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Review
. 2024 Jan-Feb;14(1):101269.
doi: 10.1016/j.jceh.2023.08.005. Epub 2023 Aug 19.

2023 Update of Indian National Association for Study of the Liver Consensus on Management of Intermediate and Advanced Hepatocellular Carcinoma: The Puri III Recommendations

Ashish Kumar  1 , Subrat K Acharya  2 , Shivaram P Singh  3 , Ajay Duseja  4 , Kaushal Madan  5 , Akash Shukla  6 , Anil Arora  1 , Anil C Anand  7 , Ankur Bahl  8 , Arvinder S Soin  9 , Bhawna Sirohi  10 , Debnarayan Dutta  11 , Dinesh Jothimani  12 , Dipanjan Panda  13 , Gagan Saini  14 , Joy Varghese  15 , Karan Kumar  16 , Madhumita Premkumar  4 , Manas K Panigrahi  17 , Manav Wadhawan  18 , Manoj K Sahu  19 , Mohamed Rela  20 , Naveen Kalra  21 , Padaki N Rao  22 , Pankaj Puri  23 , Prashant Bhangui  9 , Premashis Kar  24 , Samir R Shah  25 , Sanjay S Baijal  26 , Shalimar  27 , Shashi B Paul  28 , Shivanand Gamanagatti  23 , Subash Gupta  29 , Sunil Taneja  4 , Vivek A Saraswat  30 , Yogesh K Chawla  7
Affiliations
Review

2023 Update of Indian National Association for Study of the Liver Consensus on Management of Intermediate and Advanced Hepatocellular Carcinoma: The Puri III Recommendations

Ashish Kumar et al. J Clin Exp Hepatol. 2024 Jan-Feb.

Abstract

Hepatocellular carcinoma (HCC) presents significant treatment challenges despite considerable advancements in its management. The Indian National Association for the Study of the Liver (INASL) first published its guidelines to aid healthcare professionals in the diagnosis and treatment of HCC in 2014. These guidelines were subsequently updated in 2019. However, INASL has recognized the need to revise its guidelines in 2023 due to recent rapid advancements in the diagnosis and management of HCC, particularly for intermediate and advanced stages. The aim is to provide healthcare professionals with evidence-based recommendations tailored to the Indian context. To accomplish this, a task force was formed, and a two-day round table discussion was held in Puri, Odisha. During this event, experts in their respective fields deliberated and finalized consensus statements to develop these updated guidelines. The 2023 INASL guidelines offer a comprehensive framework for the diagnosis, staging, and management of intermediate and advanced HCC in India. They represent a significant step forward in standardizing clinical practices nationwide, with the primary objective of ensuring that patients with HCC receive the best possible care based on the latest evidence. The guidelines cover various topics related to intermediate and advanced HCC, including biomarkers of aggressive behavior, staging, treatment options, and follow-up care.

Keywords: TACE-TARE-SBRT; guide-lines; hepatocellular-carcinoma; systemic therapy.

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Figures

Figure 1
Figure 1
The ‘INASL modification of BCLC staging’ (INASL-BCLC) for prognosis prediction and treatment of HCC. BCLC, Barcelona Clinic Liver Cancer; HCC, Hepatocellular carcinoma; INASL-BCLC, Indian National Association for the Study of the Liver modification of BCLC
Figure 2
Figure 2
The Liver Cancer Study Group of Japan's classification for PVTT, which categorized PVTT into five grades: (1) Vp0, no PVTT; (2) Vp1, presence of PVTT not in, but distal to, the 2nd order branches of the portal vein; (3) Vp2, presence of PVTT in the 2nd order branches of the portal vein; (4) Vp3, presence of PVTT in the 1st order branches of the portal vein; and (5) Vp4, presence of PVTT in the main trunk of the portal vein or a portal vein branch contralateral to the mainly involved lobe (or both). PVTT, Portal Vein Tumor Thrombus
Figure 3
Figure 3
Algorithmic approach to systemic therapy.
See this image and copyright information in PMC

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