Ron C Gaba1. 1. Department of Radiology, Interventional Radiology Section, University of Illinois Medical Center at Chicago, 1740 W Taylor St, MC 931, Chicago, IL 60612, USA. rgaba@uic.edu
Abstract
OBJECTIVE: The objective of our study was to assess patterns of chemoembolization use; identify variations in application, technique, and follow-up; and recognize areas of practice conformity and divergence. MATERIALS AND METHODS: During August and September 2010, Society of Interventional Radiology (SIR) members with "chemoembolization expertise" were invited to participate in an anonymous online questionnaire. RESULTS: Two hundred sixty-eight of 1157 invited SIR members (23%) answered the 34-item survey. Respondents were predominantly male (93%) fellowship-trained full-time interventional radiologists (IRs) (87%) in practice for less than 15 years (69%) at community hospitals (61%) in the United States (91%). IRs (53%) most commonly drove therapeutic decision making. Most respondents (61%) performed 1-5 chemoembolizations per month and preferred drug-eluting beads to iodized oil for unifocal (46% vs 39%, respectively) and multifocal (40% vs 30%) hepatocellular carcinoma (HCC), although (90)Y radioembolization was favored when portal vein thrombosis was present (48% vs 28%). IRs showed variability in recognized procedure contraindications. Most respondents agreed on chemotherapeutic regimen but showed variable particle embolization use (17-45%) during oily chemoembolization. The 100- to 300-μm (49%) LC Beads (AngioDynamics) (65%) were the favored drug-eluting beads. Lobar chemoembolization was preferred. Treatment endpoints lacked consensus, but substasis was most desirable (56%). Up to 19% of respondents performed outpatient chemoembolization. Concurrent percutaneous ablation was infrequently used (applied in 0-25% of cases by 61-91% of respondents). Most (up to 74%) IRs preferred CT follow-up with the decision for retreatment based on CT evidence of viable disease (93%). CONCLUSION: Variability in chemoembolization practice exists among IRs. Continued investigation of treatment strategies and devices is necessary to better optimize and standardize transcatheter therapies for liver tumors.
OBJECTIVE: The objective of our study was to assess patterns of chemoembolization use; identify variations in application, technique, and follow-up; and recognize areas of practice conformity and divergence. MATERIALS AND METHODS: During August and September 2010, Society of Interventional Radiology (SIR) members with "chemoembolization expertise" were invited to participate in an anonymous online questionnaire. RESULTS: Two hundred sixty-eight of 1157 invited SIR members (23%) answered the 34-item survey. Respondents were predominantly male (93%) fellowship-trained full-time interventional radiologists (IRs) (87%) in practice for less than 15 years (69%) at community hospitals (61%) in the United States (91%). IRs (53%) most commonly drove therapeutic decision making. Most respondents (61%) performed 1-5 chemoembolizations per month and preferred drug-eluting beads to iodized oil for unifocal (46% vs 39%, respectively) and multifocal (40% vs 30%) hepatocellular carcinoma (HCC), although (90)Y radioembolization was favored when portal vein thrombosis was present (48% vs 28%). IRs showed variability in recognized procedure contraindications. Most respondents agreed on chemotherapeutic regimen but showed variable particle embolization use (17-45%) during oily chemoembolization. The 100- to 300-μm (49%) LC Beads (AngioDynamics) (65%) were the favored drug-eluting beads. Lobar chemoembolization was preferred. Treatment endpoints lacked consensus, but substasis was most desirable (56%). Up to 19% of respondents performed outpatient chemoembolization. Concurrent percutaneous ablation was infrequently used (applied in 0-25% of cases by 61-91% of respondents). Most (up to 74%) IRs preferred CT follow-up with the decision for retreatment based on CT evidence of viable disease (93%). CONCLUSION: Variability in chemoembolization practice exists among IRs. Continued investigation of treatment strategies and devices is necessary to better optimize and standardize transcatheter therapies for liver tumors.
Authors: Dingxin Wang; Ron C Gaba; Brian Jin; Robert J Lewandowski; Ahsun Riaz; Khairuddin Memon; Robert K Ryu; Kent T Sato; Laura M Kulik; Mary F Mulcahy; Andrew C Larson; Riad Salem; Reed A Omary Journal: Radiology Date: 2014-03-28 Impact factor: 11.105