Han et al reported treatment guidelines for a patient with hepatocellular carcinoma. The authors are from multiple institutions in Japan, Korea, Hong Kong, China, Singapore and Taiwan representing the Asian Pacific Association for the Study of the Liver (APASL).
Parameters:
(1) extrahepatic spread
(2) patency of the main portal vein
(3) venous invasion
(4) resectability
(5) number of tumors
(6) diameter of the largest tumor in cm
(7) Child-Pugh stage
Confined to liver and main portal vein patent, resectable
Findings
Management
< 3 cm
resection or radiofrequency ablation (RFA)
>= 3 cm
resection
Confined to liver and main portal vein patent, unresectable
Venous Invasion
Tumor Burden
Child
Management
no
(solitary <= 5 cm) OR ( <= 3 tumors <= 3 cm)
A
local ablation
no
(solitary <= 5 cm) OR ( <= 3 tumors <= 3 cm)
B
local ablation or transplantation
no
(solitary <= 5 cm) OR ( <= 3 tumors <= 3 cm)
C
transplantation
yes
NA
A or B
TACE
NA
(solitary > 5 cm) OR (2 or 3 tumors > 3 cm) OR (>= 4 tumors)
A or B
TACE
yes
NA
C
supportive care
NA
(solitary > 5 cm) OR (2 or 3 tumors > 3 cm) OR (>= 4 tumors)
C
supportive care
Extrahepatic metastasis or thrombus in main portal vein
Findings
Management
Child A or B
sorafenib or systemic therapy
Child C
supportive care
To read more or access our algorithms and calculators, please log in or register.
