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

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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.

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  1. European Association for the Study of the Liver, European Organisation for Research, Treatment of Cancer (2012) EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol 56(4):908–943

    Google Scholar 

  2. Massarweh NN, Park JO, Farjah F et al (2010) Trends in the utilization and impact of radiofrequency ablation for hepatocellular carcinoma. J Am Coll Surg 210(4):441–448

    Article  PubMed  PubMed Central  Google Scholar 

  3. Lo CM, Ngan H, Tso WK et al (2002) Randomized controlled trial of transarterial lipiodol chemoembolization for unresectable hepatocellular carcinoma. Hepatology 35:1164–1171

    Article  CAS  PubMed  Google Scholar 

  4. Llovet JM, Real MI, Montaña X, Barcelona Liver Cancer Group et al (2002) Arterial embolisation or chemoembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomised controlled trial. Lancet 359:1734–1739

    Article  PubMed  Google Scholar 

  5. Raoul JL, Sangro B, Forner A et al (2011) Evolving strategies for the management of intermediate-stage hepatocellular carcinoma: available evidence and expert opinion on the use of transarterial chemoembolization. Cancer Treat Rev 37(3):212–220

    Article  PubMed  Google Scholar 

  6. Lammer J, Malagari K, Vogl T, PRECISION V Investigators et al (2010) Prospective randomized study of doxorubicin-eluting-bead embolization in the treatment of hepatocellular carcinoma: results of the PRECISION V study. Cardiovasc Intervent Radiol 33:41–52

    Article  PubMed  PubMed Central  Google Scholar 

  7. Sangro B, Iñarrairaegui M, Bilbao JI (2012) Radioembolization for hepatocellular carcinoma. J Hepatol 56(2):464–473

    Article  PubMed  Google Scholar 

  8. Forner A, Reig ME, de Lope CR, Bruix J (2010) Current strategy for staging and treatment: the BCLC update and future prospects. Semin Liver Dis 30:61–74

    Article  CAS  PubMed  Google Scholar 

  9. (1998) A new prognostic system for hepatocellular carcinoma: a retrospective study of 435 patients: the Cancer of the Liver Italian Program (CLIP) investigators. Hepatology 28(3): 751–755

  10. Vauthey JN, Lauwers GY, Esnaola NF et al (2002) Simplified staging for hepatocellular carcinoma. J Clin Oncol 20(6):1527–1536

    Article  PubMed  Google Scholar 

  11. Asch DA, Jedrziewski MK, Christakis NA (1997) Response rates to mail surveys published in medical journals. J Clin Epidemiol 50(10):1129–1136

    Article  CAS  PubMed  Google Scholar 

  12. Varela M, Reig M, de la Mata M et al (2010) Treatment approach of hepatocellular carcinoma in Spain. Analysis of 705 patients from 62 centers. Med Clin 134(13):569–576

    Article  Google Scholar 

  13. Bargellini I, Sacco R, Bozzi E et al (2012) Transarterial chemoembolization in very early and early-stage hepatocellular carcinoma patients excluded from curative treatment: a prospective cohort study. Eur J Radiol 81(6):1173–1178

    Article  PubMed  Google Scholar 

  14. Majno P, Lencioni R, Mornex F, Girard N, Poon RT, Cherqui D (2011) Is the treatment of hepatocellular carcinoma on the waiting list necessary? Liver Transplant 17(Suppl 2):S98–S108

    Article  Google Scholar 

  15. Kim BK, Kim SU, Park JY et al (2012) Applicability of BCLC stage for prognostic stratification in comparison with other staging systems: single centre experience from long-term clinical outcomes of 1717 treatment-naïve patients with hepatocellular carcinoma. Liver Int 32(7):1120–1127

    Article  CAS  PubMed  Google Scholar 

  16. Pinter M, Hucke F, Graziadei I et al (2012) Advanced-stage hepatocellular carcinoma: transarterial chemoembolization versus sorafenib. Radiology 263(2):590–599

    Article  PubMed  Google Scholar 

  17. Marelli L, Stigliano R, Triantos C et al (2007) Transarterial therapy for hepatocellular carcinoma: which technique is more effective? A systematic review of cohort and randomized studies. Cardiovasc Interv Radiol 30(1):6–25

    Article  Google Scholar 

  18. Gaba RC (2012) Chemoembolization practice patterns and technical methods among interventional radiologists: results of an online survey. AJR Am J Roentgenol 198(3):692–699

    Article  PubMed  Google Scholar 

  19. Bartolozzi C, Lencioni R, Caramella D et al (1995) Treatment of large HCC: transcatheter arterial chemoembolization combined with percutaneous ethanol injection versus repeated transcatheter arterial chemoembolization. Radiology 197(3):812–818

    CAS  PubMed  Google Scholar 

  20. Veltri A, Moretto P, Doriguzzi A, Pagano E, Carrara G, Gandini G (2006) Radiofrequency thermal ablation (RFA) after transarterial chemoembolization (TACE) as a combined therapy for unresectable non-early hepatocellular carcinoma (HCC). Eur Radiol 16(3):661–669

    Article  PubMed  Google Scholar 

  21. Lencioni R, Crocetti L, Petruzzi P et al (2008) Doxorubicin-eluting bead-enhanced radiofrequency ablation of hepatocellular carcinoma: a pilot clinical study. J Hepatol 49(2):217–222

    Article  CAS  PubMed  Google Scholar 

  22. Kim JH, Won HJ, Shin YM et al (2011) Medium-sized (3.1–5.0 cm) hepatocellular carcinoma: transarterial chemoembolization plus radiofrequency ablation versus radiofrequency ablation alone. Ann Surg Oncol 18(6):1624–1629

    Article  PubMed  Google Scholar 

  23. Kudo M, Imanaka K, Chida N et al (2011) Phase III study of sorafenib after transarterial chemoembolisation in Japanese and Korean patients with unresectable hepatocellular carcinoma. Eur J Cancer 47(14):2117–2127

    Article  CAS  PubMed  Google Scholar 

  24. Sieghart W, Pinter M, Reisegger M et al (2012) Conventional transarterial chemoembolisation in combination with sorafenib for patients with hepatocellular carcinoma: a pilot study. Eur Radiol 22(6):1214–1223

    Article  PubMed  Google Scholar 

  25. Lencioni R (2012) Chemoembolization for hepatocellular carcinoma. Semin Oncol 39(4):503–509

    Article  CAS  PubMed  Google Scholar 

  26. Salem R, Lewandowski RJ, Mulcahy MF et al (2010) Radioembolization for hepatocellular carcinoma using Yttrium-90 microspheres: a comprehensive report of long-term outcomes. Gastroenterology 138(1):52–64

    Article  CAS  PubMed  Google Scholar 

  27. Sangro B, Carpanese L, Cianni R, European Network on Radioembolization with Yttrium-90 Resin Microspheres (ENRY) et al (2011) Survival after yttrium-90 resin microsphere radioembolization of hepatocellular carcinoma across Barcelona clinic liver cancer stages: a European evaluation. Hepatology 54(3):868–878

    Article  PubMed  Google Scholar 

  28. Mazzaferro V, Sposito C, Bhoori S et al (2013) Yttrium(90) radioembolization for intermediate-advanced hepatocarcinoma: a phase II study. Hepatology 57(5):1826–1837

    Article  CAS  PubMed  Google Scholar 

  29. Powerski MJ, Scheurig-Münkler C, Banzer J, Schnapauff D, Hamm B, Gebauer B (2012) Clinical practice in radioembolization of hepatic malignancies: a survey among interventional centers in Europe. Eur J Radiol 81(7):e804–e811

    Article  PubMed  Google Scholar 

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The authors declare that they have no conflicts of interest.

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Correspondence to Irene Bargellini.

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This study was conducted on behalf of the Italian Society of Interventional Radiology.

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Bargellini, I., Florio, F., Golfieri, R. et al. Trends in Utilization of Transarterial Treatments for Hepatocellular Carcinoma: Results of a Survey by the Italian Society of Interventional Radiology. Cardiovasc Intervent Radiol 37, 438–444 (2014).

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