Trends in Utilization of Transarterial Treatments for Hepatocellular Carcinoma: Results of a Survey by the Italian Society of Interventional Radiology

This study was designed to provide an overview of the practice of locoregional treatments for HCC by the Italian centers of Interventional Radiology (IR) with particular reference to transarterial modalities. A questionnaire of 11 questions on locoregional treatment of HCC was e-mailed to 134 Italian IR centers. The response rate was 64.9 % (87/135 centers). Of 8,959 procedures in 2011, 67 % were transarterial treatments, 31 % percutaneous ablations, and 2 % Y90-radioembolizations. Regarding (chemo)embolization, approximately 59 % of procedures were performed in the intermediate stage, 28 % in the early stage, and 12.8 % in the advanced stage. TACE techniques varied greatly; approximately 52 % of procedures were performed with drug-eluting particles and 32 % with lipiodol, drug, and reabsorbable particles. In selected cases, 53 of 78 (68 %) centers combine chemoembolization and ablation, whereas 28 centers (35.9 %) combine Sorafenib and chemoembolization. In 2011, 13 of 78 (16.7 %) responding centers performed Y90-radioembolization, with approximately 52 % of procedures performed in the advanced stage and 46 % in the intermediate stage. Approximately 62 % of Y90-radioembolizations were performed using resin spheres and 38 % using glass spheres. With almost 9,000 procedures performed each year, locoregional treatments of HCC, most of all transarterial (chemo)embolizations, represent a major part of daily clinical practice in many Italian IR centers. The high variability in responses regarding transarterial treatments for HCC patients highlights the need for solid scientific evidence allowing better definition of clinical indications and standardization of technical approaches.