Transarterial Chemoembolization – Status Quo in Germany

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

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