Liver cancer is the fifth most common cancer and the second most frequent cause of cancer-related death globally. Hepatocellular carcinoma (HCC) represents about 90% of primary liver cancers and constitutes a major global health problem. Combined hepatocellular‐cholangiocarcinoma (cHCC‐CCA) represents about 10% of total HCC, and it is by definition a highly heterogeneous tumor, which confers a negative impact on tumor prognosis compared to HCC. Selective Internal Radiation Therapy (SIRT) using yttrium-90 microspheres shows a good safety profile and local tumor control, and it is now considered among the therapeutic options for liver cancer downstaging before liver transplant (LT). We present the case of a young man with a diagnosis of hepatitis B cirrhosis and subsequent finding of advanced primary neoplasm with particularly aggressive histology of cHCC‐CCA. The patient underwent two SIRT treatments in 6 months. The first SIRT treatment provided an adequate downstaging to surgery, then a successful SIRT retreatment after surgery, in a bridging purpose, allowed for liver transplantation, with complete necrosis at explant. We demonstrated the feasibility and safety of multi treatment approaches, with two successive SIRT treatments and surgery. We outline the efficacy of an aggressive downstaging strategy allowing a potentially curative therapy as liver transplant.

Interventional radiology is nowadays one of the cornerstones of the treatment of hepatocellular carcinoma (HCC). In particular, the role of transarterial treatment including chemoembolization (TACE) and radioembolization (TARE) has been growing rapidly. TACE consists in the delivery of embolic material and anticancer drugs to the liver tumors. The procedure presents several technical variations based on the embolic material and drugs administered. Very few clinical differences were observed among the different variants. The TARE procedure relies on the delivery of radioisotope ⁹⁰Y, a pure beta-radiation emitter, in the liver. The TARE procedure involves a two-step workflow: firstly, the deposition of a ⁹⁰Y proxy (⁹⁹Tc-macroaggregated-albumin) is mapped to avoid non-target delivery; secondly, the radioisotope itself is administered. According to the ESMO guidelines, transarterial treatments have a large spectrum of indications, including Barcelona Clinic Liver Cancer stages 0–A and B for TACE and stages 0–A and B–C for TARE. Furthermore, TACE and TARE play a role in achieving all three goals of multidisciplinary treatments for HCC: downstaging, bridging and palliation. In conclusion, transarterial treatments are the past, the present and the future of HCC management. Keywords Hepatocellular carcinoma Transarterial chemoembolization Transarterial radioembolization Selective internal radiation therapy Dosimetry

Background/Objectives: For stage I non-small cell lung cancer, surgery remains the cornerstone of treatment and the use of minimally invasive techniques is desirable. The lack of tactile feedback in RATS is a well-known drawback of this approach, so precise identification of the disease is crucial for performing lung resection. Methods: We present our retrospective case history, accounting for 83 patients, which were divided into two groups based on marking technique: 99^mTc-MAA (99^mTechnetium Albumin Macroaggregates) only (Tech group) (22 cases, 26.5%) and 99^mTc-MAA + Indocyanine Green (Tech + ICG group) (61 cases, 73.49%). Results: In the Tech group, there were 11 males (50%) ad 11 females (50%), the median nodule diameter was 21.5 mm (IQR 16), and the median distance of the nodule from the visceral pleura was 18 mm (IQR 21). Eighteen out of 22 nodules (81.82%) were subsolid. Three conversions were reported, all due to failure to identify the nodule (13.63%). The mean operative time was 111.6 ± 45.6 min. The histopathological examination resulted in 13 lung adenocarcinomas, one squamous cell carcinoma, two minimally invasive lung adenocarcinomas, two lung adenocarcinomas in situ, three metastases from another tumor, and one benign nodule. In the Tech + ICG group, there were 27 males (44.26%) and 34 females (55.73%), the median nodule diameter was 18 mm (IQR 14), and the median distance of the nodule from the visceral pleura was 24 mm (IQR 15). Forty-six out of 61 nodules were subsolid (75.4%). Four conversions were reported, due to failure in nodule identification (6.55%). The operative time was 105.6 ± 36.8 min. The histopathological examination resulted in 12 lung adenocarcinomas, seven squamous cell carcinomas, nine minimally invasive lung adenocarcinomas, 12 lung adenocarcinomas in situ, one typical carcinoid, seven atypical adenomatous hyperplasias, seven metastases from another tumor, and six benign nodules. The two groups are homogeneous in terms of median nodule diameter (p = 0.676), the median distance from visceral pleura (p = 0.114), SUV max (p = 0.894), operative time (p = 0.512), and nodule characteristics (solid vs. subsolid) (p = 0.724). The conversion rate was lower in the Tech + ICG group (6.55% vs. 13.63%), but the difference was not statistically significant (p = 0.375). Conclusions: Both techniques appear to be safe and reproducible. Further standardized studies are needed to validate and confirm the results obtained from our case series.

Background: For stage I non-small cell lung cancer surgery remains the cornerstone of the treatment and the use of minimally invasive technique is desirable. The lack of tactile feedback in RATS is a well-known drawback of this approach, so the precise identification of the disease is crucial for performing the lung resection. Methods: We present our retrospective case history, accounting for 82 patients, divided into two groups based on marking technique: 99^mTc-MAA (99^mTechnetium Albumin Macroaggregates) only (Tech group) (22 cases, 26,5%) and 99^mTc-MAA + Indocianine green (Tech+ICG group) (61 cases, 73,49%). Results: In Tech group there were 11 males (50%) ad 11 females (50%), median nodule diameter was 21,5mm (IQR 16), median distance of the nodule from visceral pleura was 18 mm (IQR 21). Eighteen out of 22 nodules (81,82%) were subsolid. Three conversions were reported, all due to failure to identify the nodule (13,63%). Mean operative time was 111,6 ± 45,6 min. At the histopathological examination resulted 13 lung adenocarcinomas, 1 squamous cells carcinomas, 2 minimally invasive lung adenocarcinomas, 2 lung adenocarcinomas in situ, 3 metastases from another tumor and 1 benign nodule. In Tech+ICG group there were 27 males (44,26%) and 34 females (55,73%), median nodule diameter was 18mm (IQR 14), median distance of the nodule from visceral pleura was 24mm (IQR 15). Forty-six out of 61 nodules were subsolid (75,4%). Four conversion was reported, due to failure in nodule identification (6,55%). Operative time was 105,6 ± 36,8 min. At the histopathological examination resulted 12 lung adenocarcinomas, 7 squamous cells carcinoma, 9 minimally invasive lung adenocarcinomas, 12 lung adenocarcinomas in situ, 1 typical carcinoid, 7 atypical adenomatous hyperplasias, 7 metastases from another tumor and 6 benign nodules. The two groups are homogeneous in terms of median nodule diameter (p = 0,676), median distance from visceral pleura (p = 0,114), SUV max (p = 0,894), operative time (p = 0,512), nodule characteristics (solid vs subsolid) (p = 0,724). Conclusions: Both techniques appear to be safe and reproducible. Further standardized studies are needed to validate and confirm the results obtained from our case series.