A patient with Child-Pugh A cirrhosis has a 4.5 cm single hepatocellular carcinoma (HCC) within the Milan criteria. ECOG performance status is 0. Locoregional therapies are available. According to BCLC (Barcelona Clinic Liver Cancer) 2022 staging update, what is the first-line curative-intent treatment if liver transplantation waiting time exceeds 6 months?
- A Transarterial chemoembolisation (TACE) as bridging therapy
- B Sorafenib targeted therapy
- C Stereotactic body radiotherapy (SBRT)
- D Surgical resection, as it is the first-line curative option in BCLC A with preserved liver function ✓
Explanation
The BCLC 2022 updated guideline reclassified surgical resection as the preferred first-line treatment for BCLC-A (early stage) HCC in patients with preserved liver function (Child-Pugh A), single tumour, and adequate functional hepatic reserve, rather than limiting resection only to patients not eligible for transplant. Liver transplantation (within Milan criteria) remains curative if available promptly; if waiting time is prolonged, resection or ablation are preferred to avoid tumour progression. TACE is palliative, not curative. Sorafenib is for advanced (BCLC C) stage. SBRT is an emerging option but not yet first-line in current guidelines.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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