The results of a web-based survey designed to shed light on the practice of transarterial chemoembolization (TACE) in the UK have shown that there is a wide variation in practice with some centres using conventional TACE (with lipiodol and doxorubicin) and others using, newer drug-eluting beads.
Shueh Hao Lim from the Department of Radiology, Edinburgh Royal Infirmary, Edinburgh, UK, presented the results of the study at the British Society of Interventional Radiology (BSIR) annual meeting in Liverpool in November 2014. The senior author was Jim Gordon-Smith.
Lim made the point that evidence remains equivocal as to whether conventional or drug-eluting TACE is the superior treatment and noted that no overview of the practice of TACE in the UK is currently available.
“A web-based survey of BSIR members was carried out from December 2013 to March 2014. Questions from the survey focused on which treatment type was used as well as who was responsible for referral, treatment types, reasons for current, timing of follow-up imaging, volume of disease treated in a single session and volume of TACE performed annually,” explained Lim.
Data was obtained from 28 centres in the UK. Of these, 11 centres performed more than 50 cases annually. Fifty eight per cent of centres used drug-eluting bead TACE as their only treatment method. Twelve per cent used only conventional TACE and 23% used a combination of both methods. Seven per cent of centres currently used conventional TACE for patients not included in trials and TACE with drug-eluting beads for those enrolled in trials, and cited cost as the main reason deterring them from switching completely to the use of drug-eluting beads.
The survey also found that nearly 20% of those surveyed would treat high volume disease in a single procedure. Referrals for TACE were mostly obtained from hepatologists (50%). Respondents also revealed that 89% of centres performed their first follow-up scan within 4–6 weeks of the procedure. Nearly 90% of interventionists also disagreed with the 2011 Cochrane Library Report (Review) findings that TACE should not be used for the treatment for unresectable hepatocellular carcinoma until stronger evidence is available.
“With both forms of TACE being used in regular clinical practice in the UK, the possibility of creating a head-to-head trial between drug-eluting bead and conventional TACE is realistic,” Lim concluded.