Image-guided percutaneous laser ablation for primary and secondary liver tumours

NICE did a rapid review of the published literature on the efficacy and safety of this procedure. This comprised a comprehensive literature search and detailed review of the evidence from 13 sources, which was discussed by the committee. The evidence included 4 randomised controlled trials, 1 quasi-randomised controlled trial, 1 retrospective non-randomised comparative study, 1 case-control study, 5 cohort studies and 1 case report. It is presented in the summary of key evidence section in the interventional procedures overview. Other relevant literature is in the appendix of the overview.

The professional experts and the committee considered the key efficacy outcomes to be: complete tumour ablation, local tumour progression, local or distant recurrence, overall survival and disease-free survival.

The professional experts and the committee considered the key safety outcomes to be: mortality, bleeding, infection and damage to surrounding tissues.

Patient commentary was sought but none was received.

A clinical expert advised that this procedure could allow better control of the ablation area, but further evidence is needed to support this.

The procedure has evolved over time, including techniques to visualise the ablation area.

Multiple laser fibres can be used for each treatment session and the fibres can be moved.

Tumour ablation procedures are commonly done under general anaesthesia to prevent the person moving during treatment.

The committee was informed that a software planning system can be used to help with planning the size and location of ablation.

The committee noted that the quality of evidence was higher for hepatocellular carcinoma.