Child Pugh Score Page 3

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Hepatocellular Carcinoma Algorithm
(Modified from: Barcelona Clinic Liver Cancer (BCLC) Llovet
JM et al. J Natl Cancer Inst. 2008;100:698-711.)
Stage A-C
Stage 0
PST 0-2,
PST 0,
Stage D
Child-Turcotte-Pugh A or B
Child-Turcotte-Pugh A
PST >2,
Child-Turcotte-Pugh C
Intermediate stage (B)
Advanced stage (C)
Early stage (A)
Multinodular, PST 0
Portal invasion,
Very early stage (0)
Terminal
Single nodule <5 cm
N1, M1, PST 1-2
Single <2 cm
or 3 nodules ≤3 cm,
stage (D)
carcinoma in situ
PST 0
3 nodules ≤3 cm
Single
TACE, TABE or TARE
Local Chemo- or Radio-
Increased portal
therapy
Associated
pressure and elevated
Yes
(Chemo or Bead
Sorafenib
diseases
bilirubin levels
embolization,
Chemo
Radioembolization)
Supportive Care
Median survival 11-20 months
Survival <3 months
No
Yes
No
*Sequence: TARE,
*Combinations,
TABE, SBRT ±
SBRT, TARE,
b
b
sorafenib?
TABE?
Liver transplantation
a
RFA (PEI
)
(CLT or LDLT)
Resection
Salvage
Ablation (SBRT,
RF, TABE>TARA
or SBRT)
• < 3 tumors
Salvage
•< 5 cm
a
b
Rarely used.
Confirmation required from RCTs.
Downstage Bridge
SBRT = Stereotactic Body Radiation Therapy
5-year survival 40%-70%
3

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