List of Clinical Questions.
| Internal medicine |
| 1. Could the incidence of HCC be reduced by primary, secondary, or tertiary prevention? |
| 2. How should we determine the high-risk group, imaging tests, roles of tumor markers, and diagnostic criteria? |
| 3. Should we limit exposure to radiation to that necessary to diagnose and treat patients with HCC? |
| 4. What staging system is applicable in Korea? |
| 5. Who can obtain a survival benefit from sorafenib therapy? Is it safe and feasible in patients with hepatic impairment? |
| 6. Does cytotoxic chemotherapy have a role in advanced HCC? Who should be considered for cytotoxic chemotherapy? |
| 7. Does adjuvant therapy have a role after curative treatment for HCC? |
| 8. When can preemptive antiviral therapy for hepatitis B be considered for patients undergoing treatment for HCC? |
| 9. Can preemptive antiviral therapy for hepatitis C be considered for patients undergoing treatment for HCC? |
| 10. How should we address pain management for patients with HCC? |
| 11. For what kinds of pain medication should we adjust the dose and intervals? What can we adopt as a parameter of liver function in patients with HCC? |
| 12. What criteria can we use to assess response to HCC treatment? |
| 13. When and how should we follow-up patients after curative treatment for HCC? |
| Surgery |
| 1. Should we consider size of the tumor and patient age when performing liver resection for HCC? |
| 2. Is it applicable to perform the ICG-R15 test, Fibroscan, MRI, or PET to decide on liver resection? |
| 3. How good are the outcomes of liver resection in patients with mild portal hypertension? |
| 4. What is the safe volume of residual liver after liver resection in patients with liver cirrhosis? |
| 5. Is anatomical resection superior to nonanatomical resection? |
| 6. Is it useful to perform preconditioning when performing surgical resection for HCC? |
| 7. Is it useful to perform surgical resection for HCC with bile duct invasion? |
| 8. Is it useful to perform surgical resection for HCC with vascular invasion? |
| 9. Is it useful to perform surgical resection for ruptured HCC? |
| 10. What are the results (i.e., 5-year survival rate, mortality rate, and recurrence rate) of liver resection? |
| 11. Is laparoscopic liver resection comparable to open resection? What are the advantages and indications? |
| 12. When can we recommend liver transplantation as a primary treatment? |
| 13. Do subcentimeter nodules alter the indications for liver transplantation? |
| 14. What tests should be performed to investigate extrahepatic spread prior to liver transplantation? |
| 15. How can we manage patients with HCC on the waiting list for liver transplantation? Is neoadjuvant therapy effective for them? Does neoadjuvant therapy decrease the withdrawal rate? |
| 16. Can living donor liver transplantation be a substitute for deceased donor liver transplantation? |
| 17. Do the Milan criteria have a role as indications for living donor liver transplantation or salvage transplantation? |
| 18. Is the donor safe when performing living donor liver transplantation? |
| 19. Can salvage transplantation be curative for recurred HCC? |
| 20. Is it safe to perform salvage transplantation for recurred HCC after surgical resection? |
| 21. What kinds of bridging therapies are available for patients on the transplant waiting list? Do they have a clinical impact? |
| 22. When do we need to downstage HCC prior to liver transplantation? Can we improve clinical outcomes or broaden indications? |
| 23. How should we treat liver transplant recipients with immunosuppressive or antiviral agents? |
| 24. Should patients receive adjuvant therapy after liver transplantation? Is it useful or necessary? |
| Radiology |
| 1. Is it applicable to diagnose HCC on the basis of noninvasive criteria using 4-phase multidetector CT or liver dynamic contrast-enhanced MRI? Should this only be done for patients with liver cirrhosis? |
| 2. What is the size limit for a lesion for noninvasive diagnostic criteria? |
| 3. What is the accuracy of noninvasive diagnostic criteria for a subcentimeter lesion with typical enhancement? |
| 4. Can we use dynamic Gd-EOB-DTPA contrast-enhanced MRI as a surveillance test? Can it be allowed as a first-line test for a lesion identified by ultrasonography? |
| 5. Can low signal intensity on the hepatobiliary phase of dynamic Gd-EOB-DTPA contrast-enhanced MRI be accepted as a parameter for noninvasive diagnostic criteria? |
| 6. Should T2-weighted or diffusion-weighted imaging be included as a parameter for noninvasive diagnostic criteria? |
| 7. Is contrast-enhanced ultrasound acceptable as a method for noninvasive diagnostic criteria? |
| 8. How long should be the intervals between follow-up CT for patients with HCC? |
| 9. Is radiofrequency ablation comparable with surgical resection for HCC with respect to survival? |
| 10. When does combination therapy of radiofrequency ablation and transarterial chemoembolization have advantage over radiofrequency ablation monotherapy? |
| 11. Are patients treated with radiofrequency ablation more likely to have microscopically residual disease (R1) than those treated with surgical resection? |
| 12. Does local recurrence affect long-term survival after locoregional therapy? |
| 13. How can the technical limitations of radiofrequency ablation due to location or invisibility of lesions be overcome? |
| 14. Is percutaneous ethanol injection safer than radiofrequency ablation for HCC adjacent to the central bile duct? |
| 15. Does radiofrequency ablation have a role for recurred HCC following surgical resection? |
| 16. Do newer methods of locoregional therapy such as cryoablation or microwave ablation have a role? |
| 17. When can we recommend transarterial chemoembolization as a first-line treatment? |
| 18. Can we recommend transarterial chemoembolization as a curative therapy for HCCs that are curable but not amenable to other curative treatments? |
| 19. Can we recommend transarterial chemoembolization for advanced HCCs with vascular invasion or metastasis? |
| 20. Is there a role of chemolipiodolization? |
| 21. Is there a role of combination therapy of transarterial chemoembolization and other therapies such as radiofrequency ablation, percutaneous ethanol injection, radiotherapy, and sorafenib? |
| 22. When can we recommend drug-eluting bead transarterial chemoembolization? Does it have any advantage over conventional transarterial chemoembolization, or can we recommend it as a standard therapy? |
| 23. Is transarterial radioembolization safe? When can we recommend transarterial radioembolization? Does transarterial radioembolization gain any advantage or survival benefit over conventional transarterial chemoembolization? Is it useful for downstaging prior to liver transplantation? Can we recommend it as a standard therapy? |
| Radio-oncology |
| 1. When can external-beam radiotherapy be performed? What are the indications for external-beam radiotherapy? |
| 2. Does combined radiotherapy play a role in the treatment of localized HCCs where transarterial chemoembolization is not expected to be effective? |
| 3. Can we recommend external-beam radiotherapy for HCC with portal vein tumor thrombosis? |
| 4. Can we recommend external-beam radiotherapy for HCCs < 5 cm not amenable to surgical resection or locoregional therapy? |
| 5. Can we recommend external-beam radiotherapy to alleviate pain or symptoms caused by distant metastases? |
| 6. Can external-beam radiotherapy play a role in bridging therapy in advanced HCCs prior to surgical resection? |
| 7. Can we treat advanced HCCs with a combination of external-beam radiotherapy and systemic chemotherapy? |
CT = computed tomography, HCC = hepatocellular carcinoma, Gd-EOB-DTPA = gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid, MRI = magnetic resonance imaging, PET = positron emission tomography