HCC — SCE Medical Oncology MCQ

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A 72-year-old woman with advanced HCC (Child-Pugh A5, BCLC-B) has multifocal bilobar disease exceeding Milan criteria but confined to the liver. There is no vascular invasion or extrahepatic spread. What locoregional therapy is most appropriate?

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Correct answer: B — Transarterial chemoembolisation (TACE)

BCLC stage B (intermediate) HCC — multifocal disease without vascular invasion or extrahepatic spread in patients with preserved liver function — is the primary indication for TACE. TACE delivers chemotherapy (typically doxorubicin or cisplatin) directly into hepatic artery branches feeding the tumour followed by embolisation. TACE improved survival compared with best supportive care in the Llovet meta-analysis. Drug-eluting bead TACE (DEB-TACE) is a widely used variant.

Reference: NICE NG Liver cancer pathway; ESMO 2024 HCC Guidelines; BCLC staging system; Llovet et al Hepatology 2003