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Review
. 2016 Apr;3(2):119-136.
doi: 10.2217/hep-2015-0006. Epub 2016 Mar 23.

Comparative analysis of current guidelines for the treatment of hepatocellular carcinoma

Francesco Tovoli  1 , Giulia Negrini  1 , Luigi Bolondi  1
Affiliations
Review

Comparative analysis of current guidelines for the treatment of hepatocellular carcinoma

Francesco Tovoli et al. Hepat Oncol. 2016 Apr.

Abstract

Hepatocellular carcinoma is one of the most common malignancies and represents a unique challenge for physicians and patients. Treatment patterns are not uniform between areas despite efforts to promote a common protocol. Even if most hepatologists worldwide adopt the Barcelona Clinic Liver Cancer staging system, Asian and North American physicians are also independently making an effort to expand the indications of each treatment, combining therapies for better outcomes. Also, new therapeutic techniques have emerged and an increasing number of studies are trying to include these paradigm shifts into newer treatment guidelines. Controversial and diverging points in the current international guidelines are emphasized and discussed. Unanswered questions are also analyzed to identify the most needed and promising future perspectives.

Keywords: chemoembolization; hepatocellular carcinoma; thermal ablation.

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Conflict of interest statement

Financial & competing interests disclosure L Bolondi in the last 2 years has received honoraria for lectures and/or participation to advisory boards by the following companies: Bayer, Bristol Myers Squibb, Syrtex, MSD. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. No writing assistance was utilized in the production of this manuscript.

Figures

<b>Figure 1.</b>
Figure 1.. The 2010 Barcelona Clinic for Liver Cancer algorithm for the treatment of hepatocellular carcinoma.
BSC: Best supportive care; HCC: Hepatocellular carcinoma; OS: Overall survival; PEI: Percutaneous ethanol injection; PS: Performance status; RFA: Radiofrequency ablation; TACE: Transarterial chemoembolization. Reproduced with permission from [15].
<b>Figure 2.</b>
Figure 2.. The 2010 Asian-Pacific Association for the Study of the Liver guidelines for the treatment of hepatocellular carcinoma.
HCC: Hepatocellular carcinoma; RFA: Radio-frequency ablation; TACE: transarterial chemoembolisation. Reproduced with permission from [20].
<b>Figure 3.</b>
Figure 3.. Proposed substaging and treatment indications for patients at first observation with intermediate hepatocellular carcinoma.
†With severe/refractory ascites and/or jaundice. ‡Only if up to 7 IN and PS 0. BCLC: Barcelona Clinic for Liver Cancer; BSC: Best supportive care; CP: Child-Pugh; ECOG PS: Eastern Cooperative Oncology Group; LT: Liver transplantation; PS: Performance status; PVT: Portal vein thrombosis; SOR: Sorafenib; TACE: Transarterial chemoembolization; TARE: Transarterial radioembolization. Reproduced with permission from [101].
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