Table 10

Liver-directed therapies: SIGN recommendations

Quality of evidences (SIGN)RecommendationStrength of recommendation
BPatients with liver-limited disease who are not candidates for radical surgery can benefit from a combination strategy with systemic therapy and RFA.69 Conditional for
D*Ablative techniques (RFA, MW, cryoablation) or external irradiation (SBRT, 3D CRT, IMRT) could be useful in selected oligometastatic liver disease unsuitable for surgery.Conditional for
D*Intrahepatic radioembolisation in combination with a systemic treatment can achieve liver disease control.Conditional for
D*Intrahepatic chemotherapy and TACE (ideally with DEBIRI) could represent a therapeutic option only for patients unsuitable for standard systemic treatment in
I, II and III line.
Conditional against
  • *Panel opinion.

  • CRT, confocal radiation therapy; DEBIRI, irinotecan-loaded drug-eluting beads; IMRT, intensity modulated radiotherapy; MW, micowaves; RFA, radiofrequency ablation; SBRT, stereotactic body radiation therapy; SIGN, Scottish Intercollegiate Guidelines Network; TACE, transcathether arterial chemoembolisation.