A 55-year-old man with alcoholic cirrhosis (Child-Pugh A) has a 3 cm solitary hepatocellular carcinoma on MRI showing arterial enhancement with portal-phase washout. No vascular invasion or extrahepatic spread. He is BCLC stage A. According to BCLC guidelines, the first-line treatment options include:
- A Sorafenib systemic therapy as monotherapy
- B Transarterial chemoembolisation (TACE) as the first-line curative treatment
- C Stereotactic body radiotherapy (SBRT) exclusively
- D Surgical resection, liver transplantation (if within Milan criteria), or ablation (RFA/microwave) — all are guideline-recommended curative-intent options ✓
Explanation
BCLC stage A (early HCC) encompasses patients with single HCC or up to 3 nodules ≤3 cm, PS 0, with preserved liver function. BCLC 2022 guidelines recommend resection for patients with adequate liver reserve, liver transplantation for those within Milan criteria (single ≤5 cm or up to 3 nodules ≤3 cm) who are resection candidates or have portal hypertension, and thermal ablation (RFA/microwave) for lesions ≤3 cm. TACE is the recommended treatment for intermediate stage (BCLC B). Sorafenib is first-line for advanced (BCLC C) disease. SBRT is an emerging but not primary guideline recommendation.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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