Scientific publications

Defining textbook outcome for selective internal radiation therapy of hepatocellular carcinoma: an international expert study

Feb 1, 2023 | Magazine: European Journal of Nuclear Medicine and Molecular Imaging

Jules Gregory  1   2   3   4 , Lambros Tselikas  5 , Caroline Allimant  6 , Thierry de Baere  5 , Irene Bargellini  7 , Jon Bell  8 , José Ignacio Bilbao  9 , Antoine Bouvier  10 , Julius Chapiro  11 , Carlo Chiesa  12 , Thomas Decaens  13 , Alban Denys  14 , Rafael Duran  14 , Julien Edeline  15 , Etienne Garin  16 , Julien Ghelfi  13 , Thomas Helmberger  17 , Farah Irani  18 , Marnix Lam  19 , Robert Lewandowski  20 , David Liu  21 , Romaric Loffroy  22 , David C Madoff  11 , Charles Mastier  23 , Riad Salem  20 , Bruno Sangro  24 , Daniel Sze  25 , Valérie Vilgrain  26   27 , Michael Vouche  28 , Boris Guiu  6 , Maxime Ronot  26   27

Background: A textbook outcome (TO) is a composite indicator covering the entire intervention process in order to reflect the "ideal" intervention and be a surrogate for patient important outcomes. Selective internal radiation therapy (SIRT) is a complex multidisciplinary and multistep intervention facing the challenge of standardization. This expert opinion-based study aimed to define a TO for SIRT of hepatocellular carcinoma.

Methods: This study involved two steps: (1) the steering committee (4 interventional radiologists) first developed an extensive list of possible relevant items reflecting an optimal SIRT intervention based on a literature review and (2) then conducted an international and multidisciplinary survey which resulted in the final TO. This survey was online, from February to July 2021, and consisted three consecutive rounds with predefined settings. Experts were identified by contacting senior authors of randomized trials, large observational studies, or studies on quality improvement in SIRT. This study was strictly academic.

Results: A total of 50 items were included in the first round of the survey. A total of 29/40 experts (73%) responded, including 23 interventional radiologists (79%), three nuclear medicine physicians (10%), two hepatologists, and one oncologist, from 11 countries spanning three continents. The final TO consisted 11 parameters across six domains ("pre-intervention workup," "tumor targeting and dosimetry," "intervention," "post-90Y imaging," "length of hospital stay," and "complications"). Of these, all but one were applied in the institutions of > 80% of experts.

Conclusions: This multidimensional indicator is a comprehensive standardization tool, suitable for routine care, clinical round, and research.

CITATION  Eur J Nucl Med Mol Imaging. 2023 Feb;50(3):921-928. doi: 10.1007/s00259-022-06002-5. Epub 2022 Oct 25.

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