Eldeeb Hatem Abdelmoneim, Shaaban Abdelgalil Mahmoud, Ghalwash Asem Ahmed, Elganady Asmaa, Qafesha Ruaa Mustafa, Alkhawaldeh Ibraheem M, Hindawi Mahmoud Diaa, Jaradat Jaber H, Abduljalil Shabaan Mohamed, Abdelgawad Hussien Ahmed H
Faculty of Medicine, Alazhar University, Cairo, Egypt.
Faculty of Medicine, Ain-Shams University, 359 Abd Allah Nadim Street, Cairo, Egypt.
Cardiovasc Intervent Radiol. 2024 Dec;47(12):1696-1707. doi: 10.1007/s00270-024-03865-z. Epub 2024 Oct 7.
Transarterial radioembolization (TARE) is a minimally invasive therapy combining embolization and radiation for cancer treatment. This meta-analysis compares radiation exposure, quality of life, and safety of the transradial (TRA) versus transfemoral (TFA) approaches in TARE for liver tumors.
We searched PubMed, SCOPUS, Cochrane, EMBASE, and Web of Science for studies comparing TRA versus TFA in TARE for liver tumors. Our primary outcomes focused on various measures of patient radiation exposure, including procedure time, fluoroscopy time, air kerma, and dose-area product (DAP). For secondary outcomes, we evaluated safety parameters, such as overall pain experienced during the procedure, pain in the recovery room post-procedure, the incidence of adverse events, and the impact on quality of life. Study quality was assessed using Cochrane's ROB 2 tool for RCTs and the Newcastle-Ottawa scale for observational studies. Data analysis was conducted with REVMAN 5.4.1 software.
Six studies, comprising one RCT and five cohort studies with 1,209 patients, underwent comprehensive analysis. The aggregated findings revealed a significant reduction in procedure duration associated with TRA (MD =- 6.30, 95% CI [- 9.88, - 2.73], P = 0.005). However, no statistically significant differences were found between TRA and TFA groups concerning fluoroscopy time, recovery time, air kerma, DAP, pain in the recovery room, overall pain during the procedure, quality of life measuring mental health and physical function or adverse events.
TRA and TFA showed comparable results in TARE for liver tumors, but TRA offered a shorter procedure time. Further RCTs with larger samples are needed to confirm these findings. Future studies should assess long-term efficacy for a more complete evaluation.
经动脉放射性栓塞术（TARE）是一种将栓塞与放疗相结合的微创癌症治疗方法。本荟萃分析比较了经桡动脉（TRA）与经股动脉（TFA）途径在TARE治疗肝肿瘤中的辐射暴露、生活质量和安全性。
我们检索了PubMed、SCOPUS、Cochrane、EMBASE和Web of Science，以查找比较TRA与TFA在TARE治疗肝肿瘤中的研究。我们的主要结局集中在患者辐射暴露的各种测量指标上，包括手术时间、透视时间、空气比释动能和剂量面积乘积（DAP）。对于次要结局，我们评估了安全参数，如手术期间经历的总体疼痛、术后恢复室的疼痛、不良事件的发生率以及对生活质量的影响。使用Cochrane的ROB 2工具评估随机对照试验的研究质量，使用纽卡斯尔-渥太华量表评估观察性研究的质量。使用REVMAN 5.4.1软件进行数据分析。
对6项研究进行了综合分析，其中包括1项随机对照试验和5项队列研究，共1209例患者。汇总结果显示，TRA相关的手术持续时间显著缩短（MD = - 6.30，95% CI [- 9.88，- 2.73]，P = 0.005）。然而，TRA组和TFA组在透视时间、恢复时间、空气比释动能、DAP、恢复室疼痛、手术期间的总体疼痛、测量心理健康和身体功能的生活质量或不良事件方面没有统计学上的显著差异。
在TARE治疗肝肿瘤中，TRA和TFA显示出可比的结果，但TRA的手术时间更短。需要进一步开展更大样本量的随机对照试验来证实这些发现。未来的研究应评估长期疗效以进行更全面评估。
