Defining textbook outcome for selective internal radiation therapy of hepatocellular carcinoma: an international expert study
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.
CITA DEL ARTÍCULO Eur J Nucl Med Mol Imaging. 2023 Feb;50(3):921-928. doi: 10.1007/s00259-022-06002-5. Epub 2022 Oct 25.