TABLE 5.
Baseline factors that contribute to unsuitability for TACE
| Proposed factors for TACE unsuitability | |
|---|---|
| Tumor size | Beyond UNOS-DS criteria |
| Tumor appearance | Multinodular, bilobar, with > 50% liver involvement Infiltrative or nodular with poorly defined margins |
| Tumor marker | Marked AFP elevationsa |
| PVTT | Large vessel vascular invasion, e.g., main PVTT or hepatic vein tumor thrombus |
| Liver function | ALBI 2–3, especially if tumor exceeds segmental treatment zone Deteriorating liver function over time |
| Proposed factors for Y90 unsuitability | |
| Lung shunt | >25 Gray in a single treatment >30 Gray cumulative in multiple treatments |
| Nontarget treatment | Infusion zone includes gastric/duodenal branches unable to correct with embolization |
| PVTT | Large vessel vascular invasion, e.g., main PVTT/Vp4 or hepatic vein tumor thrombus Inability to deliver boosted dose and/or lack of uptake in the PVTT on 99mTc macroaggregated albumin scan |
| Liver function | ALBI 2–3, especially if tumor exceeds segmental treatment zone Deteriorating liver function over time |
Abbreviations: AFP, alpha fetoprotein; ALBI, albumin-bilirubin; PVTT, portal vein tumor thrombosis; TACE, transarterial chemoembolization; Y90, yttrium-90.
a
No specific cutoff has been identified although marked elevations or increasing AFP may suggest increased risk of metastatic spread and/or poor response to locoregional therapy.