Treatment of Intermediate Stage Hepatocellular Carcinoma – from Guidelines and Beyond
Pp. 319-333 (15)
Hepatocellular carcinoma (HCC) BCLC-B class is characterized by an
extensive heterogeneity due to the wide range of liver function (Child Pugh A or B
cirrhosis) and variable lesion number and size. With this regard, hepatologists must
develop a better stratification of this HCC stage for patients to benefit from a better
Trans-arterial chemo-embolization (TACE) procedure is the most widely used
therapeutic option for intermediate stage HCC. One therapy is not beneficial unless
clinicians might predict its outcome. Along these lines, several predictive factors for
the TACE success have emerged such as mRECIST criteria, HAP and mHAP, Munich
and CHIP score. The overall survival (OS) after the TACE procedure is around 16
months and in rigorous selected candidates, might increase the survival up to 3 years.
Nevertheless, in some BCLC B patients, other therapies have proved their benefit
compared to TACE. Resection and liver transplantation when technically possible is
associated with an increased OS versus TACE. Moreover, astounding results have
arisen from the combination of TACE with radiofrequency ablation. However, the
literature fails to support the use of multi-kinase inhibitors in combination with TACE.
Selective internal radiation therapy (SIRT) also known as radioembolization (TARE)
induces fewer side effects and maintains a better tumoral control than TACE, but it is
less available worldwide and is less cost-efficient.
In conclusion, navigating through all these treatment options, we believe that
intermediate stage HCC has to be managed in a personalized way for each patient in
order to have the best outcome.
Hepatocellular carcinoma, Intermediate stage BCLC B, TACE