Current trends in the interventional treatment of hepatocellular carcinoma: A cross-sectional survey of transarterial embolization techniques.

Abstract

e15627 Background: Since two randomized controlled trials demonstrated the superiority of Transarterial chemoembolization (TACE) to supportive care, it has been a mainstay of treatment for unresectable hepatocellular carcinoma (HCC). The technical aspects of the TACE procedure, including drug type, embolic agent, bead type and size, procedural endpoint and follow up are heterogeneous throughout the literature, making meaningful comparisons less impactful. The goal of this study was to determine the common technical practices in the interventional therapy of HCC over several geographical areas. Methods: An anonymous 18 question online survey was distributed via email to practicing members of the Cardiovascular and Interventional Radiology Society of Europe (CIRSE), Chinese Society of Interventional Radiology (CSIR), Japanese Society of Interventional Radiology (JSIR), Korean Society of Interventional Radiology (KSIR), and the Society of Interventional Radiology (SIR). An estimated 15,700 surveys were distributed and 1160 responses obtained from 62 countries for a total response rate of 7.4%. Results: Excluding bead size, responses were statistically different by region (p < 0.05). Doxorubicin was more commonly used among SIR, CIRSE, and KSIR members than JSIR and CSIR members (p < 0.05). A fixed dose of cytotoxin was favored by SIR and CIRSE members, while dosing dependent on tumor-size was used by KSIR, JSIR, and CSIR members (p < 0.05). Drug eluting bead-TACE (DEB-TACE) was most popular in SIR and CIRSE, while classical TACE (cTACE) was most popular in Japan, Korea, and China (p < 0.05). For DEB-TACE procedures, the favored bead size was 100 μm – 300 μm for all groups. Procedural endpoint, type of embolic agent, and use of additives and antibiotics varied among groups (p < 0.05). CT was the most commonly used modality for follow up amongst all respondents, but MR was used more by SIR members than all other groups (p < 0.05). Conclusions: This study demonstrated that there is clear evidence that the TACE technique differs by region. Understanding and reporting the current practice trends is an important step to optimize and standardize future randomized controlled trials.