Purpose: Hepatic Arteriography and C-Arm CT-Guided Ablation of liver tumors (HepACAGA) is a novel technique, combining hepatic–arterial contrast injection with C-arm CT-guided navigation. This study compared the outcomes of the HepACAGA technique with patients treated with conventional ultrasound (US) and/or CT-guided ablation. Materials and Methods: In this retrospective cohort study, all consecutive patients with hepatocellular carcinoma (HCC) or colorectal liver metastases (CRLM) treated with conventional US-/CT-guided ablation between 1 January 2015, and 31 December 2020, and patients treated with HepACAGA between 1 January 2021, and 31 October 2023, were included. The primary outcome was local tumor recurrence-free survival (LTRFS). Secondary outcomes included the local tumor recurrence (LTR) rate and complication rate. Results: 68 patients (120 tumors) were included in the HepACAGA cohort and 53 patients (78 tumors) were included in the conventional cohort. In both cohorts, HCC was the predominant tumor type (63% and 73%, respectively). In the HepACAGA cohort, all patients received microwave ablation. Radiofrequency ablation was the main ablation technique in the conventional group (78%). LTRFS was significantly longer for patients treated with the HepACAGA technique (p = 0.015). Both LTR and the complication rate were significantly lower in the HepACAGA cohort compared to the conventional cohort (LTR 5% vs. 26%, respectively; p < 0.001) (complication rate 4% vs. 15%, respectively; p = 0.041). Conclusions: In this study, the HepACAGA technique was safer and more effective than conventional ablation for HCC and CRLM, resulting in lower rates of local tumor recurrence, longer local tumor recurrence-free survival and fewer procedure-related complications.

Purpose: Trans-arterial radioembolization is a well-studied tumoricidal treatment for liver malignancies; however, consensus and evidence regarding periprocedural prophylactic medication (PPM) are lacking. Methods: A single-center retrospective analysis from 2014 to 2020 was performed in patients treated with ⁹⁰Y-glass microspheres for neuroendocrine or colorectal liver metastases. Inclusion criteria were the availability of at least 3 months of clinical, biochemical, and imaging follow-up and post-treatment ⁹⁰Y-PET/CT imaging for the determination of the whole non-tumorous liver absorbed dose (D_h). Logistic regression models were used to investigate if variables (among which are P/UDCA and D_h) were associated with either clinical toxicity, biochemical toxicity, or hepatotoxicity. Additionally, a structured literature search was performed in November 2022 to identify all publications related to PPM use in radioembolization treatments. Results: Fifty-one patients received P/UDCA as post-treatment medication, while 19 did not. No correlation was found between toxicity and P/UDCA use. D_h was associated with biochemical toxicity (p = 0.05). A literature review resulted in eight relevant articles, including a total of 534 patients, in which no consistent advice regarding PPM was provided. Conclusion: In this single-center, retrospective review, P/UDCA use did not reduce liver toxicity in patients with metastatic liver disease. The whole non-tumorous liver-absorbed dose was the only significant factor for hepatotoxicity. No standardized international guidelines or supporting evidence exist for PPM in radioembolization.

First-line treatment strategies for (very) early-stage hepatocellular carcinoma (HCC) include liver transplantation, surgical resection and thermal ablation. Stereotactic body radiotherapy (SBRT) has recently been included in the European Association for the Study of the Liver Clinical Practice Guidelines on the management of hepatocellular carcinoma as an alternative ablative strategy. We aimed to carry out a systematic review and meta-analysis on oncological outcomes and toxicity of SBRT focused on early-stage HCC treatment. We carried out a systematic literature search in PubMed, Embase, and the Cochrane Library from inception throughout October 2022. Studies of SBRT targeting treatment-naive (very) early-stage HCC (BCLC 0/A) patients were included. One prospective and 15 retrospective studies were included in this review. In aggregate, SBRT in 1249 patients resulted in a 1-, 2-, and 3-year local control rate of 94% (95% CI 92%-97%), 89% (95% CI 85%-93%), and 79% (95% CI 68%-90%), respectively. The pooled results of the 1-, 2-, and 3-year overall survival rate were 90% (95% CI 85%-94%), 75% (95% CI 63%-87%), and 59% (95% CI 45%-73%), respectively. Grade ≥3 toxicity was observed in 2% of patients (95% CI 0%-4%). This systematic review and meta-analysis showed that SBRT is an effective and safe treatment modality for treatment-naive patients with early-stage HCC. The data support incorporation of SBRT as a treatment option in the treatment algorithms for (very) early-stage HCC.

Purpose: Hepatobiliary scintigraphy (HBS) provides quantitative assessment of (future remnant) liver function, aiding clinical decision-making for surgical resection and radioembolization of hepatocellular carcinoma (HCC). However, its role for thermal ablation remains unexplored. This pilot study aimed to explore the potential role of HBS in guiding patient selection and risk stratification for thermal ablation. Methods: All HCC patients who underwent thermal ablation between January 2021 and August 2025 and had HBS performed prior to ablation were retrospectively reviewed. Ablated non-tumor liver volumes (i.e., volume of ablated healthy parenchyma) were quantified using 3D segmentation. Absolute ablated liver function (i.e., the proportion of total HBS-derived liver function ablated) was also assessed. Clinical outcomes included changes in clinical scores (e.g., Child–Pugh) and the occurrence of hepatic decompensation after ablation. Results: Nine patients (13 tumors) were included. Median global HBS-derived liver function was 3.2%/min/m² (range 1.6–6.8%/min/m²). Three patients developed hepatic decompensation > 3 months after ablation, unlikely related to thermal ablation itself. The patient with the lowest baseline function (1.6%/min/m²) tolerated ablation without hepatic decompensation. Median ablated non-tumor liver volume was 14.4 cm³ (range 3.1–46.7 cm³), corresponding to a median of 0.9% (range 0.2–3.6%) of total liver volume ablated per lesion. Median absolute ablated function was 0.05%/min/m² (range 0.02–0.21%/min/m²). Conclusions: Thermal ablation was feasible and well tolerated even in patients with severely impaired liver function. Routine pre-ablation HBS does not appear necessary for thermal ablation of HCC, as only a small percentage of total functional liver volume is ablated.