2019 Update of Indian National Association for Study of the Liver Consensus on Prevention, Diagnosis, and Management of Hepatocellular Carcinoma in India: The Puri II Recommendations

Abstract

Hepatocellular carcinoma (HCC) is one of the major causes of morbidity, mortality, and healthcare expenditure in patients with chronic liver disease in India. The Indian National Association for Study of the Liver (INASL) had published its first guidelines on diagnosis and management of HCC (The Puri Recommendations) in 2014, and these guidelines were very well received by the healthcare community involved in diagnosis and management

Clinical Management of Liver Cancer in India and Other Developing Nations: A Focus on Radiation Based Strategies

“…SBRT is presently less expensive compared to imported microspherebased TARE formulations, but this may change with greater clinical uptake of generic/indigenous radionuclide therapies. Although the Indian Council of Medical Research guidelines acknowledge the option of SBRT for patients with early and advanced HCC, EBRT is not currently recommended in India for HCC outside of clinical trials by the INASL [87].…”

“…However, the Hong Kong Consensus Statements for management of unresectable HCC state that TARE is useful as a bridge therapy to liver transplantation in suitable candidates and for C-P A patients with multifocal or large burden HCC, and it can be considered for unresectable/unabalatable lesions [ 5 cm [56]. TARE has also been suggested for patients with C-P score A/B that fail to respond to TACE, reported to score better on tumor response, safety and quality of life (QoL) parameters [25,56,87]. A 2016 meta-analysis comparing TARE and TACE suggested a longterm benefit of TARE in terms of delayed tumor progression [89].…”

“…A 2016 meta-analysis comparing TARE and TACE suggested a longterm benefit of TARE in terms of delayed tumor progression [89]. As previously stated, PVT is a contraindication to chemoembolization, another area where TARE can improve QoL for the patient [87]. Reports have suggested that segmented TARE application can be prescribed for specific early BCLC stage patients not eligible for resection/ablation because of proximity of the hepatic lesions to vital viscera.…”

The Role of Tumor Associated Macrophages in Hepatocellular Carcinoma

“…The poor prognosis of HCC is primarily due to its late diagnosis, as well as its high risk of potential recurrence and metastasis 2 , 3 . Other non-surgical interventions, including transarterial chemoembolization (TACE) and radiofrequency ablation (RFA), can provide disease control only for advanced-stage patients 4 . Systemic administration of sorafenib exerts a weak therapeutic effect in patients with metastatic HCC 5 .…”

Complete Regression of Hepatocellular Carcinoma with Low Dose of Sorafenib

“…As the majority of hepatocellular carcinoma (HCC) patients present with advanced disease, systemic chemotherapy or palliative care remains the only treatment option available. 1 Although spontaneous regression of HCC has been well documented, very limited data is available in patients receiving sorafenib. 2 Here, we discuss a patient of locally advanced HCC with portal vein thrombosis, achieving complete regression on a subtherapeutic dose of sorafenib.…”