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EUS-guided fiducial placement for GI malignancies: a systematic review and meta-analysis
Gastrointestinal Endoscopy ( IF 7.7 ) Pub Date : 2018-11-13 , DOI: 10.1016/j.gie.2018.10.047
Emmanuel Coronel , Irina M. Cazacu , Atsushi Sakuraba , Adriana Alexandra Luzuriaga Chavez , Angad Uberoi , Yimin Geng , Yutaka Tomizawa , Adrian Saftoiu , Eun Ji Shin , Cullen M. Taniguchi , Albert C Koong , Joseph M. Herman , Manoop S. Bhutani

Background and Aims

Image-guided radiotherapy (IGRT) allows the delivery of radiation with high precision to a target lesion while minimizing toxicity to surrounding tissues. EUS provides excellent visualization of GI tumors and consequently is being used for fiducial placement with increased frequency. Our goal was to perform a systematic review and meta-analysis of studies evaluating the technical aspects, safety, and efficacy of EUS fiducial placement for IGRT in GI malignancies.

Methods

A systematic literature search was carried out in the following databases: Medline, PubMed, Embase, Web of Science, and Cochrane Library, using Medical Subject Headings terms combined with text words. A random effects model was used to determine pooled proportions of technical success, migration, and adverse event rates. Heterogeneity was assessed using the I2 statistic. Publication bias was assessed visually using a funnel plot and by the Begg and Egger tests.

Results

Nine full articles and 5 abstracts reporting on 1155 patients, 49% from a single study by Dhadham et al, were included in the meta-analysis. The pooled rate of technical success was 98% (95% confidence interval [CI], 96-99). Moderate heterogeneity (I2 = 34.18) was present, which appeared to be due to variable sample sizes. Publication bias was present, suggesting that studies with less-substantial outcomes may have not been reported (Begg test, P = .87; Egger test, P < .01). Pooled rates for fiducial migration and adverse events were 3% (95% CI, 1.0-8.0) and 4% (95% CI, 3-7), respectively.

Conclusions

Our meta-analysis showed that EUS-guided insertion of gold fiducials for IGRT is technically feasible and safe. Further controlled studies assessing its long-term effectiveness in GI malignancies are needed.



中文翻译:

EUS指导的胃肠道恶性肿瘤的基准放置:系统评价和荟萃分析

背景和目标

影像引导放射疗法(IGRT)可以将放射线高精度地传递到目标病变,同时最大程度地减少对周围组织的毒性。EUS可提供出色的GI肿瘤可视化效果,因此被用于频率更高的基准放置。我们的目标是对胃肠道恶性肿瘤中IGRT的EUS基准放置的技术方面,安全性和有效性进行研究的系统评价和荟萃分析。

方法

使用医学主题词与文本词相结合,在以下数据库中进行了系统的文献检索:Medline,PubMed,Embase,Web of Science和Cochrane图书馆。随机效应模型用于确定技术成功率,迁移率和不良事件发生率的总比例。使用I 2统计量评估异质性。使用漏斗图以及通过Begg和Egger测试在视觉上评估出版偏倚。

结果

荟萃分析包括9篇完整的文章和5篇摘要,报道了1155名患者,其中49%来自Dhadham等人的单项研究。汇总的技术成功率为98%(95%置信区间[CI],96-99)。存在中等程度的异质性(I 2  = 34.18),这似乎是由于样本量可变所致。目前存在出版偏倚,提示尚未报道实质性研究较少的研究(Begg检验,P  = 0.87; Egger检验,P  <.01)。基准迁移和不良事件的合并发生率分别为3%(95%CI,1.0-8.0)和4%(95%CI,3-7)。

结论

我们的荟萃分析表明,以EUS指导的IGRT黄金基准插入是技术上可行和安全的。需要进行进一步的对照研究,以评估其在胃肠道恶性肿瘤中的长期有效性。

更新日期:2018-11-13
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