Management of primary hepatic malignancies during the COVID-19 pandemic: recommendations for risk mitigation from a multidisciplinary perspective

Aisling Barry¹, Smith Apisarnthanarax², Grainne M O'Kane³, Gonzalo Sapisochin⁴, Robert Beecroft⁵, Riad Salem⁶, Sang Min Yoon⁷, Young-Suk Lim⁸, John Bridgewater⁹, Brian Davidson¹⁰, Marta Scorsetti¹¹, Luigi Solbiati¹², Adam Diehl¹³, Pablo Munoz Schuffenegger¹⁴, Jonathan G Sham¹⁵, David Cavallucci¹⁶, Zita Galvin¹⁷, Laura A Dawson¹⁸, Maria A Hawkins¹⁹

Affiliations

¹ Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada; Radiation Medicine Program, Toronto General Hospital, University Health Network, Toronto, ON, Canada. Electronic address: aisling.barry@rmp.uhn.ca.
² Seattle Cancer Care Alliance, and Department of Radiation Oncology, University of Washington, Seattle, WA, USA.
³ Department of Medical Oncology and Haematology, Toronto General Hospital, University Health Network, Toronto, ON, Canada.
⁴ Princess Margaret Cancer Centre, and Department of Surgery, Toronto General Hospital, University Health Network, Toronto, ON, Canada.
⁵ Department of Medical Imaging, Toronto General Hospital, University Health Network, Toronto, ON, Canada.
⁶ Department of Interventional Radiology, Northwestern University, Chicago, IL, USA.
⁷ Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
⁸ Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
⁹ UCL Cancer Institute, University College London, London, UK.
¹⁰ Department of Surgical Biotechnology, UCL Division of Surgery and Interventional Science, University College London, London, UK.
¹¹ Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center, IRCCS Humanitas Research Hospital, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy.
¹² Radiology Department, Humanitas Clinical and Research Center, IRCCS Humanitas Research Hospital, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy.
¹³ Department of Medical Oncology, University of Washington, Seattle, WA, USA.
¹⁴ Radiation Oncology Unit, Department of Hematology Oncology, Pontifical Catholic University of Chile, Santiago, Chile.
¹⁵ Department of Surgery, University of Washington, Seattle, WA, USA.
¹⁶ Department of Surgery, Royal Brisbane and Women's Hospital, University of Queensland, Brisbane, QLD, Australia.
¹⁷ Multi-Organ Transplant Program, Toronto General Hospital, University Health Network, Toronto, ON, Canada.
¹⁸ Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada; Radiation Medicine Program, Toronto General Hospital, University Health Network, Toronto, ON, Canada.
¹⁹ UCL Cancer Institute, University College London, London, UK; Department of Medical Physics and Biomedical Engineering, University College London, London, UK.

PMID: 32511951
PMCID: PMC7274990
DOI: 10.1016/S2468-1253(20)30182-5

Review

Management of primary hepatic malignancies during the COVID-19 pandemic: recommendations for risk mitigation from a multidisciplinary perspective

Aisling Barry et al. Lancet Gastroenterol Hepatol. 2020 Aug.

. 2020 Aug;5(8):765-775.

doi: 10.1016/S2468-1253(20)30182-5. Epub 2020 Jun 6.

Authors

Affiliations

¹ Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada; Radiation Medicine Program, Toronto General Hospital, University Health Network, Toronto, ON, Canada. Electronic address: aisling.barry@rmp.uhn.ca.
² Seattle Cancer Care Alliance, and Department of Radiation Oncology, University of Washington, Seattle, WA, USA.
³ Department of Medical Oncology and Haematology, Toronto General Hospital, University Health Network, Toronto, ON, Canada.
⁴ Princess Margaret Cancer Centre, and Department of Surgery, Toronto General Hospital, University Health Network, Toronto, ON, Canada.
⁵ Department of Medical Imaging, Toronto General Hospital, University Health Network, Toronto, ON, Canada.
⁶ Department of Interventional Radiology, Northwestern University, Chicago, IL, USA.
⁷ Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
⁸ Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
⁹ UCL Cancer Institute, University College London, London, UK.
¹⁰ Department of Surgical Biotechnology, UCL Division of Surgery and Interventional Science, University College London, London, UK.
¹¹ Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center, IRCCS Humanitas Research Hospital, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy.
¹² Radiology Department, Humanitas Clinical and Research Center, IRCCS Humanitas Research Hospital, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy.
¹³ Department of Medical Oncology, University of Washington, Seattle, WA, USA.
¹⁴ Radiation Oncology Unit, Department of Hematology Oncology, Pontifical Catholic University of Chile, Santiago, Chile.
¹⁵ Department of Surgery, University of Washington, Seattle, WA, USA.
¹⁶ Department of Surgery, Royal Brisbane and Women's Hospital, University of Queensland, Brisbane, QLD, Australia.
¹⁷ Multi-Organ Transplant Program, Toronto General Hospital, University Health Network, Toronto, ON, Canada.
¹⁸ Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada; Radiation Medicine Program, Toronto General Hospital, University Health Network, Toronto, ON, Canada.
¹⁹ UCL Cancer Institute, University College London, London, UK; Department of Medical Physics and Biomedical Engineering, University College London, London, UK.

PMID: 32511951
PMCID: PMC7274990
DOI: 10.1016/S2468-1253(20)30182-5

Abstract

Around the world, recommendations for cancer treatment are being adapted in real time in response to the pandemic of COVID-19. We, as a multidisciplinary team, reviewed the standard management options, according to the Barcelona Clinic Liver Cancer classification system, for hepatocellular carcinoma. We propose treatment recommendations related to COVID-19 for the different stages of hepatocellular carcinoma (ie, 0, A, B, and C), specifically in relation to surgery, locoregional therapies, and systemic therapy. We suggest potential strategies to modify risk during the pandemic and aid multidisciplinary treatment decision making. We also review the multidisciplinary management of intrahepatic cholangiocarcinoma as a potentially curable and incurable diagnosis in the setting of COVID-19.

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Figures

**Figure**
Proposed treatment pathway for hepatocellular carcinoma during the COVID-19 pandemic BCLC=Barcelona Clinic Liver Cancer. TACE=transarterial chemoembolisation. TAE=transarterial embolisation. TARE=transarterial radioembolisation. *Surveillance involves blood tests every 1–3 months (eg, for α-fetoprotein in secreting tumours) and diagnostic imaging every 3 months.

See this image and copyright information in PMC

References

1. Martin R. Covid vs. US daily average cause of death. April 21, 2020. https://public.flourish.studio/visualisation/1712761/
1. American Society of Clinical Oncology ASCO coronavirus resources. https://www.asco.org/asco-coronavirus-information
1. American Society for Radiation Oncology COVID-19 recommendations and information. Summary. https://www.astro.org/Daily-Practice/COVID-19-Recommendations-and-Inform...
1. American Association for the Study of Liver Diseases COVID-19 resources. https://www.aasld.org/about-aasld/covid-19-resources
1. Boettler T, Newsome PN, Mondelli MU. Care of patients with liver disease during the COVID-19 pandemic: EASL-ESCMID position paper. JHEP Rep. 2020;2 - PMC - PubMed

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Management of primary hepatic malignancies during the COVID-19 pandemic: recommendations for risk mitigation from a multidisciplinary perspective

Affiliations

Management of primary hepatic malignancies during the COVID-19 pandemic: recommendations for risk mitigation from a multidisciplinary perspective

Authors

Affiliations

Abstract

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References

Publication types

MeSH terms

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Full Text Sources

Medical