Taiwan Academy of Tumor Ablation (TATA) consensus on hepatocellular carcinoma ablation

Hepatocellular carcinoma (HCC) ranks sixth in incidence and third in mortality worldwide, underscoring its public health burden. Ablation therapy is one of the curative treatments for early-stage HCC. With recent advances in systemic therapy, combining ablation with other modalities has demonstrated improved outcomes and has extended applicability to selected patients with intermediate and advanced disease. In parallel, ablation technologies have advanced considerably. The introduction of next-generation microwave devices, multi-needle systems, and high-power generators has enabled the creation of larger and more predictable ablation zones. Non-thermal modalities have expanded treatment options for tumors located near bile ducts or major vessels, where thermal injury risk is high. Additionally, automatic fusion imaging has improved detection and targeting of inconspicuous or small lesions, thereby enhancing precision and safety. These developments highlight the need for updated treatment guidelines that reflect contemporary clinical practice. The guideline described herein, initiated by the Taiwan Academy of Tumor Ablation, was developed through collaboration among hepatology, surgery, radiology, and oncology experts. The process followed principles of evidence-based medicine and employed the Delphi method to reach consensus. In phase one, a systematic literature review and expert surveys informed preliminary recommendations, which were refined through online discussions. In phase two, structured voting with statistical analysis was performed to assess the consistency and strength of agreement. The final guideline provides detailed, evidence-based recommendations with explanatory notes. It incorporates emerging technologies, reflects recent clinical advances, and anticipates future trends, including the integration of artificial intelligence and automation into HCC ablation therapy.