Treatment of Hepatocellular Carcinoma at BCLC Stage B (Intermediate Stage)
BCLC Stage B (intermediate-stage) hepatocellular carcinoma designates patients with multinodular disease who are candidates for locoregional therapy. The treatment approach for this stage is supported by strong evidence-based guidance.
Clinical scenario
This protocol applies to patients with hepatocellular carcinoma classified at BCLC Stage B — the intermediate stage — in whom systemic or surgical options are not the primary approach and locoregional intervention is indicated.
Treatment approach
The recommended treatment involves transarterial therapy delivered to the tumour. An alternative locoregional approach may be considered in selected patients. The complete regimen, including technique selection, sequencing, and procedural considerations, is available in the full protocol.
Treatment goal
Objective tumour response with no definite viable disease on multiphase CT or contrast-enhanced MRI, assessed at the appropriate imaging interval after therapy.
References
- Patients with BCLC Stage B HCC should be treated with transarterial chemoembolization (Level 1, Strong Recommendation).
- AASLD advises radioembolization as an alternative therapy to chemoembolization in patients with BCLC Stage B HCC (Level 3, Strong Recommendation).
- Transarterial therapies should be performed in a selective/segmental fashion (over lobar treatment) whenever possible given a lower risk of hepatic dysfunction (Level 5, Strong Recommendation).
- Patients treated with TACE should undergo multiphase CT or contrast-enhanced MRI approximately 6 weeks after treatment, whereas those treated with TARE or EBRT should undergo imaging to assess response approximately 12 weeks after treatment.
DOI: 10.1097/HEP.0000000000000466
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