Version July 2025
HAIC: hepatic arterial infusional chemotherapy; HCC: hepatocellular carcinoma; PVE: portal vein embolization; PVTT: portal vein tumor thrombus; RFA: radiofrequency ablation; SBRT: stereotactic body radiation therapy; TACE: transcatheter arterial chemoembolization; TARE: transarterial radioembolization.
* Selected patients with Child-Pugh class B cirrhosis may be amenable to limited resection.
¶ Bridging therapy refers to the administration of local treatment (typically RFA or TACE) while awaiting orthotopic liver transplantation in order to reduce risk of progressing beyond Milan criteria.
Δ In the United States, patients with underlying chronic liver disease (cirrhosis, hepatitis C virus infection) are potentially eligible for orthotopic liver transplant if they fulfill the Milan criteria (ie, solitary HCC ≤5 cm in diameter or up to three separate lesions none of which is larger than 3 cm, no evidence of gross vascular invasion, and no regional nodal or distant metastases). Patients who meet extended liver transplantation criteria may undergo downstaging therapy (eg, RFA, arterially-directed therapies) followed by reassessment for liver transplantation.
◊ The selection of systemic therapy is based on performance status, liver function, and tumor molecular alterations. For further details, refer to UpToDate content on systemic therapy for advanced unresectable and metastatic HCC.
§ RFA is most effective at treating smaller tumors, and many institutions restrict RFA to lesions <4 cm.
