Revolutionizing Liver Cancer Care in India: The 2023 INASL Guidelines for Hepatocellular Carcinoma

2024 | Vol-1 | Issue-1 | Date of Submission: | Date of Publication:

Abstract

The 2023 INASL guidelines for Hepatocellular Carcinoma (HCC) represent a pivotal update in the management of liver cancer, particularly in the Indian context. The introduction of the INASL-BCLC staging system is a major development, offering a more relevant framework for the Indian population compared to the traditional BCLC staging. This new system is significant for its incorporation of combination treatments and a downstaging component, which were notably absent in previous guidelines. The guidelines highlight the growing importance of combination therapies in HCC treatment. The integration of locoregional therapies, such as TACE (Transarterial Chemoembolization), with systemic treatments, including novel targeted therapies and immunotherapies, is emphasized. This approach has demonstrated improved outcomes in survival rates, particularly in intermediate and advanced stages of HCC. Another notable aspect is the inclusion of Stereotactic Body Radiation Therapy (SBRT) in the treatment algorithm. The emerging evidence supporting the efficacy of SBRT presents new avenues for patient care, especially for those who are not candidates for conventional treatments. The guidelines also delve into the nuances of patient selection for various therapies, stressing the need for individualized treatment plans. They underline the importance of multidisciplinary team involvement in decision-making, ensuring that each patient receives the most appropriate treatment based on their specific clinical profile. Additionally, the guidelines address the need for vigilant surveillance and early diagnosis of HCC. The role of advanced imaging techniques and biomarkers in early detection and monitoring of treatment response is underscored, highlighting the shift towards more personalized and precise management of HCC. Overall, the 2023 INASL guidelines for HCC set forth a comprehensive, evidence-based approach to the management of liver cancer in India. They reflect significant progress in the field, acknowledging the latest scientific advancements and tailoring recommendations to the unique needs of the Indian population.