INTRODUCTION External beam radiotherapy (EBRT) is actively used for hepatocellular carcinoma (HCC) treatment in clinical practice but has not got attention in several guidelines owing to the lack of high-level evidences. We evaluated HCC treatment guidelines from the radiation oncology perspective using the Appraisal of Guidelines for Research and Evaluation (AGREE II) model, to provide information to choose suitable guidelines and for future guidelines developments. METHODS Guidelines and consensuses for HCC management involving EBRT that have been published until May 2019 were included. Seven appraisers from 6 countries participated; all were radiation oncologists specialized in HCC. Guidelines were assessed using the AGREE II (December 2017 update), and we added an additional domain, "Radiotherapy Content," to evaluate the fidelity of evidence and participation of relevant specialists. Inconsistency among appraisers was evaluated, and standard deviations (SD) among the average scores of each domain were calculated. RESULTS Eighteen guidelines or consensuses were included; 4 of them (NCCN, EASL, AASLD, and KLCSG)* were considered applicable without modification. Overall scores were evenly and significantly affected by all domain scores, with "Rigour of Development" showing the most significant correlation. The median scores were the highest for "Scope and Purpose" (63.9%) and "Clarity of Presentation" (65.7%) and the lowest for "Applicability" (36.1%). Inconsistency among appraisers was higher in "Editorial Independence" (median SD: 1.96) than in other domains. CONCLUSION Although the median overall score was moderate (64.3%), further efforts are necessary as all domains had scores <50% except "Scope and Purpose" and "Clarity of Presentation". Future guidelines need to consider more on "Applicability" because modern HCC treatment requires multidisciplinary approaches involving up-to-date techniques and systemic agents. The independency of development and role of funders should be comprehensively described in future guidelines. *National Cancer Comprehensive Network, European Association for the Study of the Liver, American Association for the Study of the Liver Disease, Korean Liver Cancer Study Group.

中文翻译：

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从放射肿瘤学角度评估肝细胞癌实践指南

引言 外照射放疗（EBRT）在临床实践中积极用于肝细胞癌（HCC）治疗，但由于缺乏高水平证据，在一些指南中并未得到重视。我们使用研究和评估指南评估 (AGREE II) 模型从放射肿瘤学的角度评估 HCC 治疗指南，为选择合适的指南和未来的指南制定提供信息。方法 包括已发布至 2019 年 5 月的涉及 EBRT 的 HCC 管理指南和共识。来自6个国家的7位评估师参加；所有人都是专门研究 HCC 的放射肿瘤学家。使用 AGREE II（2017 年 12 月更新）评估指南，我们添加了一个额外的域，“放射治疗内容”，评估证据的真实性和相关专家的参与。评估评估者之间的不一致，并计算每个领域的平均分数之间的标准差 (SD)。结果 纳入了 18 项指南或共识；其中 4 个（NCCN、EASL、AASLD 和 KLCSG）* 被认为无需修改即可适用。总体得分受到所有领域得分的均匀和显着影响，其中“发展的严谨性”显示出最显着的相关性。“范围和目的”(63.9%) 和“表达的清晰度”(65.7%) 的中位数得分最高，“适用性”(36.1%) 的得分最低。“编辑独立性”（中值 SD：1.96）中评估师之间的不一致程度高于其他领域。结论 尽管总分中位数为中等 (64.3%)，但由于除“范围和目的”和“表述的清晰度”外，所有领域的得分均小于 50%，因此需要进一步努力。未来的指南需要更多地考虑“适用性”，因为现代 HCC 治疗需要涉及最新技术和全身药物的多学科方法。发展的独立性和资助者的作用应在未来的指南中进行全面描述。*国家癌症综合网络、欧洲肝脏研究协会、美国肝病研究协会、韩国肝癌研究小组。未来的指南需要更多地考虑“适用性”，因为现代 HCC 治疗需要涉及最新技术和全身药物的多学科方法。发展的独立性和资助者的作用应在未来的指南中进行全面描述。*国家癌症综合网络、欧洲肝脏研究协会、美国肝病研究协会、韩国肝癌研究小组。未来的指南需要更多地考虑“适用性”，因为现代 HCC 治疗需要涉及最新技术和全身药物的多学科方法。发展的独立性和资助者的作用应在未来的指南中进行全面描述。*国家癌症综合网络、欧洲肝脏研究协会、美国肝病研究协会、韩国肝癌研究小组。