Contraindications for TACE in HCC

Exclusion criteria/contraindications for TACE in HCC patients

Contraindications for TACE can be categorized based on tumor status, liver disease, patient performance status, procedural aspects, and chemotherapy characteristics. Exclusion criteria based on laboratory values are not definitively established. Greater than 50% liver replacement with tumor, bilirubin level of more than 2 mg/dL, a lactate dehydrogenase level of more than 425 mg/dL, and an aspartate aminotransferase level of more than 100 IU/L have been reported to be strongly associated with increased postprocedural mortality. However, individual abnormalities of these four parameters have not been shown to predict adverse outcome from TACE. A total bilirubin cutoff value of more than 3 mg/dL has been described in the literature, although some operators have performed TACE in patients with total bilirubin of more than 3 mg/dL if they are listed for liver transplantation. Portal vein thrombosis is no longer considered an absolute contraindication; however, highly selective embolization and adjustment of the chemotherapy dose may minimize liver damage.

Exclusion Criteria and Contraindications for TACE

Tumor statusSingle resectable tumor
BCLC class D
Liver diseaseChild-Pugh class C
Active gastrointestinal bleeding
Patient performance statusECOG > 2
ProceduralRenal insufficiency/failure
Uncorrectable coagulopathy
Intractable systemic infection
Severe anaphylactic/anaphylactoid contrast reaction
Doxorubicin relatedWBC < 3000 cells/mm ; neutrophils < 1500 cells/mm 3
Left-ventricular ejection fraction < 50%

BCLC, Barcelona Clinic Liver Cancer; ECOG, Eastern Cooperative Oncology Group; WBC, white blood cell.


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