Defining textbook outcome for selective internal radiation therapy of hepatocellular carcinoma: an international expert study

Jules Gregory*, Lambros Tselikas, Caroline Allimant, Thierry de Baere, Irene Bargellini, Jon Bell, José Ignacio Bilbao, Antoine Bouvier, Julius Chapiro, Carlo Chiesa, Thomas Decaens, Alban Denys, Rafael Duran, Julien Edeline, Etienne Garin, Julien Ghelfi, Thomas Helmberger, Farah Irani, Marnix Lam, Robert LewandowskiDavid Liu, Romaric Loffroy, David C. Madoff, Charles Mastier, Riad Salem, Bruno Sangro, Daniel Sze, Valérie Vilgrain, Michael Vouche, Boris Guiu, Maxime Ronot

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)921-928
Number of pages8
JournalEuropean Journal of Nuclear Medicine and Molecular Imaging
Issue number3
StatePublished - Feb 2023


  • Complex intervention
  • Hepatocellular carcinoma
  • Selective internal radiation therapy
  • Standardization
  • Textbook outcome
  • Transarterial radioembolization

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging


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