Table 3. . Synopsis of principal guidelines recommendations and contraindications for ablative therapies in patients with hepatocellular carcinoma.
| Organization | Extrahepatic metastasis/vascular invasion | Tumor extension | Liver function | Technique | Combined treatments |
|---|---|---|---|---|---|
| EASL-EORTC | Contraindication | Single nodule or three or fewer nodules each ≤3 cm when resection is not possible | Child-Pugh A or B | RFA better than PEI in nodules <5 cm RFA = PEI in nodules <2 cm | Not considered |
| NCCN | Contraindication | First choice (as resection) in patients with three or fewer nodules of ≤3 cm | Child-Pugh A or B | No clear recommendations | TACE + ablation in nodules between 3 and 5 cm |
| APASL | Contraindication | Small HCC (<3 cm) with three or fewer nodules when resection is not possible Acceptable alternative to resection for small HCC | Child-Pugh A or B | No clear recommendations | No clear recommendations |
| JSH | Contraindication | First choice (as resection) in patients with three or fewer nodules of ≤3 cm (NCCN) Only guidelines that consider local ablation in hypovascular early HCC |
Child-Pugh A or B. Child-Pugh C is not an absolute contraindication (experimental treatment in patients meeting Milan criteria when hepatic encephalopathy and intractable ascites are absent and bilirubin is less than 3 mg/dl) | No clear recommendations | TACE + ablation in nodules >3 cm, when resection is not indicated or TACE + ablation in >four nodules |
| AISF | Contraindication | EASL but it is the first choice (as resection) in nodules ≤2 cm | Child-Pugh A or B | RFA better than PEI in nodules <2 cm | TACE + ablation in unresectable nodules >3 cm (<5?) |
AISF: Italian Association for the Study of the Liver; APASL: Asian-Pacific Association for the Study of the Liver; EASL: European Association for Study of Liver; EORTC: European Organization for Research and Treatment of Cancer; HCC: Hepatocellular carcinoma; JSH: Japanese Society of Heptology; NCCN: National Comprehensive Cancer Network; PEI: Percutaneous ethanol injection; RFA: Radiofrequency ablation; TACE: Transarterial chemoembolization.