title: Transarterial chemoembolisation in intermediate-stage hepatocellular carcinoma. Survey on clinical practice in hospitals in the Madrid Region.
abstract: BACKGROUND
  Transarterial chemoembolisation (TACE), having demonstrated survival benefits, is the treatmentof choice in intermediate-stage hepatocellular carcinoma, although there is great heterogeneity in its clinical application.
  
  
  METHODS
  A survey was sent to the Madrid Regional hospitals to assess applicability, indications and treatment protocols. The assessment was made overall and according to the type of hospital (groups A vs. B and C).
  
  
  RESULTS
  Seventeen out of 22 hospitals responded (8/8 group A, 9/ 14 group B-C). All do/indicate transarterial chemoembolisation, 13/17 at their own facilities. Eight of the 17 hospitals have multidisciplinary groups (5/8 A, 3/9 B-C). Nine hospitals perform > 20 procedures/year (7 group A), and 6 from group B-C request/perform < 10/year. It is performed on an "on-demand" basis in 12/17. In 5 hospitals, all the procedures use drug-eluting beads loaded with doxorubicin. The average number of procedures per patient is 2. The mean time from diagnosis of hepatocellular carcinoma to transarterial chemoembolisation is ≤ 2 months in 16 hospitals. In 11/17 hospitals, response is assessed by computed tomography. Radiological response is measured without specific criteria in 12/17 and the other five hospitals (4 group A) assessed using standardised criteria.
  
  
  CONCLUSIONS
  Uniformity among the Madrid Regional hospitals was found in the indication and treatment regimen. The use of DEB-TACE has become the preferred form of TACE in clinical practice. The differentiating factors for the more specialised hospitals are a larger volume of procedures, decision-making by multidisciplinary committees and assessment of radiological response more likely to be standardised.
authors: Department of Gastroenterology, Sección de Hepatología, Hospital General Universitario Gregorio Marañón, Madrid. Spain.
authors: Ana Matilla
authors: AM
authors: Peña
authors: Gastroenterology Unit, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain.
authors: Óscar
authors: Ó
authors: Núñez-Martínez
authors: Gastroenterology Unit, Hospital Universitario del Sureste, Arganda del Rey, Madrid, Spain.
authors: Antonio
authors: A
authors: Díaz-Sánchez
authors: Department of Gastroenterology, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
authors: Fernando
authors: F
authors: Pons-Renedo
authors: Department of Gastroenterology, Hospital Universitario de Getafe, Getafe, Madrid, Spain.
authors: Mariano
authors: M
authors: Gómez-Rubio
authors: Department of Gastroenterology, Fundación Jiménez Díaz, Madrid, Spain.
authors: Benjamín
authors: B
authors: Polo-Lorduy
authors: Department of Gastroenterology, Hospital Universitario Ramón y Cajal, Madrid, Spain.
authors: José L
authors: JL
authors: Lledó-Navarro
authors: Department of Gastroenterology, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
authors: María
authors: M
authors: Trapero-Marugán
authors: Department of Gastroenterology, Hospital Clínico San Carlos, Madrid, Spain.
authors: José María
authors: JM
authors: Ladero-Quesada
authors: Department of Gastroenterology, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain.
authors: Elvira
authors: E
authors: Poves-Martínez
authors: Gastroenterology Unit, Hospital Universitario del Henares, Coslada, Madrid, Spain.
authors: Alberto
authors: A
authors: Ibáñez-Pinto
authors: Department of Gastroenterology, Hospital Universitario 12 de Octubre, Madrid, Spain.
authors: Ana María
authors: AM
authors: Martín-Algívez
authors: Gastroenterology Unit, Hospital Universitario Infanta Leonor, Madrid, Spain.
authors: Mar
authors: M
authors: Lozano-Maya
authors: Department of Gastroenterology, Hospital Universitario de Móstoles, Móstoles, Madrid, Spain.
authors: Raquel
authors: R
authors: González-Alonso
authors: Department of Gastroenterology, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain.
authors: Belén
authors: B
authors: Piqueras-Alcol
authors: Department of Gastroenterology, Hospital Universitario de La Princesa, Madrid, Spain.
authors: Leticia
authors: L
authors: González-Moreno
authors: Department of Gastroenterology, Hospital Universitario Fundación de Alcorcón, Alcorcón, Madrid, Spain.
authors: Conrado
authors: C
authors: Fernández-Rodríguez
authors: Department of Gastroenterology, Hospital Universitario Severo Ochoa, Leganés, Madrid, Spain.
authors: Francisco
authors: F
authors: Gea-Rodríguez
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D016461:Chemoembolization, Therapeutic / Q000639:trends*; D019983:Guideline Adherence / Q000639:trends; D019538:Health Care Surveys; D006761:Hospitals / Q000639:trends*; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D009367:Neoplasm Staging; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000639:trends*; D013030:Spain; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome