Riccardo Lencioni1, Thierry de Baere2, Robert C Martin3, Charles W Nutting4, Govindarajan Narayanan5. 1. Division of Diagnostic Imaging and Intervention, Pisa University School of Medicine, Pisa, Italy; Division of Vascular Interventional Radiology, University of Miami Miller School of Medicine, Miami, Fla., USA. 2. Department of Interventional Radiology, Institut Gustav-Roussy, Villejuif Cedex, France. 3. Division of Surgical Oncology, University of Louisville, Louisville, Ky., USA. 4. Sky Ridge Medical Center, Lone Tree, Colo., USA. 5. Division of Vascular Interventional Radiology, University of Miami Miller School of Medicine, Miami, Fla., USA.
Abstract
BACKGROUND: Image-guided ablation is used to treat patients with unresectable malignant hepatic tumors that are limited in number and size, especially hepatocellular carcinoma (HCC) and colorectal hepatic metastases. While radiofrequency ablation (RFA) has been the most popular technique, several alternate options for focal tissue destruction have recently attracted attention. These technologies appear to be able to overcome some specific limitations of RFA. Currently, there is no accepted algorithm for the use of the different techniques for image-guided ablation. SUMMARY: A panel of physicians practicing in North America or Europe met to develop a set of recommendations aimed at providing directions for clinical validation of energy-based, thermal and non-thermal image-guided ablation technologies in the treatment of malignant liver tumors. The recommendations were developed through a critical appraisal of potential advantages and disadvantages of each ablation technology, based on experimental findings and available data, as well as on critical considerations for their clinical validation in hepatic tumor treatment from a Western perspective. KEY MESSAGES: Significant variability appears to exist among the different equipment and devices within each type of technology. A comprehensive understanding of the data and a critical appraisal of the efficacy and safety profile of each ablation system is required. Clinical practice guidelines should include specific information of the recommended techniques and protocols instead of a generic indication of the technology.
BACKGROUND: Image-guided ablation is used to treat patients with unresectable malignant hepatic tumors that are limited in number and size, especially hepatocellular carcinoma (HCC) and colorectal hepatic metastases. While radiofrequency ablation (RFA) has been the most popular technique, several alternate options for focal tissue destruction have recently attracted attention. These technologies appear to be able to overcome some specific limitations of RFA. Currently, there is no accepted algorithm for the use of the different techniques for image-guided ablation. SUMMARY: A panel of physicians practicing in North America or Europe met to develop a set of recommendations aimed at providing directions for clinical validation of energy-based, thermal and non-thermal image-guided ablation technologies in the treatment of malignant liver tumors. The recommendations were developed through a critical appraisal of potential advantages and disadvantages of each ablation technology, based on experimental findings and available data, as well as on critical considerations for their clinical validation in hepatic tumor treatment from a Western perspective. KEY MESSAGES: Significant variability appears to exist among the different equipment and devices within each type of technology. A comprehensive understanding of the data and a critical appraisal of the efficacy and safety profile of each ablation system is required. Clinical practice guidelines should include specific information of the recommended techniques and protocols instead of a generic indication of the technology.
Authors: Xiaodong Wang; Constantinos T Sofocleous; Joseph P Erinjeri; Elena N Petre; Mithat Gonen; Kinh G Do; Karen T Brown; Anne M Covey; Lynn A Brody; William Alago; Raymond H Thornton; Nancy E Kemeny; Stephen B Solomon Journal: Cardiovasc Intervent Radiol Date: 2012-04-26 Impact factor: 2.740
Authors: Debra A Gervais; S Nahum Goldberg; Daniel B Brown; Michael C Soulen; Steven F Millward; Dheeraj K Rajan Journal: J Vasc Interv Radiol Date: 2009-07 Impact factor: 3.464
Authors: Ryan T Groeschl; Charles H C Pilgrim; Erin M Hanna; Kerri A Simo; Ryan Z Swan; David Sindram; John B Martinie; David A Iannitti; Mark Bloomston; Carl Schmidt; Hooman Khabiri; Lawrence A Shirley; Robert C G Martin; Susan Tsai; Kiran K Turaga; Kathleen K Christians; William S Rilling; T Clark Gamblin Journal: Ann Surg Date: 2014-06 Impact factor: 12.969
Authors: Mikhail T Silk; Thomas Wimmer; Kyungmouk S Lee; Govindarajan Srimathveeravalli; Karren T Brown; Peter T Kingham; Yuman Fong; Jeremy C Durack; Constantinos T Sofocleous; Stephen B Solomon Journal: J Vasc Interv Radiol Date: 2013-11-18 Impact factor: 3.464
Authors: Iwan Paolucci; Marius Schwalbe; Gian Andrea Prevost; Anja Lachenmayer; Daniel Candinas; Stefan Weber; Pascale Tinguely Journal: Surg Endosc Date: 2018-02-12 Impact factor: 4.584
Authors: L Cardarelli-Leite; A Hadjivassiliou; D Klass; J Chung; S G F Ho; H J Lim; P T W Kim; A Mujoomdar; D M Liu Journal: Curr Oncol Date: 2020-11-01 Impact factor: 3.677
Authors: Xifu Wang; Zhanliang Su; Tianchu Lyu; Matteo Figini; Daniel Procissi; Junjie Shangguan; Chong Sun; Bin Wang; Na Shang; Shanzhi Gu; Quanhong Ma; Andrew C Gordon; Kai Lin; Jian Wang; Robert J Lewandowski; Riad Salem; Vahid Yaghmai; Andrew C Larson; Zhuoli Zhang Journal: Radiology Date: 2017-12-12 Impact factor: 11.105