Outpatient Versus Inpatient Care Pathway for Intra-arterial Treatment of Primary Liver Cancer (CHOC)

Summary

Randomized multicentre trial comparing two care organisations (ambulatory vs conventional inpatient) for patients undergoing transarterial chemoembolization (TACE) or radioembolization (TARE) for primary liver cancer (Hepato Cellular Carcinoma (HCC) or intrahepatic cholangiocarcinoma (iCCA)). Patients are followed for 7 months to assess patient satisfaction, safety and clinical outcomes. A qualitative implementation study and a medico-economic evaluation (cost analysis and 5-years budget impact analysis) are embedded to assess acceptability, adoption, feasability, and sustainability and to inform scaling.

Eligibility

Inclusion Criteria:

* Age ≥ 18 years
* HCC or iCCA diagnosed according to the criteria of the European Association for the Study of the Liver (2024) or histologically proven.
* Patient with HCC or iCCA eligible for intra-arterial treatment (transarterial chemoembolization \[TACE\] or transarterial radioembolization \[TARE\]), with no prior intra-arterial treatment of the same type as the one planned in the trial:

  * no prior TACE for patients included for TACE;
  * no prior TARE for patients included for TARE. Prior intra-arterial treatment of the other type is allowed (prior TACE before TARE, or prior TARE before TACE). Prior non-intra-arterial treatments are allowed.
* If TACE is proposed at the multidisciplinary tumour board (RCP):

  * Patient Child-Pugh \< B8
  * Single or multiple HCC
  * Absence of lobar or truncal portal obstruction
  * Absence of bile duct dilatation
* If treatment by TARE proposed in RCP:

  * Absence of truncal portal tumor invasion
  * Uni-lobar tumor invasion (except for centrohepatic iCCA)
  * Total bilirubin \< 20 mg/l (or 35 µmol/L)
* Patient affiliated to or benefiting from a social security scheme
* Patient having signed an informed consent form

Exclusion Criteria:

* Technical contraindication or morphological elements of predictable technical difficulty
* Planned combined same-day therapeutic strategies at the index procedure (e.g., TACE combined with percutaneous ablation) are not allowed; sequential (non-same-day) treatments are allowed.
* Chronic renal insufficiency (Clairance \< 30 ml/min)
* Known allergy to a contrast agent or chemotherapy agent
* inability to participate in ambulatory care (inability to understand and follow discharge instructions, lack of reliable telephone access, absence of a responsible accompanying adult for the first night after discharge, or inability to access urgent care in a timely manner if symptoms occur)
* Patient previously included in the study
* Patient who, for psychological, social, family or geographical reasons, could not be regularly monitored, patient who, for psychological, social, family or geographical reasons, could not be followed regularly
* Concomitant disease or severe uncontrolled clinical situation
* Severe uncontrolled infection
* Pregnant, breast-feeding or parturient woman
* Person deprived of liberty by judicial or administrative decision
* Person under compulsory psychiatric care
* Person under a legal protection measure
* Person unable to give consent

Conditions5

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