Makuuchi et al reported guidelines developed in Japan in 2005. These have subsequently have been updated as targeted therapy has become available. The authors are from the Japanese Red Cross Medical Center in Tokyo.
Patient selection: hepatocellular carcinoma (presumably limited to the liver)
Parameters:
(1) Child-Pugh grade (as a measure of hepatic damage)
(2) number of tumor nodules
(3) diameter of largest tumor nodule
Child-Pugh Grade
Number
Diameter
Management
A or B
single
<= 2 cm
ablation
A or B
single
2.1 to 5 cm
resection
A or B
2 or 3
<= 3 cm
resection, ablation
A or B
2 or 3
> 3 cm
resection, TAE
A or B
>= 4
NA
TAE, HAIC
C
1
<= 5 cm
transplantation
C
2 or 3
<= 3 cm
transplantation
C
other
NA
palliative care
where:
• TAE: transarterial embolization
• HAIC: hepatic arterial infusion chemotherapy
• Not every possible combination of findings is outlined in the table.
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