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Summary of Recommendations for Focal Tumour Ablation
 

These recommendations lay out the framework for serving the focal tumour ablation needs of patients in Ontario.  These recommendations were formed by consensus of the Focal Tumour Ablation Advisory Committee and are based on best available evidence, the current practice in Ontario, and guidance from other jurisdictions and experts in the field.  

To request a copy of Focal Tumour Ablation in Ontario: Recommendations Report 2015, send an email to SSOinfo@cancercare.on.ca .

Clinical Criteria  

  1. The Advisory Committee recommends that patients must meet specific clinical criteria to be considered eligible for treatment. (Specific criteria for decision making are described in Recommendations 2 through 5.)
  2. For liver tumour patients, the Advisory Committee recommends thermal ablation according to the following criteria:
    1. Radiofrequency ablation (RFA) is recommended for diagnosed hepatocellular carcinoma (HCC) in the following cases:
      1. For primary liver cancer, “very early stage” or “early stage” disease, according to the Barcelona Clinic Liver Cancer (BCLC) classification, and
      2. Where the patient is not a surgical candidate, and
      3. The size of the tumour is up to and including four centimetres, and
      4. The maximum number of tumours is three per presentation.
    2. RFA alone is not recommended when surgical resection is recommended.
    3. RFA is recommended for liver metastases of colorectal cancer in the following cases:
      1. Unresectable metastases, and
      2. The size of the tumour is up to an including four centimetres, and
      3. The maximum number of tumours is three per presentation, and
      4. No evidence of vascular invasion or unresectable extrahepatic spread.
      5. Intraoperative RFA for metastases of colorectal cancer may be used to treat a greater number of tumours if combined with surgical resection.
  3. For kidney tumour patients, the Advisory Committee recommends thermal ablation of the kidney according to the following criteria:
    1. RFA is recommended for renal cell carcinoma (RCC) in the following cases:
      1. Biopsy proven stage T1a N0 M0 RCC, in whom surgery or active surveillance is not recommended, and
      2. The size of the tumour is up to and including four centimetres, and
      3. The maximum number of tumours is three per presentation.
  4. For lung tumour patients, the Advisory Committee recommends thermal ablation under the following criteria:
    1. RFA for lung tumours in the following cases:
      1. Early-stage primary lung cancers, or
      2. Metastases, where surgery is contraindicated, and
      3. Unresectable tumour, and
      4. The size of the tumour is up to and including four centimetres, and
      5. The maximum number of tumours is three in both lungs, per presentation.
    2. RFA alone is not recommended for patients eligible for surgical resection.
  5. The Advisory Committee recommends transcatheter arterial chemoembolization (TACE) of the liver under the following criteria:
    (Note: TACE refers to both conventional transcatheter chemoembolization and drug eluting beads.)
    1. TACE is recommended for HCC in the following cases:
      1. Diagnosed “intermediate” stage HCC, using BCLC classification, and
      2. Unresectable/untransplantable HCC, and
      3. No major vascular invasion or extrahepatic spread.
    2. Follow-up imaging with contrast-enhanced CT or MRI is recommended at appropriate intervals, with consideration for repeat procedures as needed.
    3. TACE is not recommended where surgical resection or RFA is recommended.
  6. The Advisory Committee does not recommend microwave ablation for liver, kidney, and lung tumours at this time. Further evidence is needed.

Service Providers

  1. The Advisory Committee recommends that patients being considered for treatment with focal tumour ablation services should receive care under the oversight of a multidisciplinary care team and have their case reviewed at a multidisciplinary cancer conference (MCC), which includes a liver, kidney or thoracic surgeon as relevant to the case.
  2. The Advisory Committee recommends that centres providing focal tumour ablation services must meet, at a minimum, the following criteria for delivering services to ensure high quality care:
    1. Have the necessary infrastructure
      1. MCC in place to review cases (onsite or offsite), and
      2. Multidisciplinary care team, and
      3. Necessary capital equipment (e.g. CT scanner, ultrasound machine, etc.), and
      4. Space to support the treatment and recovery of patients.
    2. Perform sufficient volumes of treatment to maintain expertise.

System

  1. The Advisory Committee recommends that provincial oversight be established by CCO for the delivery of focal tumour ablation services in Ontario.
  2. The Advisory Committee recommends that centres providing focal tumour ablation services work together as part of a provincial program to ensure equitable and appropriate access to services for all patients in Ontario.
  3. The Advisory Committee recommends that appropriate funding be made available to support the delivery of equitable, accessible, and high quality services for all eligible patients in Ontario.
  4. The Advisory Committee recommends that hospitals report ambulatory focal tumour ablation services as part of the National Ambulatory Cancer Reporting System (NACRS). 
  5. The Advisory Committee recommends that appropriate program quality indicators be developed.
Last modified: Fri, Nov 13, 2015
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