1Centre de Recherche de L'Inflammation (CRI), Université Paris Cité, INSERM U1149, Paris, France. email@example.com.
2Department of Radiology, APHP Nord, Hôpital Beaujon, Clichy, France. firstname.lastname@example.org.
3FHU MOSAIC, APHP, Paris, France. email@example.com.
4Centre of Research in Epidemiology and Statistics (CRESS), Université Paris Cité, Inserm, INRAE, Paris, France. firstname.lastname@example.org.
5Institut Gustave Roussy, Villejuif, France.
6CHU Saint Eloi, Montpellier, France.
7Pisa University Hospital, Pisa, Italy.
8The Christie National Health Service Foundation Trust, Manchester, UK.
9Clínica Universidad de Navarra, Pamplona, Spain.
10CHU Angers, Angers, France.
11Yale University School of Medicine, New Haven, USA.
12Foundation IRCCS Istituto Nazionale Tumori, Milan, Italy.
13CHU Grenoble Alpes, Grenoble, France.
14CHU Vaudois, Lausanne, Switzerland.
15Centre Eugène Marquis, Rennes, France.
16CHU Pontchaillou, Rennes, France.
17Klinikum Bogenhausen, Munich, Germany.
18Singapore General Hospital, Singapore, Singapore.
19University Medical Center, Utrecht, Netherlands.
20Northwestern Memorial Hospital, Chicago, USA.
21Vancouver General Hospital, Vancouver, Canada.
22CHU François Mitterand, Dijon, France.
23Centre Leon Bérard, Lyon, France.
24Clínica Universidad de Navarra-CCUN and CIBEREHD, Pamplona, Spain.
25Stanford University, Stanford, USA.
26Centre de Recherche de L'Inflammation (CRI), Université Paris Cité, INSERM U1149, Paris, France.
27Department of Radiology, APHP Nord, Hôpital Beaujon, Clichy, France.
28Institut Jules Bordet-Université Libre de Bruxelles, Brussels, Belgium.
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.