The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on the use of radiofrequency ablation for hepatocellular carcinoma.
NICE has issued guidance on radiofrequency ablation for the treatment of colorectal metastases in the liver. NICE has also produced guidance on microwave ablation for hepatocellular carcinoma and for the treatment of metastases of the liver.
This is a minimally invasive treatment for liver tumours. Hepatocellular carcinoma (HCC) and metastasis from colorectal carcinoma are the two most common malignant tumours to affect the liver. The annual incidence of HCC is estimated to be at least one per million. Untreated HCC has a median survival of four to six months from the time of diagnosis.
Metastatic liver disease is frequently associated with primary colorectal carcinoma. Approximately 50% of colorectal cancer patients will develop recurrence within five years of initial diagnosis with the liver being the most common site for metastatic disease.
This procedure is a recently developed thermoablative technique that induces temperature changes by utilising high-frequency alternating current applied via an electrode(s) placed within the tissue to generate ionic agitation. The ionic agitation is generated in the areas surrounding the electrode tip as the ions attempt to change directions and follow the alternating current, thereby creating localised friction heat. The resultant frictional heating of tissue surrounding the electrode generates localised areas of coagulative necrosis and tissue desiccation.
The radiofrequency energy radiates from the individual electrodes into the adjacent tissue. The energy level and thus the heating effect dissipates rapidly at an increasing distance from the electrodes so that the highest temperature will always be at the points nearest to the electrodes. Radiofrequency ablation (RFA) can be applied percutaneously, laparoscopically or intraoperatively.
The majority of malignant liver tumours remain inoperable due to their number, distribution and/or the presence of residual disease. Therefore, a number of alternative therapies have been developed including hepatic artery infusion chemotherapy (HAIC), as well as non-resectional chemotherapy, percutaneous ethanol injection (PEI), cryoablation, microwave coagulation therapy (MCT), laserinduced thermotherapy, and radiofrequency ablation.
This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account, and specifically any special arrangements relating to the introduction of new interventional procedures. The guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.
Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties. Providers should ensure that governance structures are in place to review, authorise and monitor the introduction of new devices and procedures.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.