Multimodality Management for Barcelona Clinic Liver Cancer Stage C Hepatocellular Carcinoma

Abstract

This review summarizes the contents of a workshop on multimodality management for Barcelona Clinic Liver Cancer (BCLC) stage C hepatocellular carcinoma (HCC) held on July 6, 2013, under the auspices of the 4th Asia-Pacific Primary Liver Cancer Expert Meeting Scientific Advisory Committee. BCLC stage C HCC represents a varied disease spectrum and, therefore, further stratification of BCLC stage C should be explored. Although sorafenib is currently the standard treatment for BCLC stage C HCC, the survival benefits are modest and new treatment strategies are still needed. Based on the opinions of Asian experts, there are numerous alternative options aside from sorafenib for the treatment of BCLC stage C HCC, including surgical resection, hepatic arterial infusion chemotherapy, transarterial chemoembolization, and external radiotherapy. Moreover, there are several studies on the multimodality management of BCLC stage C HCC, mainly in the form of retrospective studies and a few phase I and II trials. Multimodality management with combinations of various locoregional therapies or locoregional therapies with systemic targeted therapy using sorafenib needs to be actively investigated. The Asia-Pacific clinical practice guidelines on multimodality management for BCLC stage C HCC need recommendations based on the level of evidence, the strength of the data, and the strength of recommendations of previously reported systems.

Keywords: Advanced stage; Hepatocellular carcinoma; Multimodality management; Staging systems.

Fig. 1

Time course of localized concurrent intra-arterial chemotherapy plus external beam radiotherapy (CCRT) in patients with locally advanced hepatocellular carcinoma with portal vein tumor thrombus. Dx=diagnosis; AG=angiography; R15=indocyanine green R15; AFP=alpha-fetoprotein.

Fig. 2

(a) Initial dynamic CT scan of the liver in a 41year-old patient with inferior vena cava thrombus (IVC, black arrow). (b) Isodose lines encompassing both the primary hepatocellular carcinoma and IVC thrombus, a bold yellow line encompassed normal organ (“Liver”). This line defined the outline of the liver. (c) Follow-up dynamic CT liver scan after concurrent chemoradiotherapy followed by the eleventh cycle of HAIC showing clinical complete response (disappearance of the IVC thrombus and arterial enhancing portion). (d) Surgical specimen from right hepatectomy showing pathologic complete tumor necrosis.