Caren van Roekel

20 Chapter 2 1.3. Patient selection Currently, radioembolization is mainly indicated in a palliative setting for unresectable, chemorefractory primary and secondary hepatic malignancies (2). Several studies investigate(d) the role of radioembolization combined with systemic therapy in the first and second line treatment of colorectal cancer liver metastases (18) (19). Work-up for radioembolization includes clinical status, hematologic and biochemical status, anatomic assessment with CT/MR imaging and, when appropriate, molecular imaging with SPECT/CT or PET/CT. Indications and contraindications for radioembolization are listed in Table 1, according to Braat et al. (2). Since a higher age has no influence on prognosis, age is not a contraindication (20). In patients with hepatocellular carcinoma (HCC), radioembolization is reserved for patients with intermediate and early advanced disease stages (with Barcelona Clinic Liver Cancer [BCLC] stage B-C, liver-dominant disease, Eastern Cooperative Oncology Group [ECOG] status 1-2, and a portal vein tumor thrombus [PVT]). Patients with a Child-Pugh score >B7 and a main portal vein tumor thrombus tend to have a limited potential survival benefit after radioembolization, thus patient selection should be done carefully (2). It should be noted that, as clinical experience accumulates over the years, indications and contraindications may change over time. 2. WORKUP 2.1. Clinical investigations During clinical investigation, a detailed medical history of the patient should be obtained. Previous treatments, current use of medication, chronic diseases, allergies and recent periods of acute illness should be recorded. Also, the performance status (as defined by the World Health Organization(WHO)/ECOG (21)) should be defined: 0 – asymptomatic, 1 – symptomatic but completely ambulatory, 2 – symptomatic and <50% of time in bed, 3 – symptomatic and >50% of time in bed but not bedbound, 4 – bedbound, 5 – dead. A performance status >2 is considered an exclusion criterion for radioembolization.