ACR Appropriateness Criteria® Management of Liver Cancer: 2022 Update

Area of Science:

• Interventional Radiology
• Oncology
• Evidence-Based Medicine

Background:

• Hepatic malignancies present complex management challenges due to diverse primary/metastatic types and varied treatment modalities.
• Determining the optimal timing and selection of treatments is crucial for effective patient care in liver cancer.
• Interventional radiologists are central to delivering liver-directed therapies, including ablation and embolization techniques.

Framework:

• The ACR Appropriateness Criteria provide evidence-based guidelines for managing hepatic malignancies.
• Guidelines are developed and revised annually by multidisciplinary expert panels.
• Methodology includes systematic literature analysis and adaptation of principles like GRADE.

Implementation:

• This document outlines the appropriateness of various liver-directed treatments based on 9 clinical variants.
• Specific treatments discussed include percutaneous ablation, transarterial embolization (TAE), transarterial chemoembolization (TACE), and transarterial radioembolization (TARE).
• The RAND/UCLA Appropriateness Method guides the evaluation of procedures for specific clinical scenarios.

Implications:

• These guidelines aim to ensure the most appropriate care for patients with liver malignancies.
• The framework supports informed decision-making in complex oncological cases.
• Expert opinion serves as a primary evidence source when peer-reviewed literature is limited or inconclusive.