A proposed five-step simplified algorithm for the management of hepatocellular carcinoma in India
Hepatocellular carcinoma (HCC) is the eighth-most frequent cause of cancer mortality in India. The staging system most often used for treatment decisions in India is the Barcelona clinic liver cancer (BCLC) system. However, this staging system is often criticised for several reasons, such as heterog...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2022-01-01
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| Series: | Current Medicine Research and Practice |
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| Online Access: | http://www.cmrpjournal.org/article.asp?issn=2352-0817;year=2022;volume=12;issue=5;spage=224;epage=231;aulast=Arora |
| _version_ | 1828130103571251200 |
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| author | Anil Arora Ashwani K Singal Praveen Sharma Ashish Kumar |
| author_facet | Anil Arora Ashwani K Singal Praveen Sharma Ashish Kumar |
| author_sort | Anil Arora |
| collection | DOAJ |
| description | Hepatocellular carcinoma (HCC) is the eighth-most frequent cause of cancer mortality in India. The staging system most often used for treatment decisions in India is the Barcelona clinic liver cancer (BCLC) system. However, this staging system is often criticised for several reasons, such as heterogeneity of patient prognosis in each BCLC stage, limited guidance on expanding the role of liver transplantation (LT), no recommendation on combination therapies, no guidance on downstaging and limited treatment options for late presenters (stages C or D). Hence, we propose a simplified five-step algorithm for making treatment decisions for HCC patients in India. This algorithm incorporates evidence-based treatment allocations based on the step-by-step assessment of major prognostic and treatment-related parameters. The five steps of the algorithm are – Step 1: assessment of performance status, Step 2: assessment of extrahepatic spread and macrovascular invasion, Step 3: assessment for living donor LT, Step 4: assessment for the eligibility of liver resection and Step 5: assessment for appropriate locoregional therapy. Each of these steps does not require any separate investigations, and the initial workup for the diagnosis of HCC (dynamic computed tomography/magnetic resonance imaging and routine laboratory tests) would suffice in this five-step algorithm. We hope that this algorithm will not only simplify the management approach to HCC patients in India, but also it will bring uniformity in the treatment protocol for HCC in India. |
| first_indexed | 2024-04-11T16:28:33Z |
| format | Article |
| id | doaj.art-d13f6c66543c424c8b72b5d052e02f6e |
| institution | Directory Open Access Journal |
| issn | 2352-0817 2352-0825 |
| language | English |
| last_indexed | 2024-04-11T16:28:33Z |
| publishDate | 2022-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
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| series | Current Medicine Research and Practice |
| spelling | doaj.art-d13f6c66543c424c8b72b5d052e02f6e2022-12-22T04:14:05ZengWolters Kluwer Medknow PublicationsCurrent Medicine Research and Practice2352-08172352-08252022-01-0112522423110.4103/cmrp.cmrp_69_22A proposed five-step simplified algorithm for the management of hepatocellular carcinoma in IndiaAnil AroraAshwani K SingalPraveen SharmaAshish KumarHepatocellular carcinoma (HCC) is the eighth-most frequent cause of cancer mortality in India. The staging system most often used for treatment decisions in India is the Barcelona clinic liver cancer (BCLC) system. However, this staging system is often criticised for several reasons, such as heterogeneity of patient prognosis in each BCLC stage, limited guidance on expanding the role of liver transplantation (LT), no recommendation on combination therapies, no guidance on downstaging and limited treatment options for late presenters (stages C or D). Hence, we propose a simplified five-step algorithm for making treatment decisions for HCC patients in India. This algorithm incorporates evidence-based treatment allocations based on the step-by-step assessment of major prognostic and treatment-related parameters. The five steps of the algorithm are – Step 1: assessment of performance status, Step 2: assessment of extrahepatic spread and macrovascular invasion, Step 3: assessment for living donor LT, Step 4: assessment for the eligibility of liver resection and Step 5: assessment for appropriate locoregional therapy. Each of these steps does not require any separate investigations, and the initial workup for the diagnosis of HCC (dynamic computed tomography/magnetic resonance imaging and routine laboratory tests) would suffice in this five-step algorithm. We hope that this algorithm will not only simplify the management approach to HCC patients in India, but also it will bring uniformity in the treatment protocol for HCC in India.http://www.cmrpjournal.org/article.asp?issn=2352-0817;year=2022;volume=12;issue=5;spage=224;epage=231;aulast=Aroraablationbarcelona clinic liver cancer stagingbest supportive carehepatocellular carcinomaliver cancerliving donor liver transplantationperformance statussorafenibtransarterial chemoembolisationtransarterial radioembolisation |
| spellingShingle | Anil Arora Ashwani K Singal Praveen Sharma Ashish Kumar A proposed five-step simplified algorithm for the management of hepatocellular carcinoma in India Current Medicine Research and Practice ablation barcelona clinic liver cancer staging best supportive care hepatocellular carcinoma liver cancer living donor liver transplantation performance status sorafenib transarterial chemoembolisation transarterial radioembolisation |
| title | A proposed five-step simplified algorithm for the management of hepatocellular carcinoma in India |
| title_full | A proposed five-step simplified algorithm for the management of hepatocellular carcinoma in India |
| title_fullStr | A proposed five-step simplified algorithm for the management of hepatocellular carcinoma in India |
| title_full_unstemmed | A proposed five-step simplified algorithm for the management of hepatocellular carcinoma in India |
| title_short | A proposed five-step simplified algorithm for the management of hepatocellular carcinoma in India |
| title_sort | proposed five step simplified algorithm for the management of hepatocellular carcinoma in india |
| topic | ablation barcelona clinic liver cancer staging best supportive care hepatocellular carcinoma liver cancer living donor liver transplantation performance status sorafenib transarterial chemoembolisation transarterial radioembolisation |
| url | http://www.cmrpjournal.org/article.asp?issn=2352-0817;year=2022;volume=12;issue=5;spage=224;epage=231;aulast=Arora |
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