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Abstract Details
Clinical consensus statement: Establishing the roles of locoregional and systemic therapies for the treatment of intermediate-stage hepatocellular carcinoma in Canada
Cancer Treat Rev. 2023 Apr;115:102526. doi: 10.1016/j.ctrv.2023.102526.Epub 2023 Mar 2.
1University of Calgary, 2500 University Dr NW, Calgary, AB T2N 1N4, Canada. Electronic address: wongjk@ucalgary.ca.
2BC Cancer Agency, 600 West 10th Avenue, Vancouver, BC V5Z 4E6, Canada. Electronic address: hlim@bccancer.bc.ca.
3Tom Baker Cancer Centre, University of Calgary, 1331 29 St NW, Calgary, AB T2N 4N2, Canada. Electronic address: Vincent.Tam@albertahealthservices.ca.
4University of Calgary, 2500 University Dr NW, Calgary, AB T2N 1N4, Canada. Electronic address: kwburak@ucalgary.ca.
5Princess Margaret Cancer Centre, University of Toronto, 610 University Ave, Toronto, ON M5G 2C1, Canada. Electronic address: laura.dawson@rmp.uhn.ca.
6McGill University, 845 Rue Sherbrooke O, Montréal, QC H3A 0G4, Canada. Electronic address: prosanto.chaudhury@mcgill.ca.
7Department of Diagnostic Radiology, Dalhousie University, 6299 South St, Halifax, NS B3H 4R2, Canada. Electronic address: robert.abraham@dal.ca.
8Juravinski Cancer Centre, 699 Concession St, Hamilton, ON L8V 5C2, Canada. Electronic address: meyersbr@hhsc.ca.
9University of Toronto, 27 King's College Cir, Toronto, ON M5S, Canada. Electronic address: gonzalo.sapisochin@uhn.ca.
10McGill University, 845 Rue Sherbrooke O, Montréal, QC H3A 0G4, Canada. Electronic address: david.valenti@mcgill.ca.
11Hopital Sacre-Coeur de Montreal, University of Montreal, 5400 Boul Gouin O, Montréal, QC H4J 1C5, Canada. Electronic address: setareh.samimi.cnmtl@ssss.gouv.qc.ca.
12Department of Medicine, Dalhousie University, 6299 South St, Halifax, NS B3H 4R2, Canada. Electronic address: Ravi.Ramjeesingh@nshealth.ca.
14Kaleidoscope Strategic, Inc. 1 King Street W, Suite 4800 - 117, Toronto, ON M5H 1A1, Canada. Electronic address: ilidio@kstrategic.com.
15University of Calgary, 2500 University Dr NW, Calgary, AB T2N 1N4, Canada. Electronic address: Elijah.dixon@albertahealthservices.ca.
16Department of Surgery, Vancouver General Hospital, Jim Pattison Pavilion, 899 W 12th Ave, Vancouver, BC V5Z 1M9, Canada. Electronic address: maja.segedi@vch.ca.
17School of Biomedical Engineering, University of British Columbia, 2329 West Mall Vancouver, BC V6T 1Z4, Canada. Electronic address: david.liu@ubc.ca.
Abstract
Background: Hepatocellular carcinoma (HCC) a leading cause of cancer mortality worldwide and approximately one-third of patients present with intermediate-stage disease. The treatment landscape of intermediate-stage HCC is rapidly evolving due to developments in local, locoregional and systemic therapies. Treatment recommendations focused on this heterogenous disease stage and that take into account the Canadian reality are lacking. To address this gap, a pan-Canadian group of experts in hepatology, transplant, surgery, radiation therapy, nuclear medicine, interventional radiology, and medical oncology came together to develop consensus recommendations on management of intermediate-stage HCC relevant to the Canadian context.
Methods: A modified Delphi framework was used to develop consensus statements with strengths of recommendation and supporting levels of evidence graded using the AHA/ACC classification system. Tentative consensus statements were drafted based on a systematic search and expert input in a series of iterative feedback cycles and were then circulated via online survey to assess the level of agreement.
Results & conclusion: The pre-defined ratification threshold of 80 % agreement was reached for all statements in the areas of multidisciplinary treatment (n = 4), intra-arterial therapy (n = 14), biologics (n = 5), radiation therapy (n = 3), surgical resection and transplantation (n = 7), and percutaneous ablative therapy (n = 4). These generally reflected an expansion in treatment options due to developments in previously established or emergent techniques, introduction of new and more active therapies and increased therapeutic flexibility. These developments have allowed for greater treatment tailoring and personalization as well as a paradigm shift toward strategies with curative intent in a wider range of disease settings.