Background/Objectives: This systematic review and meta-analysis evaluated the effectiveness and the safety of transarterial radioembolization using Holmium-166 microspheres (Ho-166-TARE) for the treatment of primary and secondary liver tumors. The aim of the study was to offer a detailed analysis of clinical outcomes and the potential benefits of this innovative therapy. Methods: The study was conducted according to the PRISMA 2020 guidelines. The systematic search was performed in five databases in November 2023 and updated in June 2024. All 16 eligible studies were original research that evaluated Ho-166-TARE. The endpoints analyzed were disease control rate (DCR), overall survival (OS), progression-free survival (PFS), clinical and laboratory adverse events, healthy-liver- and tumor-liver-absorbed doses. The risk of bias was assessed using the MINORS checklist. Results: The pooled overall disease control rate (DCR) was 72% (95% CI, 46–89%); by mRECIST, it was 93% (95% CI, 71–99%); and by RECIST 1.1, it was 54% (95% CI, 22–83%) at 3-month follow-up. Overall survival (OS) at 3, 6, 12, and 30 months was 98%, 89%, 74%, and 39%, respectively. Severe clinical adverse events were minimal, although some patients showed elevated GGT levels and lymphocytopenia. Tumor-absorbed doses were nearly three times higher than those in healthy liver tissue. Conclusions: These findings suggest that Ho-166-TARE is a safe and effective locoregional treatment option for liver tumors, especially in cases where systemic therapy alone is insufficient or surgical resection is not feasible. Further studies are needed to investigate tumor-specific response, optimize dosimetry strategies, and establish standardized protocols for long-term outcome assessment.

We have previously reported that serum albumin-coated bone allograft (BoneAlbumin, BA) is an effective bone substitute. It improves bone regeneration at the patellar and tibial donor sites six months after harvesting bone-patellar tendon-bone (BPTB) autografts for primary anterior cruciate ligament reconstruction (ACLR). In the present study, we examined these donor sites seven years after implantation. The study group (N = 10) received BA-enhanced autologous cancellous bone at the tibial and BA alone at the patellar site. The control group (N = 16) received autologous cancellous bone at the tibial and blood clot at the patellar site. We evaluated subcortical density, cortical thickness, and bone defect volume via CT scans. At the patellar site, subcortical density was significantly higher in the BA group at both time points. There was no significant difference in cortical thickness between the two groups at either donor site. The control group’s bone defect significantly improved and reached the BA group’s values at both sites by year seven. Meanwhile, the bone defects in the BA group did not change significantly and were comparable to the six-month measurements. No complications were observed. There are two limitations in this study: The number of patients recruited is small, and the randomization of the patients could have improved the quality of the study as the control group patients were older compared to the study group patients. Our 7-year results seem to demonstrate that BA is a safe and effective bone substitute that supports faster regeneration of donor sites and results in good-quality bone tissue at the time of ACLR with BPTB autografts. However, studies with a larger number of patients are required to definitively confirm the preliminary results of our study.

Objectives: CT-guided interventions are associated with radiation exposure, prolonged procedural time, and complications. Navigation systems (NS) have been developed to improve procedural precision and efficiency. This study aimed to evaluate the impact of NS on procedural outcomes, radiation dose, and complication rates compared with conventional freehand techniques. Materials and methods: A systematic review and meta-analysis was performed including 30 studies (11 randomized controlled trials, 19 cohort studies) published through November 2023, involving 2785 patients (1418 NS; 1367 control). Outcomes included the number of needle manipulations, procedural time, radiation dose, complication rates, technical success, and diagnostic success. Random-effects models were applied with subgroup analyses by study design, intervention type, and target organ. Risk of bias was assessed using RoB 2 and ROBINS-I, and certainty of evidence using the GRADE framework. Results: Navigation systems significantly reduced needle manipulations (mean difference [MD], −2.58; 95% CI: −3.30 to −1.85) and procedural time (MD, −8.07 min; 95% CI: −12.27 to −3.87). Radiation dose decreased by 37% (ratio of means [ROM], 0.63; 95% CI: 0.58–0.69). Complication rates were lower overall (odds ratio [OR], 0.64), with fewer chest tube insertions during lung ablations (OR, 0.58; 95% CI: 0.39–0.86). Diagnostic success improved (OR, 1.66; 95% CI: 1.01–2.73), whereas technical success was comparable (OR, 1.41; 95% CI: 0.89–2.24). Conclusions: Navigation systems significantly enhance the efficiency and safety of CT-guided interventions by reducing needle manipulations, radiation exposure, and complication rates, while improving diagnostic success.

We present a case demonstrating the potential of radioembolization with Ho-166-labelled microparticles as an effective bridging therapy for hepatocellular carcinoma (HCC) in a 70-year-old male patient with liver cirrhosis awaiting liver transplantation. The patient received a calculated dose of 3 GBq of Ho-166 microspheres, which were selectively administered intra-arterially to the target area during the radioembolization procedure. Post-treatment dosimetry revealed an average tumor absorbed dose of 332 Gy. Contrast-enhanced CT scan performed one month later revealed a necrotic, non-enhancing area at the tumor site, indicating a complete response. The patient successfully underwent liver transplantation 2.5 months after radioembolization. This case suggests that Ho-166 radioembolization is a promising locoregional therapy for HCC, particularly for patients requiring a bridging approach to transplantation.

Background Hepatocellular carcinoma with portal vein tumor thrombosis and marked arterioportal shunting presents a major challenge for transarterial radioembolization because shunting can lead to poor tumor targeting and increased non-target microsphere deposition. This case is noteworthy because it demonstrates how a balloon-occlusion microcatheter can temporarily modify hepatic blood flow and make radioembolization feasible in a patient whose initial treatment planning was unfavorable. Case presentation: A 70-year-old male patient with alcohol-related liver cirrhosis and a 6 cm hepatocellular carcinoma was diagnosed with right portal vein tumor thrombosis and intense arterioportal shunting. The patient had preserved liver function and good performance status. Initial angiography demonstrated intense arterioportal shunting. Although portal venous filling decreased after embolization of the shunt-related arterial branches, subsequent Technetium-99m macroaggregated albumin planning still demonstrated unfavorable tracer distribution, with predominant accumulation in the normal liver parenchyma and suboptimal tumor targeting. A second planning procedure was therefore performed using a balloon-occlusion microcatheter positioned in the right hepatic artery. With balloon inflation, repeat planning showed a markedly improved tumor-to-normal uptake ratio while maintaining an acceptable lung shunt fraction. Transarterial radioembolization with Yttrium-90 labeled glass microspheres was then successfully delivered through the inflated balloon catheter without complications. Follow-up imaging at 1, 3, and 6 months demonstrated reduced arterial enhancement, slight tumor regression, and progressive recanalization of the previously affected portal vein branch. No new intrahepatic lesions developed. The patient subsequently started systemic atezolizumab-bevacizumab therapy, and disease stability was maintained. Conclusions Temporary balloon occlusion can overcome unfavorable flow redistribution caused by arterioportal shunting and portal vein tumor thrombosis, thereby enabling safe and selective radioembolization in advanced hepatocellular carcinoma. This technique may serve as a practical rescue strategy in cases that would otherwise be unsuitable for treatment and may support multimodal management combined with systemic therapy.

Background/Objectives: Transarterial radioembolization (TARE) plays an increasing role in the treatment of hepatocellular carcinoma (HCC). Several isotope platforms have been introduced; however, comparative data remain limited. We aimed to compare outcomes following Holmium-166 (Ho-166) and Yttrium-90 (Y-90) TARE in HCC patients. Methods: We retrospectively analyzed a prospectively maintained cohort of HCC patients treated with Ho-166 or Y-90 TARE between 2022 and 2024. Tumor burden and treatment response were assessed using contrast-enhanced CT or MRI. Overall survival (OS) and progression-free survival (PFS) were estimated using the Kaplan–Meier method and further evaluated using multivariable Cox regression analyses adjusted for baseline confounders. Results: A total of 73 patients were analyzed, including 39 treated with Y-90 and 34 with Ho-166 TARE. Median follow-up duration was 20.9 months. No significant differences in OS or PFS were observed between treatment groups. Response outcomes, including objective response rate, complete response rate, and duration of response, were also comparable between groups. In the overall cohort, median OS was not reached in Barcelona Clinic Liver Cancer (BCLC) A or B patients and was 12.9 months in BCLC C patients. Median PFS was 20.1, 11.7, and 6.1 months in BCLC A, B, and C patients, respectively. Conclusions: Ho-166 and Y-90 TARE achieved favorable outcomes across different BCLC stages without significant differences in survival, treatment response, or duration of response between the two platforms. These findings further support the role of TARE in the management of patients with HCC.