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HCC Guidelines 2011. NCCN guidelines. Clinical presentation. Surveillance. Treatment. Imaging every 3–6 months for 2 years, then annually AFP, if initially elevated, every 3 months for 2 years, then every 6 months. Transplant candidate. Transplant.
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NCCN guidelines Clinical presentation Surveillance Treatment • Imaging every 3–6 months for 2 years, then annually • AFP, if initially elevated, every 3 months for 2 years, then every 6 months Transplantcandidate Transplant Evaluate whether patient is a candidate for transplant (See UNOS criteria under Surgical Assessment HCC-4)b • Inadequate hepatic reserve • Tumor location • Options: • Sorafenib(Child–Pugh Class A [category 1] or B) • Chemotherapy + RT only in the context of a clinical trial • Clinical trial • Locoregional therapy • RT (conformal or stereotactic) (category 2B) • Supportive care • Systemic or intra-arterial chemotherapy in clinical trial Not a transplant candidate Unresectable Extensive liver disease • Options: • Sorafenib(Child–Pugh Class A [category 1] or B) • Clinical trial • Locoregional therapy • RT (conformal or stereotactic) (category 2B) • Supportive care Inoperable by perfomance status or comorbidity, local disease only • Sorafenib(Child–Pugh Class A [category 1] or B) • Supportive care • Clinical trial Metastatic disease NCCN Clinical Practice Guidelines in Oncology. Hepatobiliary Cancer. V2.2010; Available from: www.nccn.org.
APASL guidelines HCC Confined to the liver Main portal vein patent Extrahepatic metastasis Main portal vein tumor thrombus Resectable Child–Pugh A/B Child–Pugh C Sorafenib or systemic therapy trial Yes No Solitary tumor < 5 cm < 3 tumors < 3 cm No venous invasion Tumor > 5 cm > 3 tumors Invasion of hepatic / portal vein branches Resection/RFA (for < 3 cm HCC) Child–Pugh A Child–Pugh B Child–Pugh C Child–Pugh A/B Child–Pugh C Local ablation Transplantation TACE Supportive care APASL recommendations on HCC, Omata M, et al. Hepatol Int. 2010;4:439–474
AASLD guidelines HCC Stage 0PST 0, Child–Pugh A Stage A–CPST 0–2, Child–Pugh A–B Stage DPST > 2, Child–Pugh C Very early stage (0) 1 HCC < 2 cmCarcinoma in situ Early stage (A) 1 HCC or 3 nodules< 3 cm, PST 0 Intermediate stage (B) Multinodular,PST 0 Advanced stage (C) Portal invasion, N1, M1, PST 1–2 End stage (D) 1 HCC 3 nodules ≤ 3 cm Portal pressure/bilirubin Increased Associated diseases Normal No Yes Symptomatictreatment (20%) Survival < 3 months Resection Liver transplantation PEI/RFA TACE Sorafenib Curative treatments (30%) 5-year survival (40–70%) Palliative treatments (50%) Median survival 11–20 months Adapted from Bruix J, Sherman M. Hepatology. In press 2010. Available from http://www.aasld.org. Last accessed September 2010.Llovet JM, et al. J Natl Cancer Inst. 2008;100:698-711.
BCLC guidelines HCC Stage 0PST 0, Child–Pugh A Stage A–CPST 0–2, Child–Pugh A–B Stage DPST > 2, Child–Pugh C Very early stage (0) 1 HCC < 2 cmCarcinoma in situ Early stage (A) 1 HCC or 3 nodules< 3 cm, PST 0 Intermediate stage (B) Multinodular,PST 0 Advanced stage (C) Portal invasion, N1, M1, PST 1–2 End stage (D) 1 HCC 3 nodules ≤ 3 cm Portal pressure/bilirubin Increased Associated diseases Normal No Yes Symptomatictreatment (20%) Survival < 3 months Resection Liver transplantation PEI/RFA TACE Sorafenib Curative treatments (30%) 5-year survival (40–70%) Palliative treatments (50%) Median survival 11–20 months Adapted from Bruix J, Sherman M. Hepatology. In press 2010. Available from http://www.aasld.org. Last accessed September 2010.Llovet JM, et al. J Natl Cancer Inst. 2008;100:698-711.
