title: Multidisciplinary management of hepatocellular carcinoma in clinical practice.
abstract: BACKGROUND
  Hepatocellular carcinoma (HCC) patients require different treatment strategies according to disease extension, liver function, and patient's fitness. We evaluated HCC multidisciplinary management in clinical practice.
  
  
  METHODS
  Consecutive patients were followed and treated with tailored medical, locoregional, and surgical treatments, according to disease stage and patient's fitness (age, Cumulative Illness Rating Scale (CIRS)). Activity, efficacy, and safety were evaluated.
  
  
  RESULTS
  Thirty-eight patients were evaluated: median age, 74; elderly 92%; CIRS secondary 28 (74%); Child-Pugh A 20 (53%), B 11 (29%); and Barcelona Clinic Liver Cancer (BCLC) 0 2 (5%), A 9 (24%), B 10 (26%), C 13 (34%), and D 4 (11%). Overall survival (OS) was 30 months. At 9 months median follow-up, among 25 unresectable HCC, OS was 10 months; BCLC B-D unfit for sorafenib showed OS 3 months. Ten patients (40%) received sorafenib: Child-Pugh A 5 (50%) and B 5 (50%) and disease control rate 89%, progression-free survival 7 months, and OS 9 months. G3-4 toxicities: anorexia, hypertransaminaemia, hyperbilirubinemia, and hypercreatininemia. Limiting toxicity syndromes were 40%, all multiple sites.
  
  
  CONCLUSIONS
  HCC patients require multidisciplinary clinical management to properly select tailored treatments according to disease stage, fitness, and liver function. Patients suitable for sorafenib should be carefully selected, monitored for individual safety, and prevalently characterized by limiting toxicity syndromes multiple sites.
authors.affiliation: Medical Oncology, S. Salvatore Hospital, University of L'Aquila, 67100 L'Aquila, Italy ; Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, 67100 L'Aquila, Italy.
authors.forename: Gemma
authors.identifier: 0000-0002-8407-2479
authors.initials: G
authors.lastname: Bruera
authors.affiliation: Medical Oncology, S. Salvatore Hospital, University of L'Aquila, 67100 L'Aquila, Italy.
authors.forename: Katia
authors.initials: K
authors.lastname: Cannita
authors.affiliation: Radiology, S. Salvatore Hospital, 67100 L'Aquila, Italy.
authors.forename: Aldo Victor
authors.initials: AV
authors.lastname: Giordano
authors.affiliation: Radiology, S. Salvatore Hospital, 67100 L'Aquila, Italy.
authors.forename: Rosa
authors.initials: R
authors.lastname: Manetta
authors.affiliation: Hepatobiliar-Pancreatic Surgery, S. Salvatore Hospital, 67100 L'Aquila, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Vicentini
authors.affiliation: Radiology, S. Salvatore Hospital, 67100 L'Aquila, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Carducci
authors.affiliation: Gastroenterology, S. Salvatore Hospital, 67100 L'Aquila, Italy.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Saltarelli
authors.affiliation: Infective Disease, S. Salvatore Hospital, 67100 L'Aquila, Italy.
authors.forename: Nerio
authors.initials: N
authors.lastname: Iapadre
authors.affiliation: Pathology, S. Salvatore Hospital, 67100 L'Aquila, Italy.
authors.forename: Gino
authors.initials: G
authors.lastname: Coletti
authors.affiliation: Medical Oncology, S. Salvatore Hospital, University of L'Aquila, 67100 L'Aquila, Italy ; Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, 67100 L'Aquila, Italy.
authors.forename: Corrado
authors.initials: C
authors.lastname: Ficorella
authors.affiliation: Medical Oncology, S. Salvatore Hospital, University of L'Aquila, 67100 L'Aquila, Italy ; Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, 67100 L'Aquila, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Ricevuto
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000188:drug therapy* / Q000473:pathology* / Q000628:therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000473:pathology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009536:Niacinamide / Q000031:analogs & derivatives / Q000627:therapeutic use; D010671:Phenylurea Compounds / Q000627:therapeutic use; D012720:Severity of Illness Index; D000077157:Sorafenib
chemical_list: D000970:Antineoplastic Agents; D010671:Phenylurea Compounds; D009536:Niacinamide; D000077157:Sorafenib