title: Image-Guided Ablation of Malignant Liver Tumors: Recommendations for Clinical Validation of Novel Thermal and Non-Thermal Technologies - A Western Perspective.
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.
  
  
  CONCLUSIONS
  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.
  
  
  CONCLUSIONS
  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.affiliation: 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.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Lencioni
authors.affiliation: Department of Interventional Radiology, Institut Gustav-Roussy, Villejuif Cedex, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: de Baere
authors.affiliation: Division of Surgical Oncology, University of Louisville, Louisville, Ky., USA.
authors.forename: Robert C
authors.initials: RC
authors.lastname: Martin
authors.affiliation: Sky Ridge Medical Center, Lone Tree, Colo., USA.
authors.forename: Charles W
authors.initials: CW
authors.lastname: Nutting
authors.affiliation: Division of Vascular Interventional Radiology, University of Miami Miller School of Medicine, Miami, Fla., USA.
authors.forename: Govindarajan
authors.initials: G
authors.lastname: Narayanan
keywords: Cryoablation; Hepatocellular carcinoma; Irreversible electroporation; Microwave ablation; Radiofrequency ablation