Current trends in the treatment of hepatocellular carcinoma with transarterial embolization: a cross-sectional survey of techniques

Purpose: Despite being accepted as a mainstay of treatment for hepatocellular carcinoma (HCC), technical aspects of transarterial chemoembolization (TACE) continue to vary by reporting author, leading to heterogeneity in the literature and making meaningful comparisons between treatments difficult. The goal of this survey was to report international chemoembolization practices for the treatment of HCC in an effort to understand current treatment strategies as a first step towards technique standardization. Materials and methods: An anonymous 18-question online survey, evaluating technical aspects of their TACE practice, was distributed via email to practicing members of the five largest interventional radiology societies in Chinese and English. A total of 1160 responses were obtained from 62 countries. Responses were categorized according to region of practice and analyzed using Fisher’s exact test and chi-square test with Bonferroni correction as needed. Results: There were significant statistical differences between regions for nearly all questions. Doxorubicin was more commonly used among respondents from North America, Europe, and South Korea than Japan and China (p = 0.0001). For single and multiple HCCs, drug-eluting bead TACE was most popular in North America and Europe (p = 0.0001), while conventional TACE was most popular in Japan, Korea, and China (p = 0.0001). CT was the most commonly used modality for follow-up among all respondents, although MR was used more commonly in North America and in academic centers (p = 0.0001). Conclusion: This survey provides comprehensive information on and confirms the heterogeneous nature of current practice patterns in regard to TA(C)E for HCC. Key Points: • There is a lack of information regarding current practice patterns in the area of technical considerations when performing transarterial chemoembolization. • Type of transarterial chemoembolization utilized to treat hepatocellular carcinoma varies widely across geographical area. • Chemotherapeutic agents and embolic agents used to perform transarterial chemoembolization for the treatment of hepatocellular carcinoma vary widely across geographical areas.