Table 4.
BCLC substage | B1 | B2 | B3 | |
Child-Pugh score | 5-7 | 5-7 | 8-9 | |
Beyond Milan and within up-to-7 | In | Out | Any | |
In | Out | |||
Sub-substage | B3-a | B3-b | ||
Concept of treatment strategy | Curative intent | Non-curative, palliative | Curative intent if within up-to-7 | Palliative, no treatment |
Treatment option | Resection Ablation Superselective c-TACE | DEB-TACE1 HAIC2 Sorafenib3 | Transplantation Ablation Superselective c-TACE | HAIC Selective DEB-TACE |
Alternative | DEB-TACE (large, C-P 7) B-TACE4 | c-TACE | DEB-TACE B-TACE, HAIC | BSC |
DEB-TACE is recommended for huge tumors that are > 6 cm;
HAIC is recommended for multiple tumors > 6;
Sorafenib is recommended for patients with liver function of Child-Pugh score 5 and 6;
B-TACE is recommended for fewer tumors. TACE: Transcatheter arterial chemoembolization; c-TACE: Conventional subsegmental lipiodol TACE; DEB-TACE: TACE with drug-eluting beads; B-TACE: Balloon occluded TACE; HAIC: Hepatic arterial infusion chemotherapy; BSC: Best supportive care; C-P: Child-Pugh score; BCLC: Barcelona Clinic Liver Cancer.