Diagnostic and Interventional Radiology
Interventional Radiology - Original Article

The position of transarterial chemoembolization with drug-eluting beads and yttrium-90 transarterial radioembolization in patients with hepatocellular carcinoma: Consensus statements from a Delphi-method expert panel in Turkey

1.

From the Department of Gastroenterology, Ege University Faculty of Medicine, İzmir, Turkey

2.

Department of Radiology, Ege University Faculty of Medicine, İzmir, Turkey

3.

Department of Radiology Ankara University Medical School, Ankara, Turkey

4.

Department of Radiology, Ankara University Faculty of Medicine, Ankara, Turkey

5.

Department of Nuclear Medicine , Ankara University Faculty of Medicine, Ankara, Turkey

6.

Department of Radiology, İstanbul University Cerrahpasa Faculty of Medicine, İstanbul

7.

Department of Gastroenterology and Hepatology, Memorial Şişli Hastanesi, İstanbul, Turkey

8.

Department of Oncology, Acibadem Maslak Hospital, İstanbul, Turkey

9.

Department of Radiology, Gazi University School of Medicine, Ankara, Turkey

10.

Department of Nuclear Medicine, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey

11.

Department of Nuclear Medicine ,İstanbul University Cerrahpasa Faculty of Medicine, İstanbul

12.

Department of Radiology, Ege University School of Medicine, İzmir, Turkey

Diagn Interv Radiol 2021; 27: 732-739
DOI: 10.5152/dir.2021.201089
Read: 83 Downloads: 34 Published: 01 November 2021

PURPOSE:Clinical studies conducted in different geographic regions using different methods to compare transarterial chemoembolization (TACE) and transarterial radioembolization (TARE) have demonstrated discordant results. Meta-analyses in this field indicate comparable overall survival (OS) with TACE and TARE, while reporting a longer time to progression and a higher downstaging effect with TARE treatment.  In terms of isolated procedure costs, treatment with TARE is 2 to 3 times more, and in some countries even more, expensive than TACE. However, relevant literature indicates that TARE is more advantageous compared to TACE regarding the need for repeat procedures, costs of complication management, total hospital stay and quality of life.  Heterogeneity of hepatocellular carcinoma (HCC) patients as well as the shortcomings of clinical classifications, randomized clinical trials and cost-effectiveness studies make it difficult to choose between treatment alternatives in this field. As in other countries, these challenges lead to differences in treatment choice across different centers in Turkey.

METHODS:The present expert panel used two round modified Delphi method to investigate the resources and clinical parameters referenced while selecting patients for drug-eluting beads (DEB)-TACE and TARE treatment modalities in Turkish clinical practice. The cost-effectiveness parameters and comparisons of these treatments have also been evaluated at a prediction level.

RESULTS:The panelists stated that they most commonly use the BCLC staging system for the management of HCC patients in Turkey. However, they did not find any of the staging systems or treatment guidelines sufficient enough for their clinical practice in terms of covering the down-staging intent of treatments. Since living donor transplant preference is higher in Turkey than the rest of the Western countries,  down-staging treatments are thought to be more prioritized in Turkey than that in other Western countries. The panelists reached a consensus that TARE may provide improved OS and reduce the number of repeat procedures compared to DEB-TACE in intermediate-stage patients with a single tumor spanning a diameter above 5 cm who experience recurrence after previous treatment with TACE and most TACE-naïve patient groups in intermediate stage.

CONCLUSION:Based on the consensus on OS and the number of procedures, the panelists assumed that TARE would be more cost-effective than DEB-TACE in most groups of TACE-naïve patients in intermediate stage and in those with a single tumor spanning a diameter above 5 cm. It was also stated that the predicted cost-effectiveness advantage of TARE could be more pronounced in patients with a tumor diameter greater than 7 cm.

You may cite this article as: Akarca US, Akhan O, Bilgiç S, et al. The position of transarterial chemoembolization with drug-eluting beads and yttrium-90 transarterial radioembolization in patients with hepatocellular carcinoma: Consensus statements from a Delphi-method expert panel in Turkey. Diagn Interv Radiol 2021; 27:732–739

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