Interventional Radiology, University Hospital of Strasbourg, 1 place de l'Hôpital, 67000, Strasbourg, France.
Vascular and Interventional Radiology Unit, Department of Diagnostic of Radiological, Oncological and Anatomopathological Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161, Rome, Italy.
Eur Radiol. 2021 May;31(5):3530-3541. doi: 10.1007/s00330-020-07382-8. Epub 2020 Nov 6.
To systematically review microwave ablation (MWA) protocols, safety, and clinical efficacy for treating bone tumors.
A systematic literature search was conducted using PubMed, the Cochrane Library, EMBASE, and Web of Science database. Data concerning patient demographics, tumor characteristics, procedure, complications, and clinical outcomes were extracted and analyzed.
Seven non-comparative studies (6 retrospective, 1 prospective) were included accounting for 249 patients and 306 tumors (244/306 [79.7%] metastases; 25/306 [8.2%] myelomas, and 37/306 [12.1%] osteoid osteomas [OO]). In malignant tumors, MWA power was 30-70 W (except in one spinal tumors series where a mean power of 13.3 W was used) with pooled mean ablation time of 308.3 s. With OO, MWA power was 30-60 W with mean ablation time of 90-102 s. Protective measures were very sporadically used in 5 studies. Additional osteoplasty was performed in 199/269 (74.0%) malignant tumors. Clinically significant complications were noted in 10/249 (4.0%) patients. For malignant tumors, estimated pain reduction on the numerical rating scale was 5.3/10 (95% confidence intervals [95%CI] 4.6-6.1) at 1 month; and 5.3/10 (95% CI 4.3-6.3) at the last recorded follow-up (range 20-24 weeks in 4/5 studies). For OO, at 1-month follow-up, effective pain relief was noted in 92.3-100% of patients.
MWA is effective in achieving pain relief at short- (1 month) and mid-term (4-6 months) for painful OO and malignant bone tumors, respectively. Although MWA seems safe, further prospective studies are warranted to further assess this aspect, and to standardize MWA protocols.
• Large heterogeneity exists across literature about ablation protocols used with microwave ablation applied for the treatment of benign and malignant bone tumors. • Although microwave ablation of bone tumors appears safe, further studies are needed to assess this aspect, as current literature does not allow definitive conclusions. • Nevertheless, microwave ablation is effective in achieving pain relief at short- (1 month) and mid-term (4-6 months) for painful osteoid osteomas and malignant bone tumors, respectively.
系统评价微波消融（MWA）治疗骨肿瘤的方案、安全性和临床疗效。
采用PubMed、Cochrane 图书馆、EMBASE 和 Web of Science 数据库进行系统文献检索。提取并分析患者人口统计学、肿瘤特征、手术、并发症和临床结局等数据。
纳入 7 项非对照研究（6 项回顾性研究，1 项前瞻性研究），共纳入 249 例患者和 306 个肿瘤（244/306[79.7%]转移瘤；25/306[8.2%]骨髓瘤，37/306[12.1%]成骨细胞瘤[OO]）。在恶性肿瘤中，MWA 功率为 30-70 W（除了一项脊柱肿瘤系列研究中使用平均功率 13.3 W 外），平均消融时间为 308.3 s。对于 OO，MWA 功率为 30-60 W，平均消融时间为 90-102 s。5 项研究中很少使用保护措施。199/269（74.0%）例恶性肿瘤行额外的骨成形术。249 例患者中有 10 例（4.0%）出现临床显著并发症。对于恶性肿瘤，1 个月时数字评分量表估计的疼痛缓解程度为 5.3/10（95%置信区间[95%CI]4.6-6.1）；最后一次记录的随访时为 5.3/10（95%CI 4.3-6.3）（4/5 项研究的随访时间为 20-24 周）。对于 OO，在 1 个月的随访时，92.3-100%的患者疼痛得到有效缓解。
MWA 可有效缓解疼痛性 OO 和恶性骨肿瘤的短期（1 个月）和中期（4-6 个月）疼痛。尽管 MWA 似乎是安全的，但需要进一步的前瞻性研究来进一步评估这一方面，并使 MWA 方案标准化。
关于微波消融治疗良性和恶性骨肿瘤的消融方案，文献中存在很大的异质性。
尽管骨肿瘤的微波消融似乎是安全的，但需要进一步的研究来评估这一方面，因为目前的文献还无法得出明确的结论。
然而，微波消融可有效缓解疼痛性成骨细胞瘤的短期（1 个月）和中期（4-6 个月）疼痛，以及恶性骨肿瘤的疼痛。
