title: ACR Appropriateness Criteria Radiologic Management of Hepatic Malignancy.
abstract: Management of primary and secondary hepatic malignancy is a complex problem. Achieving optimal care for this challenging population often requires the involvement of multiple medical and surgical disciplines. Because of the wide variety of potential therapies, treatment protocols for various malignancies continue to evolve. Consequently, development of appropriate therapeutic algorithms necessitates consideration of medical options, such as systemic chemotherapy; surgical options, such as resection or transplantation; and loco-regional therapies, such as thermal ablation and transarterial embolization techniques. This article provides a review of treatment strategies for the three most common subtypes of hepatic malignancy treated with loco-regional therapies: hepatocellular carcinoma, neuroendocrine metastases, and colorectal metastases. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every three years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
authors.affiliation: Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina. Electronic address: bkouri@wakehealth.edu.
authors.forename: Brian E
authors.initials: BE
authors.lastname: Kouri
authors.affiliation: Rush University Medical Center, Chicago, Illinois.
authors.forename: Ross A
authors.initials: RA
authors.lastname: Abrams
authors.affiliation: Georgetown University Hospital, Washington, District of Columbia, American College of Surgeons.
authors.forename: Waddah B
authors.initials: WB
authors.lastname: Al-Refaie
authors.affiliation: Sidney Kimmel Cancer Center at Johns Hopkins University, Baltimore, Maryland, American Society of Clinical Oncology.
authors.forename: Nilofer
authors.initials: N
authors.lastname: Azad
authors.affiliation: Interventional Endoscopy and Pancreatic Diseases, New Haven, Connecticut, American Gastroenterological Association.
authors.forename: James
authors.initials: J
authors.lastname: Farrell
authors.affiliation: University of Illinois Hospital, Chicago, Illinois.
authors.forename: Ron C
authors.initials: RC
authors.lastname: Gaba
authors.affiliation: Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Debra A
authors.initials: DA
authors.lastname: Gervais
authors.affiliation: University of Colorado, Anschutz Medical Campus, Aurora, Colorado.
authors.forename: Matthew G
authors.initials: MG
authors.lastname: Gipson
authors.affiliation: Oregon Health and Science University, Portland, Oregon.
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Kolbeck
authors.affiliation: Riley Hospital for Children, Indianapolis, Indiana.
authors.forename: Francis E
authors.initials: FE
authors.lastname: Marshalleck
authors.affiliation: University of Wisconsin, Madison, Wisconsin.
authors.forename: Jason W
authors.initials: JW
authors.lastname: Pinchot
authors.affiliation: Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois.
authors.forename: William
authors.initials: W
authors.lastname: Small
authors.affiliation: University of Illinois Hospital and Health Science System, Chicago, Illinois.
authors.forename: Charles E
authors.initials: CE
authors.lastname: Ray
authors.affiliation: Froedtert & the Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Hohenwalter
mesh_terms: D016461:Chemoembolization, Therapeutic / Q000592:standards*; D059248:Chemoradiotherapy / Q000592:standards*; D019317:Evidence-Based Medicine; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000628:therapy*; D017410:Practice Guidelines as Topic; D011871:Radiology / Q000592:standards*; D012955:Societies, Medical; D016896:Treatment Outcome; D014481:United States
keywords: Appropriateness criteria; Liver malignancy; ablation; chemoembolization; embolization; radioembolization