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Rofo 2013; 185(11): 1089-1094
DOI: 10.1055/s-0033-1335529
Interventionelle Radiologie
© Georg Thieme Verlag KG Stuttgart · New York

Transarterial Chemoembolization – Status Quo in Germany

Die transarterielle Chemoembolisation – Status quo in Deutschland
C. Niessen
1   Institute for Radiology, University Hospital Regensburg
,
P. Wiggermann
1   Institute for Radiology, University Hospital Regensburg
,
C. Velandia
2   Institute for Radiology, minimally-invasive therapies and nuclear medicine, SLK-Hospitals, Heilbronn
,
C. Stroszczynski
1   Institute for Radiology, University Hospital Regensburg
,
P. L. Pereira
2   Institute for Radiology, minimally-invasive therapies and nuclear medicine, SLK-Hospitals, Heilbronn
› Author Affiliations
Further Information

Publication History

16 January 2013

03 April 2013

Publication Date:
29 July 2013 (online)

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Abstract

Purpose: Against the background of the current preparation of the national disease management guideline for the diagnosis and treatment of hepatocellular carcinoma (HCC), the German Society for Interventional Radiology (DEGIR) launched a statewide survey in order to evaluate the current status of transarterial chemoembolization (TACE) in Germany.

Materials and Methods: In April 2012 an e-mail questionnaire relating to TACE practices in patients with intermediate-stage HCC was sent to all chief physicians of interventional radiology departments in Germany that were members of DEGIR.

Results: 96 questionnaires were completed and evaluated statistically. The most frequent combinations of embolic agents and cytotoxic drugs are drug-eluting beads combined with doxorubicin or epirubicin as well as lipiodol plus doxorubicin, epirubicin or cisplatin. 60 % of the interventionalists prefer superselective chemoembolization. In most cases more than one chemoembolization per patient is performed (95.5 %). The most common (77 %) time interval between two interventions ranges between one and two months.

Conclusion: The results of this survey show the often stated criticism in Germany regarding the substantial differences in TACE protocols and highlight the importance of standards of practice for TACE in patients with HCC.

Key Points:

  • For determining the suitable treatment regime for hepatocellular carcinoma, the BCLC classification has become established. TACE currently represents standard therapy for intermediate stage of HCC.

  • The results of this survey show the often stated criticism in Germany regarding the substantial differences in TACE protocols and highlight the importance of standards of practice for TACE in HCC patients.

  • Drug-eluting beads TACE (DEB-TACE) and conventional TACE with Lipiodol (cTACE) currently represent the most favoured TACE protocols with a trend toward preferably selective application of embolic and chemotherapeutic agent.

Citation Format:

  • Niessen C, Wiggermann P, Velandia C et al. Transarterial Chemoembolization – Status Quo in Germany. Fortschr Röntgenstr 2013; 185: 1089 – 1094

Zusammenfassung

Ziel: Vor dem Hintergrund der aktuell in Erstellung befindlichen S3-Leitlinie zu Diagnostik und Therapie des hepatozellulären Karzinoms (HCC) hat die Deutsche Gesellschaft für interventionelle Radiologie (DEGIR) eine Umfrage zur Statuserhebung der transarteriellen Chemoembolisation (TACE) an deutschen interventionell tätigen Röntgeninstituten in Auftrag gegeben.

Material und Methoden: Im April 2012 wurden Fragebogen per E-Mail an die Leiter der interventionell-radiologisch tätigen Zentren in Deutschland (Mitglieder der DEGIR) gesendet.

Ergebnisse: 96 Fragebogen wurden ausgefüllt und statistisch ausgewertet. Die am häufigsten verwendeten Kombinationen von Embolisat und Zytostatikum sind Drug-eluting Beads in Kombination mit Doxorubicin oder Epirubicin (43,5 %) sowie die Kombination aus Lipiodol mit Doxorubicin, Epirubicin oder Cisplatin (42 %). 60 % der teilnehmenden Kliniken bevorzugt die superselektive Chemoembolisation. Die Zeitabstände zwischen 2 Interventionen liegen in 77 % der teilnehmenden Kliniken im Bereich von 1 – 2 Monaten, dabei wird in den allermeisten Fällen mehr als eine TACE pro Patient durchgeführt (95,5 %).

Schlussfolgerung: Die Ergebnisse dieser Studie zeigen die in Deutschland vielfach kritisierte Heterogenität der aktuell durchgeführten TACE-Protokolle und unterstreichen damit die Notwendigkeit struktureller Richtlinien für TACE-Therapieschemata.

Key words

HCC - chemoembolization - interventional procedures

Deutscher Artikel/German Article

 

  • References

  • 1 EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol 2012; 56: 908-943
    PubMedGoogle Scholar
  • 2 Jemal A, Siegel R, Xu J et al. Cancer statistics, 2010. CA Cancer J Clin 2010; 60: 277-300
    CrossrefPubMedGoogle Scholar
  • 3 Llovet JM, Real MI, Montana X et al. Arterial embolisation or chemoembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomised controlled trial. Lancet 2002; 359: 1734-1739
    CrossrefPubMedGoogle Scholar
  • 4 Lo CM, Ngan H, Tso WK et al. Randomized controlled trial of transarterial lipiodol chemoembolization for unresectable hepatocellular carcinoma. Hepatology 2002; 35: 1164-1171
    CrossrefPubMedGoogle Scholar
  • 5 Vogl TJ, Mack MG, Eichler K et al. Chemoperfusion and embolization in the treatment of liver metastases. Fortschr Röntgenstr 2011; 183: 12-23
    Article in Thieme ConnectPubMedGoogle Scholar
  • 6 Wallace S, Carrasco CH, Charnsangavej C et al. Hepatic artery infusion and chemoembolization in the management of liver metastases. Cardiovasc Intervent Radiol 1990; 13: 153-160
    CrossrefPubMedGoogle Scholar
  • 7 Ramsey DE, Kernagis LY, Soulen MC et al. Chemoembolization of hepatocellular carcinoma. J Vasc Interv Radiol 2002; 13: S211-S221
    CrossrefPubMedGoogle Scholar
  • 8 Malagari K, Pomoni M, Kelekis A et al. Prospective randomized comparison of chemoembolization with doxorubicin-eluting beads and bland embolization with BeadBlock for hepatocellular carcinoma. Cardiovasc Intervent Radiol 2010; 33: 541-551
    CrossrefPubMedGoogle Scholar
  • 9 Marelli L, Stigliano R, Triantos C et al. Transarterial therapy for hepatocellular carcinoma: which technique is more effective? A systematic review of cohort and randomized studies. Cardiovasc Intervent Radiol 2007; 30: 6-25
    CrossrefPubMedGoogle Scholar
  • 10 Lewis AL, Gonzalez MV, Lloyd AW et al. DC bead: in vitro characterization of a drug-delivery device for transarterial chemoembolization. J Vasc Interv Radiol 2006; 17: 335-342
    CrossrefPubMedGoogle Scholar
  • 11 Wiggermann P, Wohlgemuth WA, Heibl M et al. Dynamic evaluation and quantification of microvascularization during degradable starch microspheres transarterial Chemoembolisation (DSM-TACE) of HCC lesions using contrast enhanced ultrasound (CEUS): A feasibility study. Clin Hemorheol Microcirc 2013; 53: 337-348
    PubMedGoogle Scholar
  • 12 Lammer J, Malagari K, Vogl T et al. Prospective randomized study of doxorubicin-eluting-bead embolization in the treatment of hepatocellular carcinoma: results of the PRECISION V study. Cardiovasc Intervent Radiol 2010; 33: 41-52
    CrossrefPubMedGoogle Scholar
  • 13 Wiggermann P, Sieron D, Brosche C et al. Transarterial Chemoembolization of Child-A hepatocellular carcinoma: drug-eluting bead TACE (DEB TACE) vs. TACE with cisplatin/lipiodol (cTACE). Med Sci Monit 2011; 17: CR189-CR195
    CrossrefPubMedGoogle Scholar
  • 14 Heuser L, Arnold CN, Morhard D et al. Quality report 2011 of the Germyn Society of Interventional Radiology (DeGIR) – report about treatment quality of minimal invasive procedures. Fortschr Röntgenstr 2012; 184: 570-576
    Article in Thieme ConnectPubMedGoogle Scholar
  • 15 Bangard C. Radiofrequency of the liver – an update. Fortschr Röntgenstr 2011; 183: 704-713
    Article in Thieme ConnectPubMedGoogle Scholar
  • 16 Llovet JM, Mas X, Aponte JJ et al. Cost effectiveness of adjuvant therapy for hepatocellular carcinoma during the waiting list for liver transplantation. Gut 2002; 50: 123-128
    CrossrefPubMedGoogle Scholar
  • 17 Llovet JM, Bruix J. Systematic review of randomized trials for unresectable hepatocellular carcinoma: Chemoembolization improves survival. Hepatology 2003; 37: 429-442
    CrossrefPubMedGoogle Scholar
  • 18 Lencioni R, Crocetti L. Local-regional treatment of hepatocellular carcinoma. Radiology 2012; 262: 43-58
    CrossrefPubMedGoogle Scholar
  • 19 Otto G, Herber S, Heise M et al. Response to transarterial chemoembolization as a biological selection criterion for liver transplantation in hepatocellular carcinoma. Liver Transpl 2006; 12: 1260-1267
    CrossrefPubMedGoogle Scholar
  • 20 Kirchhoff TD, Rudolph KL, Layer G et al. Chemoocclusion vs chemoperfusion for treatment of advanced hepatocellular carcinoma: a randomised trial. Eur J Surg Oncol 2006; 32: 201-207
    CrossrefPubMedGoogle Scholar
  • 21 Sangro B, Carpanese L, Cianni R et al. Survival after yttrium-90 resin microsphere radioembolization of hepatocellular carcinoma across Barcelona clinic liver cancer stages: a European evaluation. Hepatology 2011; 54: 868-878
    CrossrefPubMedGoogle Scholar
  • 22 Lencioni R, Llovet JM. Modified RECIST (mRECIST) assessment for hepatocellular carcinoma. Semin Liver Dis 2010; 30: 52-60
    Article in Thieme ConnectPubMedGoogle Scholar
  • 23 Bruix J, Sherman M, Llovet JM et al. Clinical management of hepatocellular carcinoma. Conclusions of the Barcelona-2000 EASL conference. European Association for the Study of the Liver. J Hepatol 2001; 35: 421-430
    CrossrefPubMedGoogle Scholar
  • 24 Gebauer B, Bohnsack O, Riess H. Radiological evaluation of tumor response in oncological studies (tumor response evaluation). Fortschr Röntgenstr 2011; 183: 695-703
    Article in Thieme ConnectPubMedGoogle Scholar
  • 25 Llovet JM, Bru C, Bruix J. Prognosis of hepatocellular carcinoma: the BCLC ging classification. Semin Liver Dis 1999; 19: 329-338
    Article in Thieme ConnectPubMedGoogle Scholar