Chemoembolization Practice Patterns and Technical Methods Among Interventional Radiologists: Results of an Online Survey

OBJECTIVE. The objective of our study was to assess patterns of chemoembolization use; identify variations in application, technique, and follow-up; and recognize areas of practice conformity and divergence. MATERIALS AND METHODS. During August and September 2010, Society of Interventional Radiology (SIR) members with "chemoembolization expertise" were invited to participate in an anonymous online questionnaire. RESULTS. Two hundred sixty-eight of 1157 invited SIR members (23%) answered the 34-item survey. Respondents were predominantly male (93%) fellowship-trained full-time interventional radiologists (IRs) (87%) in practice for less than 15 years (69%) at community hospitals (61%) in the United States (91%). IRs (53%) most commonly drove therapeutic decision making. Most respondents (61%) performed 1-5 chemoembolizations per month and preferred drug-eluting beads to iodized oil for unifocal (46% vs 39%, respectively) and multifocal (40% vs 30%) hepatocellular carcinoma (HCC), although Y-90 radioembolization was favored when portal vein thrombosis was present (48% vs 28%). IRs showed variability in recognized procedure contraindications. Most respondents agreed on chemotherapeutic regimen but showed variable particle embolization use (17-45%) during oily chemoembolization. The 100- to 300-mu m (49%) LC Beads (AngioDynamics) (65%) were the favored drug-eluting beads. Lobar chemoembolization was preferred. Treatment endpoints lacked consensus, but substasis was most desirable (56%). Up to 19% of respondents performed outpatient chemoembolization. Concurrent percutaneous ablation was infrequently used (applied in 0-25% of cases by 61-91% of respondents). Most (up to 74%) IRs preferred CT follow-up with the decision for retreatment based on CT evidence of viable disease (93%). CONCLUSION. Variability in chemoembolization practice exists among IRs. Continued investigation of treatment strategies and devices is necessary to better optimize and standardize transcatheter therapies for liver tumors.