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    Interventional procedure overview of selective internal radiation therapy for neuroendocrine tumours that have metastasised to the liver

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    Outcome measures

    PEQs indicated that disease control and symptom control were the key aims of SIRT for this indication. Efficacy outcomes reported in the included studies were tumour response, symptom response, overall survival, progression-free survival and quality of life. Safety outcomes were mostly reported in terms of clinical toxicity. The standardised measures used across most studies are detailed in the following paragraphs.

    RECIST

    The RECIST criteria standardise the measurement of tumour response to treatment. Response is in terms of change in tumour size, measured on the length of selected lesions. Change in size is summarised into categorical outcomes: complete response, partial response, stable disease and disease progression. Further categorisation into objective response (the combined rates of complete and partial response) and disease control (the combined rates of complete and partial response and stable disease) can be used. There are several versions of this outcome measure (RECIST, mRECIST, RECIST v1.1). RECIST and RECIST v1.1 are most commonly used in studies measuring tumour response because they were developed earlier and are widely used across a range of tumour types. mRECIST was developed specifically to measure hypervascular liver metastases treated with locoregional therapy because it can account for tumour necrosis and the remaining proportion of 'viable tumour' rather than overall tumour size. Professional expert questionnaires indicated that mRECIST may better reflect mNET response to intravascular interventions.

    SF-36

    SF-36 is a 36-item, validated, patient-reported questionnaire that measures health-related quality of life. It has 8 domains: general health, physical functioning, bodily pain, role limitations attributable to physical health, mental health, vitality, social functioning, role limitations attributable to emotional health. Each domain score and the overall score can range from 0 to 100.

    CTCAE

    CTCAE is a standardised classification system and severity grading scale for adverse events in cancer therapy. Severity of clinical and laboratory toxicities are graded from 1 to 5. Grade 1 is low (mild) and grade 5 is high (death). Some studies did not distinguish clinical and laboratory toxicities; toxicity only summarised by grade. This has been reported in table 3.

    Clavien Dindo Scale

    The Clavien Dindo Scale is a classification system used for grading adverse events in surgical procedures. It is graded from 1 to 5. Grade 1 is mild and grade 5 is death.