2020 saw the world of cancer adapt real-time in response to the COVID-19 pandemic, as cancer diagnosis and treatment continued but now with additional clinical, technical and safety challenges for patients and medical teams. Primary intra-hepatic malignancies are one of the highest leading causes of cancer deaths worldwide and the management requires a multi-disciplinary approach. We recognised that each discipline involved in the treatment pathways are uniquely and adversely affected by the pandemic.
In an effort to combine and develop guidelines for the management of these patients, a collaboration of 19 liver multi-disciplinary specialists from high-volume liver malignancy academic centres across five continents and seven countries at different stages of the pandemic came together.
We proposed 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 suggested potential strategies to modify risk during the pandemic and aid multidisciplinary treatment decision making. We also reviewed the multidisciplinary management of intrahepatic cholangiocarcinoma as a potentially curable and incurable diagnosis in the setting of COVID-19.
COVID-19 continues to directly affect all multi-disciplinary aspects of cancer care, therefore clinicians must continue to work together. These recommendations, that are based on the most up-to-date evidence, aim to provide guidance for centres across the world and should be used flexibly according to the dynamic state of COVID-19 in each centre.