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Since ascites drainage in patients unsuitable for LT is a palliative procedure, it is best approached along principles of palliative care. The aim of this study was therefore to explore the feasibility, effectiveness, safety, and acceptability of home drainage of ascites with long-term abdominal drains (LTAD) in an Australian health care setting as a management pathway for RA. Patient characteristics N = 12 Age in years 71 (12) Male, n(%) 8 (67) Etiology Alcohol 4 MAFLD 6 Non-cirrhotic portal hypertension 2 Child Pugh Score 9 (1) Baseline creatinine 153 (91) End of study creatinine 175 (67) MELD at insertion 16 (9) End of study MELD 19 (5) Median duration of LTAD (days) 103 (87) Comorbidities Cardiac failure 3 Renal dysfunction 6 Ongoing alcohol use 1 Hyponatremia compromising diuretic therapy 2 Effectiveness The number of LVPs before and after LTAD is listed in Table S1. Notwithstanding the small numbers in this study, its strength lies in its prospective design with a well-planned care model involving both community nursing support and supervision by hospital staff.

Background Therapeutic options for early-stage hepatocellular carcinoma (HCC) in individual patients can be limited by tumor and location, liver dysfunction and comorbidities. Many patients with early-stage HCC do not receive curative-intent therapies. Stereotactic ablative body radiotherapy (SABR) has emerged as an effective, non-invasive HCC treatment option, however, randomized evidence for SABR in the first line setting is lacking. Methods Trans-Tasman Radiation Oncology Group (TROG) 21.07 SOCRATES-HCC is a phase II, prospective, randomised trial comparing SABR to other current standard of care therapies for patients with a solitary HCC ≤ 8 cm, ineligible for surgical resection or transplantation. The study is divided into 2 cohorts. Cohort 1 will compromise 118 patients with tumors ≤ 3 cm eligible for thermal ablation randomly assigned (1:1 ratio) to thermal ablation or SABR. Cohort 2 will comprise 100 patients with tumors > 3 cm up to 8 cm in size, or tumors ≤ 3 cm ineligible for thermal ablation, randomly assigned (1:1 ratio) to SABR or best other standard of care therapy including transarterial therapies. The primary objective is to determine whether SABR results in superior freedom from local progression (FFLP) at 2 years compared to thermal ablation in cohort 1 and compared to best standard of care therapy in cohort 2. Secondary endpoints include progression free survival, overall survival, adverse events, patient reported outcomes and health economic analyses. Discussion The SOCRATES-HCC study will provide the first randomized, multicentre evaluation of the efficacy, safety and cost effectiveness of SABR versus other standard of care therapies in the first line treatment of unresectable, early-stage HCC. It is a broad, multicentre collaboration between hepatology, interventional radiology and radiation oncology groups around Australia, coordinated by TROG Cancer Research. Trial registration anzctr.org.au, ACTRN12621001444875, registered 21 October 2021.