BCLC 2022 update: Important advances, but missing external beam radiotherapy

Hallemeier, Christopher L.; Apisarnthanarax, Smith; Dawson, Laura A.

doi:10.1016/j.jhep.2021.12.029

Cited by 11 publications

(11 citation statements)

References 9 publications

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“…External beam radiotherapy (EBRT), mainly stereotactic body radiotherapy (SBRT), although not included in the 2022 BCLC update, demonstrated safety and efficacy in treating HCC patients from all BCLC stages [122]. This was confirmed in multiple prospective and randomized controlled trials [123][124][125].…”

Section: Precision Medicine and Loco-regional Proceduresmentioning

confidence: 95%

Precision Medicine for Hepatocellular Carcinoma: Clinical Perspective

Galun

Mijač

Filipović

et al. 2022

JPM

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Hepatocellular carcinoma (HCC) is one of the major malignant diseases worldwide, characterized by growing incidence and high mortality rates despite apparent improvements in surveillance programs, diagnostic and treatment procedures, molecular therapies, and numerous research initiatives. Most HCCs occur in patients with liver cirrhosis, and the competing mortality risks from the tumor and the cirrhosis should be considered. Presently, previously identified risk factors, such as hepatitis virus infection, hepatic inflammation and fibrosis, and metabolic syndrome, may be used as chemoprevention targets. The application of precision medicine for HCC management challenges the one-size-fits-all concept; moreover, patients should no longer be treated entirely according to the histology of their tumor but based on molecular targets specific to their tumor biology. Next-generation sequencing emphasizes HCC molecular heterogeneity and aids our comprehension of possible vulnerabilities that can be exploited. Moreover, genetic sequencing as part of a precision medicine concept may work as a promising tool for postoperative cancer monitoring. The use of genetic and epigenetic markers to identify therapeutic vulnerability could change the diagnosis and treatment of HCC, which so far was based on Barcelona clinic liver cancer (BCLC) staging. In daily clinical practice, the shift from a stage-oriented to a therapeutic-oriented approach is needed to direct the choice of HCC treatment toward the potentially most effective option on an individual basis. The important factor in precision medicine is the promotion of patient management based on the individual approach, knowing that the final decision must be approved by a multidisciplinary expert team.

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Section: Precision Medicine and Loco-regional Proceduresmentioning

confidence: 95%

Precision Medicine for Hepatocellular Carcinoma: Clinical Perspective

Galun

Mijač

Filipović

et al. 2022

JPM

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“… 30 , 45 , 46 Due to the lack of completed randomised trials (and hence level 1 evidence) demonstrating the efficacy of SBRT, it currently fails to find a place in liver treatment guidelines. 16 , 47 , 48 However, SBRT is applicable in HCC with recently published American Society of Radiation Oncology (ASTRO) guidelines formalising potential treatment options. 49 …”

Section: Evidence and Indications For Sbrt In Hccmentioning

confidence: 99%

Stereotactic body radiation therapy for hepatocellular carcinoma: From infancy to ongoing maturity

et al. 2022

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“…In the context of expanded therapy options pertaining to TSM, external beam radiotherapy (EBRT) that is missing in the 2022 updated guidelines, may be a useful option in algorithms for HCC[ 42 ]. The safety and efficacy of EBRT have been enough demonstrated regardless BCLC stage.…”

Section: Liver Managementmentioning

confidence: 99%

“…The safety and efficacy of EBRT have been enough demonstrated regardless BCLC stage. Hallemeier et al [ 42 ] recognize important advances in BCLC 2022 update even if EBRT is missing. Based on the current available evidence, the authors suggest to incorporate EBRT into BCLC guidelines when “first treatment options” suitable or not feasible, or disease progression after first therapy.…”

Section: Liver Managementmentioning

confidence: 99%

“…Owing the American Society for Radiation Oncology recommendations, they propose EBRT option for future BCLC updates as follow: (1) In BCLC 0/A HCC, EBRT may be an alternative non-surgical as definitive treatment or as a bridge to transplant; (2) in BCLC B/C, EBRT may be used with or without embolization or systemic treatment; and (3) in BCLC D HCC, EBRT may serve as palliative therapy for tumor-related pain. Authors acknowledge the usefulness of current and future trials for overall therapies in refining HCC therapy options, and suggest further EBRT experiments pertaining to HCC[ 42 ].…”

Section: Liver Managementmentioning

confidence: 99%

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Current management of liver diseases and the role of multidisciplinary approach

Bouare¹

2022

World J Hepatol

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Liver is an organ having extremely diversified functions, ranging from metabolic and synthetic to detoxification of harmful chemicals. The multifunctionality of the liver in principle requires the multidisciplinary and pluralistic interventions for its management. Several studies have investigated liver function, dysfunction and clinic. This editorial work discusses new ideas, challenges and perspectives of current research regarding multidisciplinary and pluralistic management of liver diseases. In one hand the discussions have carried out on the involvement of extracellular vesicles, Na + /H + exchangers, severe acute respiratory syndrome coronavirus 2 and Epstein–Barr virus infections, Drug-induced liver injury, sepsis, pregnancy, and food supplements in hepatic disorders. In the other hand this study has discussed hepatocellular carcinoma algorithms and new biochemical and imaging experiments pertaining to liver diseases. Relevant articles with an impact index value "> 0" from reference citation analysis, which is an open multidisciplinary citation analysis database based on artificial intelligence technology, have served for the study’s argumentation. This work may be a useful tool for the clinical practice and research in managing and investigating liver disorders.

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BCLC 2022 update: Important advances, but missing external beam radiotherapy

Cited by 11 publications

References 9 publications

Precision Medicine for Hepatocellular Carcinoma: Clinical Perspective

Precision Medicine for Hepatocellular Carcinoma: Clinical Perspective

Stereotactic body radiation therapy for hepatocellular carcinoma: From infancy to ongoing maturity

Current management of liver diseases and the role of multidisciplinary approach

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