Ana Matilla Peña1, Óscar Núñez-Martínez2, Antonio Díaz-Sánchez3, Fernando Pons-Renedo4, Mariano Gómez-Rubio5, Benjamín Polo-Lorduy6, José L Lledó-Navarro7, María Trapero-Marugán4, José María Ladero-Quesada8, Elvira Poves-Martínez9, Alberto Ibáñez-Pinto10, Ana María Martín-Algívez11, Mar Lozano-Maya12, Raquel González-Alonso13, Belén Piqueras-Alcol14, Leticia González-Moreno15, Conrado Fernández-Rodríguez16, Francisco Gea-Rodríguez17. 1. Department of Gastroenterology, Sección de Hepatología, Hospital General Universitario Gregorio Marañón, Madrid. Spain. 2. Gastroenterology Unit, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain. 3. Gastroenterology Unit, Hospital Universitario del Sureste, Arganda del Rey, Madrid, Spain. 4. Department of Gastroenterology, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain. 5. Department of Gastroenterology, Hospital Universitario de Getafe, Getafe, Madrid, Spain. 6. Department of Gastroenterology, Fundación Jiménez Díaz, Madrid, Spain. 7. Department of Gastroenterology, Hospital Universitario Ramón y Cajal, Madrid, Spain. 8. Department of Gastroenterology, Hospital Clínico San Carlos, Madrid, Spain. 9. Department of Gastroenterology, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain. 10. Gastroenterology Unit, Hospital Universitario del Henares, Coslada, Madrid, Spain. 11. Department of Gastroenterology, Hospital Universitario 12 de Octubre, Madrid, Spain. 12. Gastroenterology Unit, Hospital Universitario Infanta Leonor, Madrid, Spain. 13. Department of Gastroenterology, Hospital Universitario de Móstoles, Móstoles, Madrid, Spain. 14. Department of Gastroenterology, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain. 15. Department of Gastroenterology, Hospital Universitario de La Princesa, Madrid, Spain. 16. Department of Gastroenterology, Hospital Universitario Fundación de Alcorcón, Alcorcón, Madrid, Spain. 17. Department of Gastroenterology, Hospital Universitario Severo Ochoa, Leganés, Madrid, Spain.
Abstract
BACKGROUND: Transarterial chemoembolisation (TACE), having demonstrated survival benefits, is the treatmentof choice in intermediate-stage hepatocellular carcinoma, although there is great heterogeneity in its clinical application. MATERIAL AND METHODS: A survey was sent to the Madrid Regional hospitals to assess applicability, indications and treatment protocols. The assessment was made overall and according to the type of hospital (groups A vs. B and C). RESULTS: Seventeen out of 22 hospitals responded (8/8 group A, 9/ 14 group B-C). All do/indicate transarterial chemoembolisation, 13/17 at their own facilities. Eight of the 17 hospitals have multidisciplinary groups (5/8 A, 3/9 B-C). Nine hospitals perform > 20 procedures/year (7 group A), and 6 from group B-C request/perform < 10/year. It is performed on an "on-demand" basis in 12/17. In 5 hospitals, all the procedures use drug-eluting beads loaded with doxorubicin. The average number of procedures per patient is 2. The mean time from diagnosis of hepatocellular carcinoma to transarterial chemoembolisation is ≤ 2 months in 16 hospitals. In 11/17 hospitals, response is assessed by computed tomography. Radiological response is measured without specific criteria in 12/17 and the other five hospitals (4 group A) assessed using standardised criteria. CONCLUSION: Uniformity among the Madrid Regional hospitals was found in the indication and treatment regimen. The use of DEB-TACE has become the preferred form of TACE in clinical practice. The differentiating factors for the more specialised hospitals are a larger volume of procedures, decision-making by multidisciplinary committees and assessment of radiological response more likely to be standardised.
BACKGROUND: Transarterial chemoembolisation (TACE), having demonstrated survival benefits, is the treatmentof choice in intermediate-stage hepatocellular carcinoma, although there is great heterogeneity in its clinical application. MATERIAL AND METHODS: A survey was sent to the Madrid Regional hospitals to assess applicability, indications and treatment protocols. The assessment was made overall and according to the type of hospital (groups A vs. B and C). RESULTS: Seventeen out of 22 hospitals responded (8/8 group A, 9/ 14 group B-C). All do/indicate transarterial chemoembolisation, 13/17 at their own facilities. Eight of the 17 hospitals have multidisciplinary groups (5/8 A, 3/9 B-C). Nine hospitals perform > 20 procedures/year (7 group A), and 6 from group B-C request/perform < 10/year. It is performed on an "on-demand" basis in 12/17. In 5 hospitals, all the procedures use drug-eluting beads loaded with doxorubicin. The average number of procedures per patient is 2. The mean time from diagnosis of hepatocellular carcinoma to transarterial chemoembolisation is ≤ 2 months in 16 hospitals. In 11/17 hospitals, response is assessed by computed tomography. Radiological response is measured without specific criteria in 12/17 and the other five hospitals (4 group A) assessed using standardised criteria. CONCLUSION: Uniformity among the Madrid Regional hospitals was found in the indication and treatment regimen. The use of DEB-TACE has become the preferred form of TACE in clinical practice. The differentiating factors for the more specialised hospitals are a larger volume of procedures, decision-making by multidisciplinary committees and assessment of radiological response more likely to be standardised.