Professional Statements and Societal Positions Guidelines
National Institute for Health and Care Excellence (NICE) 2016
Microwave ablation for treating liver metastases recommendations:
- Current evidence on microwave ablation for treating liver metastases raises no major safety concerns and the evidence on efficacy is adequate in terms of tumor ablation. Therefore this procedure may be used provided that standard arrangements are in place for clinical governance, consent and audit.
National Comprehensive Cancer Network (NCCN) 2023
I.
General Principles
- All individuals with HCC should be evaluated for potential curative therapies (resection, transplantation, and for small lesions, ablative strategies).
Locoregional therapy should be considered in individuals who are not candidates for surgical curative treatments, or as a part of a strategy to bridge individuals for other curative therapies. These are broadly categorized into ablation, arterially directed therapies, and radiotherapy.
II.
Treatment Information
A.
Ablation (radiofrequency, cryoablation, percutaneous alcohol injection, microwave):
- All tumors should be amenable to ablation such that the tumor and, in the case of thermal ablation, a margin of normal tissue is treated.
A margin is not expected following percutaneous ethanol injection.
- Tumors should be in a location accessible for percutaneous/laparoscopic/open approaches for ablation.
- Caution should be exercised when ablating lesions near major vessels, major bile ducts, diaphragm, and other intra-abdominal organs.
- Ablation alone may be curative in treating tumors less than or equal to three (3) cm. In well-selected individuals with small properly located tumors, ablation should be considered as definitive treatment in the context of a multidisciplinary review. Lesions three (3) to five (5) cm may be treated to prolong survival using arterially directed therapies, or with combination of an arterially directed therapy and ablation as long as tumor location is accessible for ablation.
- Unresectable/inoperable lesions greater than five (5) cm should be considered for treatment using arterially directed therapy, systemic therapy, or RT. 4-6.
- Currently, no adjuvant therapies have been shown to have added value post-ablation.
