What factors determine the choice of treatment in the management of intermediate (BCLC stage B) hepatocellular carcinoma?

For Stage B disease, the major factors that I use to determine treatment (we discuss all such cases at our institutional multidisciplinary liver tumor board) are performance status, Child Pugh score/liver function, and the extent of disease. If patients have PS 0-2 and are CPA/B7, these patients may benefit from liver directed therapies with a lesser risk of decompensation. The type of treatment really depends on the configuration of disease.

In the scenario of 3 or 4 lesions in one lobe/segment which just fall outside of BCLC A criteria, I do consider SBRT to those lesions as per RTOG 1112 which permits treatment of up to 5 lesions

I also use EBRT for patients with large locally advanced tumors or tumors that are clustered unilaterally. Thes...