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.

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.