According to China’s “Diagnostic and Treatment Guidelines for Primary Liver Cancer (2017 Edition)”, the indications and contraindications for primary liver cancer intervention are as follows.
Which patients with liver cancer are suitable for interventional therapy?
- Patients with intermediate stage hepatocellular carcinoma (some patients in stages IIb, IIIa, and IIIb) with good hepatic reserve function (liver function class Child-Pugh A or B) and good physical status of the patient (ECOG score 0 to 2);
- Patients with early-stage hepatocellular carcinoma (stages Ib and IIa) who can be surgically resected but are unable or unwilling to undergo surgery for other reasons (e.g., advanced age, severe cirrhosis, etc.);
- Multiple nodular hepatocellular carcinoma;
- Incomplete obstruction of the main portal vein, or compensatory collateral vascularization between the hepatic artery and portal vein despite complete obstruction;
- hemorrhage from ruptured liver tumor or bleeding from portal hypertension due to hepatic artery-portal vein static shunt;
- Control of local pain, bleeding, and embolization of arteriovenous fistulas;
- After resection of hepatocellular carcinoma, interventional imaging can detect residual cancer or recurrent foci at an early stage and give interventional treatment.
Which patients with hepatocellular carcinoma are not suitable for interventional therapy?
- Severe hepatic dysfunction (Child-Pugh Grade C), including jaundice, hepatic encephalopathy, refractory ascites, or hepatorenal syndrome;
- Severely impaired coagulation that cannot be corrected;
- Complete embolization of the portal vein trunk by cancerous emboli with little collateral vessel formation;
- Combined with active hepatitis or severe infection and cannot be treated simultaneously;
- Extensive distant metastases with an estimated survival of no less than 3 months;
- Patients with cachexia or multi-organ failure;
- Patients with tumors that are distant and widespread, with an estimated survival of less than 3 months;
- Tumor occupying more than 70% of the whole liver (if liver function is basically normal, a small amount of iodine oil emulsion may be considered for fractional embolization);
- Significant reduction in peripheral blood leukocytes and platelets, with leukocytes below 3.0×10/L (not an absolute contraindication, as in hypersplenism, which differs from chemotherapeutic leukopenia) and platelets below 50×10/L;
- Renal dysfunction: creatinine above 2mg/dl or creatinine clearance below 30ml/min.