Table 6.
The possible therapeutic choices of hepatocellular carcinoma
| Therapeutic choices | Indications and specific programs | |
|---|---|---|
| Hepatectomy | Ia | Surgical resection |
| Ib | ||
| IIa | ||
| IIb | Preoperative neoadjuvant therapy, induction or conversion therapy may be considered. | |
| IIIa | ||
| IIIb | ||
| Adjuvant therapy after hepatectomy | Interventional therapy; Immunotherapy; Chemotherapy and targeted therapy. | |
| Liver transplantation | Transplantation criteria: Milan Criteria. | |
| Treatment while waiting for a donor liver. | ||
| Ablation therapy | Ia |
1. Radiofrequency ablation 2. Microwave ablation 3. Cryotherapy 4. Percutaneous ethanol injection therapy |
| Ib | ||
| Hepatic arterial interventional therapy | Ia | TACE (Not suitable or refused surgical resection, Liver transplantation and ablation therapy). |
| Ib | ||
| IIa | ||
| IIb |
1. TACE 2. TACE + Sorafenib |
|
| IIIa | TACE (The main portal vein of the liver is incompletely blocked, or although it is completely blocked, the compensatory collateral vessels between the hepatic artery and the portal vein are formed). | |
| IIIb | TACE + systemic therapy | |
| IV | TACE / HAIC (Liver transplantation could not or refused to be performed). | |
| Radiotherapy |
1. Small hepatocellular carcinoma is not suitable for surgery or unwilling to surgery 2. Combined with TACE treatment 3. Treatment before liver transplantation 4. Hepatic portal vein or inferior vena cava tumor thrombus 5. Patients with extrahepatic metastasis |
|
| Radionuclide immunotherapy | I |
1. HCC combined with TACE treatment, and not suitable for or refused surgical resection, liver transplantation and ablation therapy. 2. Patients who were not suitable for or refused surgical resection and liver transplantation after RFA. |
| II | ||
| First-line immunotherapy, chemotherapy and targeted drug therapy for advanced liver cancer |
Hepatic function ChildPugh A or B ( = < 7) |
1. Sorafenib 2. Systemic chemotherapy based on oxaliplatin 3. Lenvatinib 4. Donafenib 5. Atezolizumzb + bevacizumab 6. Lenvatinib + Paporizumab or navulizumab |
|
Hepatic function ChildPugh B (> 7) and C |
Best supportive care; Palliative treatment | |
| Second-line immunotherapy, chemotherapy and targeted drug therapy for advanced liver cancer | Hepatic function ChildPugh A or B ( = < 7) |
1. Regorafenib2. Ramucirumab (AFP > 400ng/ml) 3. Cabozantinib 4. Those who have used sorafenib in the past can consider Carrelizumab + FOLFOX4 5. These who have previously used oxaliplatin can consider Carrelizumab combined with Apatinib |
|
Hepatic function ChildPugh B (> 7) and C |
Best supportive care; Palliative treatment | |
Note: TACE, transcatheter arterial chemoembolization; HAIC, hepatic arterial infusion chemotherapy; RFA, Radiofrequency ablation; AFP, Alpha fetoprotein