TABLE 1.

Recommended indications for locoregional therapies of hepatocellular carcinoma.

Locoregional therapies	BCLC recommendations	CNLC recommendations	NCCN recommendations
Local ablation	RFA is the first treatment approach for very early stage HCC (without vascular invasion or extrahepatic spread, with preserved liver function and PS 0) that is not feasible to LT RFA is preferred over surgery for solitary HCC ≤3 cm without high‐risk locations for ablation RFA can be used for multifocal HCC within Milan criteria (≤3 nodules, each ≤3 cm) with contraindications to LT MWA is potentially the best option for HCC <4 cm due to achieve more extensive tumour necrosis than RFA PEI can be adopted in some patients with technical or safety concerns.	Suitable for CNLC Ia and a proportion of Ib HCC (i.e., solitary tumours with a diameter of ≤5 cm or 2–3 tumours with a maximum diameter ≤3 cm) First‐line treatment for unresectable early stage HCC TACE combined with ablation can be used for inoperable solitary or multiple tumours with a diameter of 3–7 cm Selection of MWA or RFA based on the size and position of tumours, and the operator's experience due to similar efficacy	Choice of ablative therapy for early stage HCC should be based on tumour size and location, underlying liver function, as well as available local radiologist expertise and experience Ablative treatments are most effective for tumours <3 cm in an appropriate location away from other organs and major vessels/bile ducts, with the best outcomes in tumours <2 cm MWA is an alternative to RFA for small or unresectable HCC
TACE	First‐line treatment option for the intermediate stage that defined as multifocal HCC (exceeding early stage) with preserved liver function, no cancer‐related symptoms (PS 0), and no vascular invasion or extrahepatic spread Disease with early stage not feasible or failure to curative therapy according to treatment stage migration Selection of DEB‐TACE and cTACE according to clinical preference due to the similar overall efficacy Disease without the option of liver transplant but who have preserved portal flow and defined tumour burden	IIb, IIIa, and a proportion of IIIb HCC, Child‐Pugh A/B, and a PS score of 0–2 Patients with resectable HCC (Ib/IIa stage) are unable or unwilling to receive surgery Postoperative adjuvant TACE for patients at high recurrence risk Downstaging/bridging therapy before curative surgery DEB‐TACE shared indications with cTACE; TACE‐based combinations are advocated for better outcomes	Unresectable or inoperable tumours not amenable to ablation therapy only, and the absence of large‐volume extrahepatic disease All tumours irrespective of location may be amenable to arterially directed therapies provided that the arterial blood supply to the tumour may be isolated without excessive non‐target treatment Evaluation of the arterial anatomy of the liver, patient's performance status, and liver function is necessary before the initiation of arterially directed therapy
HAIC	Not specifically including HAIC on the list of treatment options for HCC	Treatment option for TACE failure/refractoriness based on liver function Disease with major portal vascular invasion, intrahepatic multinodular lesions, and Child‐Pugh B liver function	Not specifically including HAIC on the list of treatment options for HCC
TARE	Could be considered in patients with unresectable single nodules <8 cm Radiation lobectomy by TARE could be considered in selective patients to increase remnant liver volume as a bridge to resection	Not been approved for clinical application until 2021 in Chinese mainland	As part of arterially directed therapies, sharing major indications with TACE Maybe appropriate in selective patients with advanced HCC, specifically segmental or lobar portal vein, rather than main portal vein thrombosis

Abbreviations: BCLC, Barcelona clinic liver cancer; CNLC, China liver cancer; cTACE, conventional TACE; DEB‐TACE, TACE with drug‐eluting beads; HAIC, hepatic arterial infusion chemotherapy; HCC, hepatocellular carcinoma; LT, liver transplantation; MWA, microwave ablation; NCCN, national comprehensive cancer network; PEI, Percutaneous ethanol injection; PS, performance status; RFA, radiofrequency ablation; TACE, transarterial chemoembolization; TARE, transarterial radioembolization.