Brazilian Society of Hepatology Updated Recommendations for Diagnosis and Treatment of Hepatocellular Carcinoma

Abstract

Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related mortality worldwide. The Brazilian Society of Hepatology (SBH) published in 2015 its first recommendations about the management of HCC. Since then, new data have emerged in the literature, prompting the governing board of SBH to sponsor a single-topic meeting in August 2018 in São Paulo. All the invited experts were asked to make a systematic review of the literature reviewing the management of HCC in subjects with cirrhosis. After the meeting, all panelists gathered together for the discussion of the topics and the elaboration of updated recommendations. The text was subsequently submitted for suggestions and approval of all members of the Brazilian Society of Hepatology through its homepage. The present manuscript is the final version of the reviewed manuscript containing the recommendations of SBH.

Management of Hepatocellular Carcinoma during the COVID-19 Pandemic - São Paulo Clínicas Liver Cancer Group Multidisciplinary Consensus Statement

“…○ Consider performing surgery for patients who have preserved liver function, have no clinically significant portal hypertension or other comorbidities, are young, and present with favorable locations for resection ( 19 , 21 ).…”

“…Liver Transplantation is the treatment of choice for patients with early HCC (BCLC-A) and impaired liver function (Child-Pugh B/C), clinically significant portal hypertension, and those with early HCC who are not candidates for resection ( 18 , 19 ).…”

“…The selection criteria for LT in HCC that was adopted by Brazil is an expanded version of the classic Milan Criteria. In the so-called “Brazilian Milan Criteria,” patients are eligible for an “HCC exception score” if they present with one nodule 2-5 cm in size or up to three nodules 2-3 cm in size, plus any number of nodules <2 cm in size ( 19 ).…”

“…The percutaneous ablative therapies that are most commonly performed in our country are RFA and percutaneous ethanol injection (PEI) ( 19 ); the standard indications for their use are maintained during the COVID-19 pandemic ( 18 - 20 ). Some of the characteristics of these procedures, such as decreased invasiveness, lower morbidity rates, and shorter length of hospital stay, make them valuable options during the pandemic ( 24 ).…”

“…Of these therapies, the most widely used in our country are TACE and TAE. Other treatments include drug-eluting bead embolization and transarterial radioembolization ( 19 ). Unfortunately, these treatments are not available within the HC-FMUSP complex and thus were not included in this guideline.…”