Radiation Segmentectomy for Early Hepatocellular Carcinoma is Curative.

In this Expert Opinion, we provide the rationale for concluding that radiation segmentectomy (using RADSEG method), a technique of administrating ablative, complete necrosis-inducing trans-arterial Yttrium-90 (Y90) radiotherapy in limited-disease burden hepatocellular carcinoma (HCC), is curative. Currently, curative options for early stage and other carefully selected HCC patients include transplantation, resection, and ablation. Because of issues with organ availability, co-morbidities preventing resection, and tumor size and location limiting ablation, other treatments are necessary for this selected patient population.

Utility of Hybrid Angiography-CT in Interventional Radiology: Case-Based Examples.

Although cone-beam computed tomography (CT) is the predominant cross-sectional imaging modality used by interventional radiologists, advancements in hybrid angiography-CT technology have demonstrated a strong potential for increased utilization in the angiography suite. The benefits of increased workflow efficiency, decreased relative cost, multipurpose utility, and most importantly improved patient care may encourage institutions to accept the higher upfront cost of angiography-CT rooms for potential long-term benefits. Hybrid angiography-CT setups are less prone to motion and streak artifacts and may provide superior image quality compared with cone-beam CT.

Portal Vein Recanalization Transjugular Intrahepatic Portosystemic Shunt for Noncirrhotic Chronic Portal Vein Thrombosis Leading to Successful Pregnancy: Case Report.

Portal vein recanalization transjugular intrahepatic portosystemic shunt (PVR-TIPS) is a safe and effective procedure for decompression of portal hypertension (PH). In this short case series, 2 women with chronic noncirrhotic portal vein thrombosis were treated with PVR-TIPS. Both patients hoped to conceive.

Adverse Events After Percutaneous Transhepatic Biliary Drainage: A 10-Year Retrospective Analysis.

Purpose: To determine the adverse event (AE) rates and profiles associated with percutaneous transhepatic biliary drainage (PTBD) and to identify risk factors for their occurrence.

Materials And Methods: This single-center retrospective study included 2,310 PTBD (right-sided, 1,164; left-sided, 966; bilateral, 180) interventions for biliary obstruction (benign/malignant) in 449 patients between 2010 and 2020. Patients with percutaneous cholecystostomy alone were excluded.

Radiation Segmentectomy and Modified Radiation Lobectomy for Unresectable Early-Stage Intrahepatic Cholangiocarcinoma.

Purpose: To validate the safety and effectiveness of radiation segmentectomy (RS) and modified radiation lobectomy (mRL) in intrahepatic cholangiocarcinoma (iCCA) and to evaluate long-term outcomes in patients with unresectable, early-stage iCCA.

Materials And Methods: A single-institution, retrospective study of patients with unresectable, solitary iCCA without extrahepatic disease or vascular involvement (Stage I) treated with RS and mRL was performed. Fifteen patients met inclusion criteria (median age, 65.

Efficacy and Safety of Atezolizumab plus Bevacizumab versus Sorafenib in Hepatocellular Carcinoma with Main Trunk and/or Contralateral Portal Vein Invasion in IMbrave150.

Introduction: Atezolizumab plus bevacizumab significantly improved overall survival (OS) and progression-free survival (PFS) versus sorafenib in patients with unresectable hepatocellular carcinoma (HCC) in IMbrave150. Efficacy and safety in patient subpopulations with Vp4 portal vein tumor thrombosis (PVTT) and other high-risk prognostic factors are reported.

Methods: IMbrave150 was a global, randomized (2:1), open-label, phase 3 study in systemic treatment-naive patients with unresectable HCC; OS and PFS were co-primary endpoints.

Interventional Oncology Meets Immuno-oncology: Combination Therapies for Hepatocellular Carcinoma.

The management of hepatocellular carcinoma (HCC) is undergoing transformational changes due to the emergence of various novel immunotherapies and their combination with image-guided locoregional therapies. In this setting, immunotherapy is expected to become one of the standards of care in both neoadjuvant and adjuvant settings across all disease stages of HCC. Currently, more than 50 ongoing prospective clinical trials are investigating various end points for the combination of immunotherapy with both percutaneous and catheter-directed therapies.

Yttrium-90 Radiation Segmentectomy for Treatment of Neuroendocrine Liver Metastases.

Purpose: To assess the safety and effectiveness of yttrium-90 (Y) radiation segmentectomy (RS) for neuroendocrine tumor liver metastases (NELMs).

Materials And Methods: This single-institution retrospective study included 18 patients with 23 liver tumors not amenable to resection or ablation, who underwent RS between 2009 and 2021. Tumor grades by Ki-67/mitotic indices were Grade I (n = 9/23, 39%), Grade II (n = 10/23, 45%), and Grade III (n = 4/23, 17%).

Utility of pre-procedural [Tc]TcMAA SPECT/CT Multicompartment Dosimetry for Treatment Planning of Y Glass microspheres in patients with Hepatocellular Carcinoma: comparison of anatomic versus [Tc]TcMAA-based Segmentation.

Purpose: Pre-treatment [Tc]TcMAA-based radioembolization treatment planning using multicompartment dosimetry involves the definition of the tumor and normal tissue compartments and calculation of the prescribed absorbed doses. The aim was to compare the real-world utility of anatomic and [Tc]TcMAA-based segmentation of tumor and normal tissue compartments.

Materials And Methods: Included patients had HCC treated by glass [Y]yttrium microspheres, ≥ 1 tumor, ≥ 3 cm diameter and [Tc]TcMAA SPECT/CT imaging before treatment.

Locoregional Therapies for Primary and Secondary Hepatic Malignancies.

Management of hepatic malignancies is a multidisciplinary task with the involvement of hepatologists, medical/surgical/radiation oncologists, transplant surgeons, and interventional radiologists. Patients should be selected for a specific targeted therapy after multidisciplinary consensus. Interventional oncology, with image-guided locoregional cancer therapies, can decrease systemic toxicity without compromising tumoricidal effect.

Portal vein thrombosis: diagnosis, management, and endpoints for future clinical studies.

Portal vein thrombosis (PVT) refers to the development of a non-malignant obstruction of the portal vein, its branches, its radicles, or a combination. This Review first provides a comprehensive overview of all aspects of PVT, namely the specifics of the portal venous system, the risk factors for PVT, the pathophysiology of portal hypertension in PVT, the interest in non-invasive tests, as well as therapeutic approaches including the effect of treating risk factors for PVT or cause of cirrhosis, anticoagulation, portal vein recanalisation by interventional radiology, and prevention and management of variceal bleeding in patients with PVT. Specific issues are also addressed including portal cholangiopathy, mesenteric ischaemia and intestinal necrosis, quality of life, fertility, contraception and pregnancy, and PVT in children.

Optimal patient selection for yttrium-90 glass plus chemotherapy in the treatment of colorectal liver metastases: additional quality of life, efficacy, and safety analyses from the EPOCH study.

Background: Evaluating transarterial radioembolization (TARE) in patients with metastatic colorectal carcinoma of the liver who have progressed on first-line chemotherapy (EPOCH) demonstrated superior outcomes using yttrium-90 glass microspheres plus chemotherapy (TARE/Chemo) vs chemotherapy (Chemo) to treat colorectal liver metastases. Additional exploratory analyses were undertaken to assess the impact of TARE/Chemo on efficacy, safety, time to subsequent therapy, time to deterioration in quality of life (QoL), and identify criteria for improved patient selection.

Methods: Time to deterioration in QoL was analyzed for the primary study population.

Combined Percutaneous Transhepatic Lymphatic Embolization and Peroral Duodenal Mucosal Radiofrequency Ablation to Manage Protein-Losing Enteropathy.

Percutaneous transhepatic lymphatic embolization (PTLE) and peroral esophagogastroduodenoscopy (EGD) duodenal mucosal radiofrequency (RF) ablation were performed to manage protein-losing enteropathy (PLE) in patients with congenital heart disease. Five procedures were performed in 4 patients (3 men and 1 woman; median age, 49 years; range, 31-71 years). Transhepatic lymphangiography demonstrated abnormal periduodenal lymphatic channels.

Percutaneous Biliary Interventions via the Modified Hutson Loop in Patients with Biliary-Enteric Anastomoses: A Retrospective Study.

Purpose: This study aimed to present the institutional experience and algorithm for performing biliary interventions in liver transplant patients using the modified Hutson loop access (MHLA) and the impact of percutaneous endoscopy via the MHLA on these procedures.

Methods: Over 13 years, 201 MHLA procedures were attempted on 52 patients (45 liver transplants; 24 living and 21 deceased donors) for diagnostic (e.g.

Percutaneous Endoscopy and Image-guided Retrieval of Dropped Gallstones - A Case Series.

Background: Recurrent abscesses can happen due to dropped gallstones (DGs) after laparoscopic cholecystectomy (LC). Recognition and appropriate percutaneous endoscopy and image-guided treatment options can decrease morbidity associated with this condition.

Materials And Methods: We report a minimally invasive endoscopy and image-guided technique for retrieval of dropped gallstones in a series of 6 patients (M/F=3/3; median age: 75.

Multicenter Quantification of Radiation Exposure and Associated Risks for Prostatic Artery Embolization in 1476 Patients.

Background Prostatic artery embolization (PAE) is a safe, minimally invasive angiographic procedure that effectively treats benign prostatic hyperplasia; however, PAE-related patient radiation exposure and associated risks are not completely understood. Purpose To quantify radiation dose and assess radiation-related adverse events in patients who underwent PAE at multiple centers. Materials and Methods This retrospective study included patients undergoing PAE for any indication performed by experienced operators at 10 high-volume international centers from January 2014 to May 2021.