The Role of Transarterial Embolization Plus Radiotherapy Compared to Radiotherapy or Transarterial Embolization Alone in the Management of Painful Bone Metastases: Results of a Systematic Review

This study systematically reviews the efficacy and safety of combining transarterial embolization (TAE) with radiotherapy (RT) for managing bone metastases (BM), assessing clinical response (CR), and local control (LC). A literature search using PubMed, Scopus, Web of Science, Medline Plus, and the Cochrane Library identified three relevant studies with 74 patients and 103 BM. One study included local chemotherapy infusion with TAE. All studies reported CR rates, though one used skeletal-related events as a surrogate, while only one study provided LC rates. Adverse events were noted across all studies. A quantitative analysis of CR rates showed a relative risk (RR) of 0.15 (confidence interval (CI): 0.03–0.69) favoring TAE plus RT over RT alone, while no significant differences were observed between TAE plus RT and TAE alone (RR: 0.91; CI: 0.51–1.63). The combined TAE and RT approach demonstrated effectiveness in local tumor control and produced faster, longer-lasting pain relief than RT alone, although TAE was associated with a mild, transient increase in side effects. While TAE plus RT shows potential benefit and acceptable toxicity, the current evidence is of low quality.