Caren van Roekel

21 Radioembolization TABLE 1. Common indications and relative and absolute contraindications for radioembolization Indication Relative contraindication Absolute contraindication Disease not amenable to surgical resection, liver transplantation, or curative ablative strategies Portal vein thrombosis of main branch (no contraindication in HCC) Extensive and untreated portal hypertension Disease not amenable to or refractory to chemotherapeutic alternatives, or patient not willing to receive these alternatives Abnormalities of bile ducts or stents; exceptions: papillotomy and cholecystectomy Life expectancy < 3 months Compensated or early decompensated liver cirrhosis (Child-Pugh ≤B7) Serum bilirubin >34.2 µmol/L (2 mg/dL) Active hepatitis Performance state (ECOG) ≤2 Leukocytes <2x10 9 /L or platelet count <50x10 9 /L Liver-only or liver-dominant disease Glomerular filtration rate <35 mL/min Uncorrectable gastrointestinal microsphere deposition; expected lung dose >30 Gy (or 50 Gy cumulative) Preoperative indications, such as downstaging before surgery or the inducement of contralateral hypertrophy before surgery INR (internationalized normalized ratio) >1.5 Active use of antiangiogenic agents (bevacizumab, aflibercept) Celiac axis and superior mesenteric artery occluded Occluded intrahepatic arterial network Interval since last dose of systemic therapy < 4 weeks 2.2. Laboratory investigations The laboratory investigations are needed to assess hepatobiliary function (aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, gamma-glutamyl transferase, total bilirubin, lactate dehydrogenase and albumin), renal function (creatinine, estimated glomerular filtration ratio), hematological function (white cell count, hemoglobin and hematocrit) and coagulation status (internationalized normalized ratio, thrombin time, prothrombin time, activated partial thromboplastin time and platelet count). 2