MANDARIN (S6371)

Prior treatment

• Prior interventional therapy via hepatic artery or radiotherapy treatment for HCC
• Radiation pneumonitis has been seen in patients receiving doses to the lungs greater than 30 Gy in a single treatment or greater than 50Gy in multiple treatment
• Receive any investigational therapy or anti-tumor therapy within 30 days prior to study enrollment

Other illness

• Presence of extra-hepatic metastases or additional malignancies aside from HCC
• Severe pulmonary insufficiency (FEV1/FVC\<50% or FEV1/predicting value\<50% or MVV\<50L/min)
• Clinical manifestations of decompensated cirrhosis (Grade2/3 of ascites, gastrointestinal bleeding, hepatic encephalopathy, etc. according to EASL Clinical Practice Guidelines)
• Bilobar HCC disease
• Transjugular intrahepatic portosystemic shunt (TIPS) or Hepatic arterioportal fistula

Lab values

• Patients who are allergic to contrast agents or have renal insufficiency (Serum creatinine\>2mg/ml or Creatinine clearance\<30mL/min) and are not suitable for injection of contrast agents
• AST and ALT \>5 times upper limit of normal
• uncorrectable coagulation dysfunction and severe hemogram abnormality \[Prothrombin time (PT)\>6 seconds above control or PT-International normalized ratio (INR)\>2.5, WBC\<3.0x109/L, PLT\<50x109/L\]
• Tc-99m macroaggregated albumin (MAA) hepatic arterial perfusion scintigraphy shows any deposition to the gastrointestinal tract that may not be corrected by angiographic techniques

Other

• Patients with hepatic artery malformation and unable to intubate hepatic artery
• HCC invading biliary tract or causing biliary obstruction
• Infiltrative HCC tumor type
• Any presence of portal vein or hepatic veins or artery invasion
• Occlusion of portal vein completely with less collateral vessels
• Patients during pregnancy or lactation
• The absorbed dose of lung may exceed 30Gy in preoperative evaluation
• Any other reason in which the investigator believes that the patient is unsuitable to participate in this trial

• ≥18 and ≤80 age and provided study consent
• Patients diagnosed with HCC and clinically evaluated as inoperable (as per local practice) or who refuse operation (ablation, hepatectomy and liver transplantation)
• At least one well defined HCC tumor measurable by mRECIST in contrast-enhanced MRI
• China liver cancer staging (CNLC) stage Ib\~IIb
• Child-Pugh ≤ B7
• Eastern Cooperative Oncology Group (ECOG) performance status ≤ 1
• Tumor burden ≤50% of the total liver volume