Original article
Clinical practice management
ACR Appropriateness Criteria Radiologic Management of Hepatic Malignancy

https://doi.org/10.1016/j.jacr.2015.12.001Get rights and content

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.

Section snippets

Introduction/Background

Management of hepatic malignancy remains a challenging problem. Depending on the clinical scenario, traditional therapies, such as resection, systemic chemotherapy, and external beam radiation are either unavailable or ineffective. To help address this issue, several treatment techniques have been developed by interventional radiologists to treat hepatic malignancies. These treatments include direct tumor ablation via chemical or thermal means, and endovascular techniques, such as embolization,

Summary of Recommendations

  • Management of primary and secondary hepatic malignancy remains a complex issue due to the multitude of treatment options. For this reason, a multidisciplinary approach offers the best hope for optimal treatment with respect to any individual patient.

  • Resection and transplantation remain the best options for cure in properly selected patients for primary malignancy as well as secondary malignancy in some limited scenarios; however, the role of RFA and potentially SBRT as primary treatment options

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  • Cited by (0)

    The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through society representation on expert panels. Participation by representatives from collaborating societies on the expert panel does not necessarily imply individual or society endorsement of the final document.

    Reprint Requests: [email protected].

    The authors have no conflicts of interest related to the material discussed in this article.

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