Trans-arterial chemoembolization with doxorubicin-eluting particles versus conventional trans-arterial chemoembolization in unresectable hepatocellular carcinoma: A study of effectiveness, safety and costs.

OBJECTIVES: To compare the effectiveness, survival and cost in patients with unresectable hepatic cell carcinoma (HCC) treated with trans-arterial chemoembolization using doxorubicin-eluting beads (DEB-TACE) versus conventional TACE (cTACE) in clinical practice. MATERIAL AND METHODS: This single-centered retrospective observational study compared 60 consecutive HCC unresectable patients: 30 were treated with DEB-TACE and 30 used cTACE. Comparisons were with χ(2) test, Student t-test, and Kaplan Meier method. RESULTS: Of the 60 patients with HCC in non-curative stage, baseline characteristics were similar for both groups of treatment, and of these we observed lower survival in male patients and those who had hepatitis C virus (p=0.014 and p=0.003, respectively). No statistically significant differences were observed as a function of treatment employed with respect to overall survival (OS) at 5 years (29.99 months; 95%CI: 21.38-38.60 versus 30.67 months; 95%CI:22.65-38.70; p=0.626) and progression free survival (PFS) median of 11.57 months (95%CI: 0.97-22.18) versus 12.80 months (95%CI:0.00-32.37; p=0.618). The median length of hospital admission were 2.6 and 5.4 days (p<0.001) for DEB(-)TACE and cTACE, respectively. Toxicities grade 2-4 were higher in cTACE group (54 versus 31; p<0.001). The cost of the treatment was 1581 € for DEB(-)TACE and 514.63 € for cTACE. The overall mean cost of intervention was 3134 € and 3694.35 €, respectively (p=0.173). CONCLUSIONS: Chemoembolization in patients with unresectable HCC achieved OS close to 30 months at 5 years, independent of the technique employed. Similar overall costs but better tolerance of the DEB-TACE justified the higher costs of the procedure.

Formación en radiología vascular intervencionista. ¿Una carrera de obstáculos? / No disponible

No disponible

[Professional competencies: from conflict to opportunity]. / Competencias profesionales: del conflicto a la oportunidad.

The tough [correction of turf] battles with other specialties that tend to take control of the radiological practice and some of our areas of interest are one of the most important problems that Radiology must face at the present time. Interventional Radiology is the last one and the more recent example of this phenomenon that spreads world-wide. Far from defeatist attitudes, we must learn from our past mistakes to turn this scenario into an opportunity to evolve towards a more competitive and updated specialty according to our time. The authors review the present situation of the tough [correction of turf] batlles of Radiology with other specialties, pointing to their possible causes and proposing the resolution strategies.

Competencias profesionales: del conflicto a la oportunidad / Professional competencies: from conflict to opportunity

El conflicto con otras especialidades que tienden a apropiarse de la práctica radiológica y de algunas de nuestras áreas de interés es uno de los problemas más importantes con los que la Radiología y los radiólogos debemos enfrentarnos actualmente. La Radiología Vascular Intervencionista es el último y más reciente ejemplo de este fenómeno extendido a nivel mundial. Lejos de actitudes derrotistas, debemos aprender de los errores pasados, transformando este escenario actual en una oportunidad para evolucionar hacia una especialidad más competitiva y acorde con lo que de la imagen médica se debe demandar. Los autores revisan la situación actual de los conflictos de la Radiología con otras especialidades, incidiendo en sus posibles causas y proponiendo estrategias de resolución (AU)

The turf battles with other specialties that tend to take control of the radiological practice and some of our areas of interest are one of the most important problems that Radiology must face at the present time. Interventional Radiology is the last one and the more recent example of this phenomenon that spreads world-wide. Far from defeatist attitudes, we must learn from our past mistakes to turn this scenario into an opportunity to evolve towards a more competitive and updated specialty according to our time. The authors review the present situation of the turf batlles of Radiology with other specialties, pointing to their possible causes and proposing the resolution strategies (AU)

[Stenting without prior dilatation in intracranial stenosis of the internal carotid artery: a case report]. / Colocación de endoprótesis vascular sin dilatacion previa en estenosis intracraneal de la carótida interna. A propósito de un caso.

INTRODUCTION: Recent reports have described the application of coronary stents for the treatment of intracranial stenosis of the internal carotid artery (ICA), above all in patients who do not respond to medical treatment and display advancing neurological symptoms. Stenting in intracranial vascular lesions of the carotid territory has been used almost exclusively in the treatment of the complications due to transluminal angioplasties with balloons. In selected cases and without prior dilatation of the stenosis it would be possible to place a stent. CASE REPORT: We describe a case of intracranial carotid stenting, without previous dilatation, in a 57 year old male patient with multiple arteriosclerotic risk factors. The patient presented neurological symptoms with no response to medical treatment, caused by a stenosis that affected over 70% of the cavernous segment of the right ICA, which was shown up by the arteriographic study. A favourable anatomy and the material used allowed the stent to pass through the stenosis without the need for dilatation. No immediate complications were observed and the carotid artery was seen to be of a normal calibre for stenosis. The brain angiogram also proved to be normal. The patient continues with the medical treatment and has remained neurologically stable throughout the 9 month clinical follow up. CONCLUSION: In certain selected cases, placing an intracranial carotid stent, without previous balloon dilatation, can give good results and prevent the complications that can accompany angioplasty (such as dissection, rupture or embolism)