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.
Subject(s)
Carcinoma, Hepatocellular/drug therapy , Chemoembolization, Therapeutic/trends , Hospitals/trends , Liver Neoplasms/drug therapy , Practice Patterns, Physicians'/trends , Carcinoma, Hepatocellular/mortality , Carcinoma, Hepatocellular/pathology , Guideline Adherence/trends , Health Care Surveys , Humans , Liver Neoplasms/mortality , Liver Neoplasms/pathology , Neoplasm Staging , Practice Guidelines as Topic , Spain , Surveys and Questionnaires , Time Factors , Treatment OutcomeSubject(s)
Anti-Ulcer Agents/therapeutic use , Esophagitis, Peptic/drug therapy , Esophagitis, Peptic/etiology , Gastroesophageal Reflux/complications , Gastroesophageal Reflux/drug therapy , Clinical Trials as Topic , Esophagitis, Peptic/diagnosis , Gastroesophageal Reflux/diagnosis , Humans , Practice Guidelines as TopicABSTRACT
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