？”。总共找到439篇论文，其中7篇代表了回答该临床问题的最佳证据。这些论文的作者、期刊、发表日期、国家、所研究的患者群体、研究类型、相关结果及结果已列表呈现。两者均为热消融技术，微波消融（MWA）是较新的技术，而射频消融（RFA）的应用记录更长。在技术成功和疗效的定义方面缺乏共识以及研究纳入的异质性限制了对两者的研究。唯一的直接比较研究并未显示出两种技术在实现局部控制方面存在差异。由于研究的回顾性性质以及技术、功率设置和肿瘤类型的异质性，微波消融（MWA）的证据质量非常有限。在一项微波消融（MWA）研究中，肿瘤大小和晚期癌症与更高的局部复发率相关。射频消融（RFA）研究的证据水平通常较高，包括前瞻性试验、系统评价和荟萃分析。微波消融（MWA）和射频消融（RFA）的复发率有重叠，纳入研究中微波消融（MWA）的复发率在16%至44%之间，射频消融（RFA）的复发率在9%至58%之间。因此，目前的证据并未明确表明在实现原发性肺癌局部控制方面，微波消融（MWA）比射频消融（RFA）更具优势。
