MCQs for “Transarterial chemoembolization in patients with hepatocellular carcinoma beyond Barcelona-Clinic Liver Cancer-B and portal vein tumor thrombosis: Experience from a tertiary care center” : Indian Journal of Cancer

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MCQs for “Transarterial chemoembolization in patients with hepatocellular carcinoma beyond Barcelona-Clinic Liver Cancer-B and portal vein tumor thrombosis

Experience from a tertiary care center”

Darling, H. S.; Jaiswal1, Pradeep1; Nishant, R.2; Singh3, Roshni3

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Indian Journal of Cancer 59(3):p 408-409, Jul–Sep 2022. | DOI: 10.4103/ijc.ijc_941_22
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1. According to the current standard of care, in the management of hepatocellular carcinoma (HCC), which of the following prognostic groups in the Barcelona Clinic Liver Cancer (BCLC) staging is not amenable to local or surgical management?

  1. Stage D
  2. Stages B, C, and D
  3. Stages C and D
  4. none

Q 2. Which of the following is the treatment of choice for locally advanced HCC with portal vein tumor thrombosis (PVTT)?

  1. Hepatectomy
  2. Trans-arterial chemoembolization (TACE)
  3. Trans-arterial radioembolization (TARE)
  4. Tyrosine kinase inhibitors

Q 3. As per the study which of the following variables did not affect the survival of patients with HCC?

  1. CHILD status
  2. AFP level
  3. ECOG status
  4. Up to seven

Q 4 Which of the following factors are not used in the Barcelona Clinic Liver Cancer (BCLC) staging system for liver cancers?

  1. Patient's functional status
  2. Tumor characteristics
  3. Ascites
  4. Degree of liver cirrhosis

Q 5. Portal vein invasion comes in which stage of HCC according to the BCLC staging system?

  1. Stage A
  2. Stage B
  3. Stage C
  4. Stage D

Q 6. Which chemotherapeutic drugs were used for TACE in this study?

  1. Docetaxel + Mitomycin C
  2. Doxorubicin + Mitomycin C
  3. Doxorubicin + Mitoxantrone
  4. Dacarbazine + Mitomycin C

Q 7. According to the BCLC staging system for HCC, TACE is an indication of which stage?

  1. Stage D
  2. Stage C
  3. Stage B
  4. Stage A

Q 8. What is the 2-year survival reported in this study following TACE?

  1. 10%
  2. 59%
  3. 21%
  4. 34%

Q 9. On the basis of the study, which of the following patients with advanced HCC can be considered for TACE?

  1. Patients with Right or Left PVTT
  2. Patient with Main portal vein PVTT
  3. Patients with AFP >400 and beyond BCLC-C
  4. All of the above

Q 10. Patients with which of the following characteristics in HCC patients are recommended best supportive care (BSC) only per the current standard of care?

  1. BCLC-C
  2. Child-Pugh C
  3. Performance status 2
  4. All of the above

Answers and explanations:

  1. c) Stages C and D
  2. According to the update published by the BCLC group in 2022, BCLC stages C and D are not amenable to treatment by local or surgical therapy and are treated with systemic therapy and best supportive care (BSC), respectively.[1]
  3. c) Trans-arterial radioembolization (TARE)
  4. HCC with portal vein tumor thrombus (PVTT) is generally considered to be advanced and TACE is not recommended routinely. Transarterial radioembolization (TARE) is the treatment of choice for PVTT but is very expensive and not easily available. A positive response of tumors in HCC with PVTT following TACE has also been reported.[2]
  5. a) CHILD status
  6. Table 2.[2]
  7. c) Ascites
  8. Barcelona Clinic Liver Cancer (BCLC) classifies HCC according to tumor characteristics, degree of cirrhosis, and performance status of patients and recommends stage-based treatment. Due to the stringent selection criteria of BCLC, many patients with HCC will be subjected to the best palliative care only. However, a few select patients beyond BCLC-B have been shown to have improved survival following TACE.[2]
  9. c. Stage C
  10. There are 5 stages in the BCLC staging system. Stages 0, A, B, C, and D. Stage 0 includes patients with PS 0 and Child-Pugh A, Stage A-C included patients with PS 0-2 and Child-Pugh's A–B and is divided into early stage (A), intermediate stage (B), and advanced stage (C). TACE is recommended for stage B which includes multinodular disease. Advanced stage C includes patients with portal vein invasion, N1, and M1 disease with PS-1-2. These patients generally go for sorafenib treatment. Stage D is an end-stage disease for supportive care only.[1]
  11. b) Doxorubicin + Mitomycin C
  12. A combination of anthracycline with mitomycin C has been shown to be the best chemotherapeutic drug with the best therapeutic response, the least adverse events, and good overall survival. In this study, 50 mg of doxorubicin and 10 mg of mitomycin were used.[2]
  13. b) Stage C
  14. TACE is an appropriate option for patients with a large unresectable or multifocal HCC without main or lobar branch portal vein thrombus that is not amenable to local ablation. This falls in an intermediate stage of the BCLC staging system and constitutes patients who have a multinodular lesion, preserved hepatic function (Child Pugh's between A and B), and good PS.[1]
  15. d) 34%
  16. The 2-year survival in this study was reported to be 34%. This is less than reported in the literature, the reason being that in this study, patients with more than BCLC B and with PV thrombosis were subjected to TACE.[2]
  17. a) Patients with right or left PVTT
  18. To conclude, TACE could provide improved survival in selective HCC patients beyond BCLC-B. AFP levels and performance status of patients predicted survival in our patients. PVTT not extending to the main portal vein is not a contraindication for TACE.[2]
  19. b) Child-Pugh C
  20. HCC patients who have advanced liver disease (Child's Pugh class C) and/or ECOG performance status >2 are classified as BCLC stage D. Patients in this stage do not benefit from systemic therapy and are treated with best supportive care (BSC) including palliative care.[1]

REFERENCES

1. Reig M, Forner A, Rimola J, Ferrer-Fàbrega J, Burrel M, Garcia-Criado Á, et al BCLC strategy for prognosis prediction and treatment recommendation: The 2022 update J Hepatol. 2022;76:681–93
2. Anand S, Pottakkat B, Raja K, Chandrasekar S, Satheesh S. Transarterial chemoembolization in patients with hepatocellular carcinoma beyond Barcelona-Clinic Liver Cancer- B and portal vein tumor thrombosis: Experience from a tertiary care center Indian J Cancer. 2021
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