Management of primary hepatic malignancies during the COVID-19 pandemic: recommendations for risk mitigation from a multidisciplinary perspective

Aisling Barry; Smith Apisarnthanarax; Grainne M O'Kane; Gonzalo Sapisochin; Robert Beecroft; Riad Salem; Sang Min Yoon; Young-Suk Lim; John Bridgewater; Brian Davidson; Marta Scorsetti; Luigi Solbiati; Adam Diehl; Pablo Munoz Schuffenegger; Jonathan G Sham; David Cavallucci; Zita Galvin; Laura A Dawson; Maria A Hawkins

doi:10.1016/S2468-1253(20)30182-5

Management of primary hepatic malignancies during the COVID-19 pandemic: recommendations for risk mitigation from a multidisciplinary perspective

Lancet Gastroenterol Hepatol. 2020 Aug;5(8):765-775. doi: 10.1016/S2468-1253(20)30182-5. Epub 2020 Jun 6.

Authors

Aisling Barry¹, Smith Apisarnthanarax², Grainne M O'Kane³, Gonzalo Sapisochin⁴, Robert Beecroft⁵, Riad Salem⁶, Sang Min Yoon⁷, Young-Suk Lim⁸, John Bridgewater⁹, Brian Davidson¹⁰, Marta Scorsetti¹¹, Luigi Solbiati¹², Adam Diehl¹³, Pablo Munoz Schuffenegger¹⁴, Jonathan G Sham¹⁵, David Cavallucci¹⁶, Zita Galvin¹⁷, Laura A Dawson¹⁸, Maria A Hawkins¹⁹

Affiliations

¹ Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada; Radiation Medicine Program, Toronto General Hospital, University Health Network, Toronto, ON, Canada. Electronic address: aisling.barry@rmp.uhn.ca.
² Seattle Cancer Care Alliance, and Department of Radiation Oncology, University of Washington, Seattle, WA, USA.
³ Department of Medical Oncology and Haematology, Toronto General Hospital, University Health Network, Toronto, ON, Canada.
⁴ Princess Margaret Cancer Centre, and Department of Surgery, Toronto General Hospital, University Health Network, Toronto, ON, Canada.
⁵ Department of Medical Imaging, Toronto General Hospital, University Health Network, Toronto, ON, Canada.
⁶ Department of Interventional Radiology, Northwestern University, Chicago, IL, USA.
⁷ Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
⁸ Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
⁹ UCL Cancer Institute, University College London, London, UK.
¹⁰ Department of Surgical Biotechnology, UCL Division of Surgery and Interventional Science, University College London, London, UK.
¹¹ Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center, IRCCS Humanitas Research Hospital, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy.
¹² Radiology Department, Humanitas Clinical and Research Center, IRCCS Humanitas Research Hospital, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy.
¹³ Department of Medical Oncology, University of Washington, Seattle, WA, USA.
¹⁴ Radiation Oncology Unit, Department of Hematology Oncology, Pontifical Catholic University of Chile, Santiago, Chile.
¹⁵ Department of Surgery, University of Washington, Seattle, WA, USA.
¹⁶ Department of Surgery, Royal Brisbane and Women's Hospital, University of Queensland, Brisbane, QLD, Australia.
¹⁷ Multi-Organ Transplant Program, Toronto General Hospital, University Health Network, Toronto, ON, Canada.
¹⁸ Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada; Radiation Medicine Program, Toronto General Hospital, University Health Network, Toronto, ON, Canada.
¹⁹ UCL Cancer Institute, University College London, London, UK; Department of Medical Physics and Biomedical Engineering, University College London, London, UK.

Abstract

Around the world, recommendations for cancer treatment are being adapted in real time in response to the pandemic of COVID-19. We, as a multidisciplinary team, reviewed the standard management options, according to the Barcelona Clinic Liver Cancer classification system, for hepatocellular carcinoma. We propose treatment recommendations related to COVID-19 for the different stages of hepatocellular carcinoma (ie, 0, A, B, and C), specifically in relation to surgery, locoregional therapies, and systemic therapy. We suggest potential strategies to modify risk during the pandemic and aid multidisciplinary treatment decision making. We also review the multidisciplinary management of intrahepatic cholangiocarcinoma as a potentially curable and incurable diagnosis in the setting of COVID-19.

Publication types

Review

MeSH terms

Betacoronavirus
Bile Duct Neoplasms / therapy
COVID-19
Carcinoma, Hepatocellular / pathology
Carcinoma, Hepatocellular / therapy*
Cholangiocarcinoma / therapy
Clinical Decision-Making
Coronavirus Infections / epidemiology*
Humans
Liver Neoplasms / pathology
Liver Neoplasms / therapy*
Neoplasm Staging
Pandemics*
Patient Care Team
Pneumonia, Viral / epidemiology*
Risk Factors
SARS-CoV-2