Stage-specific treatment approach to alveolar echinococcosis

WHO Classification	Surgery	Interventional treatment	Drug therapy	Suggested	Resources setting
P1N0M0	X		X	Radical resection (R0) BMZ for 2 years PET/CT controls	Optimal
				Radical resection (R0) BMZ for 3 months	Minimal
P2N0M0	X		X	Radical resection (R0) BMZ for 2 years	Optimal
				Radical resection (R0) BMZ for 3 months	Minimal
P3N0M0			X	BMZ continuously PET/CT/MRI scan initially and in 2 years intervals	Optimal
				BMZ continuously	Minimal
P3N1M0		X	X	BMZ continuously plus PET/CT/MRI scan initially and in 2 years intervals	Optimal
				Surgery, if indicated	Minimal
P4N0M0		X	X	BMZ continuously plus PET/CT/MRI scan initially and in 2 years intervals	Optimal
				Surgery, if indicated	Minimal
P4N1M1		X	X	BMZ continuously plus PET/CT/MRI scan initially and in 2 years intervals	Optimal
				Surgery, if indicated	Minimal

R0: no residue following resection; BMZ: benzimidazoles; PET: positron emission tomography; CT: computed tomography; MRI: magnetic resonance imaging.

Reproduced from: Brunetti E, Kern K, Vuitton DA, Writing Panel for the WHO-IWGE. Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans. Acta Tropica 2009; 114:1. Table used with the permission of Elsevier Inc. All rights reserved.

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Stage-specific treatment approach to alveolar echinococcosis