Department of Interventional and Diagnostic Imaging, University Hospital of Caen, Avenue de la Côte de Nacre, Caen Cedex 14033, France; Normandie Univ, UNICAEN, CEA, CNRS, ISTCT/CERVOxy Group, 14000 Caen, France.
Diagnostic, Functional and Therapeutic Imaging Department, Poitiers University Hospital, Poitiers Cedex, France.
Diagn Interv Imaging. 2018 Sep;99(9):527-535. doi: 10.1016/j.diii.2018.03.003. Epub 2018 Mar 30.
To report current practices of transarterial chemoembolization (TACE) by interventional radiologists (IR) for hepatocellular carcinoma (HCC) through a French national survey.
An electronic survey was sent by e-mail to 232 IRs performing TACE in 32 private or public centers. The survey included 66 items including indications for TACE, technical aspects of TACE, other locally available treatments for HCC, follow-up imaging and general aspects of interventional radiology practices.
A total of 64 IRs (64/232; 27%) answered the survey. Each IR performed a mean of 49±45 (SD) TACE procedures per year. Marked variations in indications for TACE in HCC were observed. Six percent of IRs (4/64) treated only patients with Barcelona Clinic Liver Cancer (BCLC) stage B HCC. Antibioprophylaxis was not used by 43/64 of IRs (67%). The number of HCC nodules was considered to select conventional TACE versus drug-eluting beadsTACE (DEB-TACE) by 17/49 IRs (35%) followed by patient performance status and Child-Pugh score by 6/49 IRs (12%). Seventy-three percent of IRs (45/62) treated nodules selectively in patients with unilobar disease with cTACE. Thirty-three percent of IRs (21/64) planned systematically a second TACE session. Doxorubicin was the most frequently used drug (52/64; 81%) and 15/64 IRs (23%) used gelatine sponge as the only embolic agent. For DEB-TACE, 100-300μm beads were used by 26/49 IRs (53%) and no additional embolization was performed by 19/48 IRs (39%). Monopolar radiofrequency technique was widely available (59/63; 94%) compared to selective internal radiation therapy (37/64; 58%). Magnetic resonance imaging was used for follow-up by 13/63 IRs (20%).
Current practices of TACE for HCC varied widely among IRs suggesting a need for more standardized practices.
通过一项法国全国性调查，报告介入放射学家（IR）对肝细胞癌（HCC）进行经动脉化疗栓塞（TACE）的当前实践。
通过电子邮件向 32 个私人或公共中心进行 TACE 的 232 名 IR 发送了电子调查。该调查包括 66 个项目，包括 TACE 的适应证、TACE 的技术方面、HCC 的其他局部可用治疗方法、随访影像学和介入放射学实践的一般方面。
共有 64 名 IR（64/232；27%）回答了调查。每位 IR 每年平均进行 49±45（SD）次 TACE 手术。在 HCC 的 TACE 适应证方面观察到明显的差异。6%的 IR（4/64）仅治疗巴塞罗那临床肝癌（BCLC）分期 B HCC 患者。43/64（67%）的 IR 未使用抗生素预防。17/49（35%）的 IR 根据 HCC 结节数量选择常规 TACE 与载药微球 TACE（DEB-TACE），6/49（12%）的 IR 根据患者的体能状态和 Child-Pugh 评分选择。73%的 IR（45/62）在单叶疾病患者中选择性地对结节进行治疗，采用 cTACE。33%的 IR（21/64）有计划地进行第二次 TACE 治疗。阿霉素是最常使用的药物（52/64；81%），15/64（23%）的 IR 仅使用明胶海绵作为唯一的栓塞剂。对于 DEB-TACE，26/49（53%）的 IR 使用 100-300μm 微球，48/49（39%）的 IR 不进行额外栓塞。单极射频技术（59/63；94%）比选择性内放射治疗（37/64；58%）更广泛地应用。13/63（20%）的 IR 使用磁共振成像进行随访。
IR 对 HCC 的 TACE 实践差异很大，表明需要更标准化的实践。
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