Submit to Special Issue Submit Abstract to Special Issue Review for Cancers Propose a Special Issue

Journal Menu

Journal Browser

► Journal Browser

Image-Guided Treatment of Liver Tumors

Print Special Issue Flyer
Special Issue Editors
Special Issue Information
Keywords
Benefits of Publishing in a Special Issue
Published Papers

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Therapy".

Deadline for manuscript submissions: 30 November 2026 | Viewed by 4776

Share This Special Issue

Special Issue Editors

Dr. Maarten L. J. Smits

E-Mail Website
Guest Editor

Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
Interests: liver; ablation; radioembolization; colorectal cancer; hepatocellular carcinoma

Dr. Niek Wijnen

E-Mail Website
Guest Editor

Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
Interests: liver; ablation; radioembolization; colorectal cancer; hepatocellular carcinoma

Special Issue Information

Dear Colleagues,

Image-guided therapies have transformed the landscape of liver tumor treatment, offering minimally invasive options with increased precision and improved patient outcomes. These therapies—ranging from ablation techniques such as microwave ablation and irreversible electroporation to vascular interventions like radioembolization with yttrium-90 microspheres, chemoembolization, portal vein embolization, and double vein embolization—are rapidly evolving with advances in imaging, technology, and interdisciplinary collaboration.

This Special Issue of Cancers aims to highlight recent innovations, clinical outcomes, and translational research in the field of image-guided treatment of liver tumors (both primary liver tumors and liver metastases). We welcome original research articles, comprehensive reviews, and case-based insights that explore novel techniques, procedural optimization, and combination strategies that enhance therapeutic efficacy and patient selection.

We invite you to contribute to this Special Issue and help advance the understanding and application of image-guided interventions for liver tumors.

We are looking forward to receiving your contributions.

Dr. Maarten L. J. Smits
Dr. Niek Wijnen
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

liver
thermal ablation
radioembolization
TACE
yttrium-90
portal vein embolization
radiation oncology
interventional oncology

Benefits of Publishing in a Special Issue

Ease of navigation: Grouping papers by topic helps scholars navigate broad scope journals more efficiently.
Greater discoverability: Special Issues support the reach and impact of scientific research. Articles in Special Issues are more discoverable and cited more frequently.
Expansion of research network: Special Issues facilitate connections among authors, fostering scientific collaborations.
External promotion: Articles in Special Issues are often promoted through the journal's social media, increasing their visibility.
Reprint: MDPI Books provides the opportunity to republish successful Special Issues in book format, both online and in print.

Further information on MDPI's Special Issue policies can be found here.

Published Papers (5 papers)

Download All Papers

Order results

Result details

Show export options Show export options

Select all

Export citation of selected articles as:

Research

21 pages, 1821 KB

Open AccessArticle

Thermal Ablation Versus Surgical Resection for Intermediate-Size (3–5 cm) Colorectal Liver Metastases: Results from the Amsterdam Colorectal Liver Met Registry (AmCORE)

by Madelon Dijkstra, Susan van der Lei, Hannah H. Schulz, Tineke E. Buffart, Rutger-Jan Swijnenburg and Martijn R. Meijerink

Cancers 2026, 18(6), 1017; https://doi.org/10.3390/cancers18061017 - 21 Mar 2026

Viewed by 737

Abstract

Purpose: Surgical resection has been the gold standard for colorectal liver metastases (CRLM) for decades. In recent years, thermal ablation has emerged as a first-line treatment option for small-size CRLM, while for intermediate-size lesions (3–5 cm), it is reserved for patients with unresectable disease. In this setting, thermal ablation has proven safe and effective, achieving durable local control (LC) in the majority of patients. This retrospective study compares oncological outcomes of thermal ablation versus surgical resection of intermediate-size (3–5 cm) CRLM. Material and methods: Patients treated with thermal ablation or surgical resection for intermediate-size CRLM between 2000 and 2025 were included. Baseline per-patient and per-procedure characteristics were compared across three groups: thermal ablation, surgical resection, and combined treatment. Per tumor characteristics were compared between thermal ablation and surgical resection. Primary outcomes included local tumor progression-free survival (LTPFS) and complication rates. Secondary outcomes were OS, distant progression-free survival (DPFS), LC, and length of hospital stay. Survival outcomes were analyzed using the Kaplan–Meier method; additionally, LTPFS was assessed using Cox proportional hazards regression models, with multivariable analyses performed to adjust for potential confounders. Results: A total of 320 patients with 448 metastases were included: 135 patients underwent thermal ablation, 156 underwent surgical resection, and 29 received combined treatment. LTPFS per tumor was significantly higher in the surgical resection group (HR 1.86, 95% CI 1.24–2.81, p = 0.0025), however, LC per tumor did not significantly differ amongst groups (HR 1.48, 95% CI 0.70–3.11, p = 0.307). Complication rates were significantly higher after resection (p < 0.001). OS and DPFS did not differ significantly between the three groups (p = 0.08 and p = 0.084). OS comparing only thermal ablation and resection was significantly lower in the thermal ablation group. Median hospital stay was 3, 5, and 7 days for the ablation, resection, and combined groups, respectively (p < 0.001). Conclusions: Thermal ablation offers a safe alternative to surgical resection for selected patients with intermediate-size (3–5 cm) CRLM, with higher treatment-site recurrence rates. With the option of repeat ablation, comparable local tumor control can be achieved. Improvements in local control with both modalities over time support the need for a prospective clinical trial. Full article

(This article belongs to the Special Issue Image-Guided Treatment of Liver Tumors)

► Show Figures

Figure 1

12 pages, 1296 KB

Open AccessArticle

An Image-Guided Combination Strategy: Immediate Hepatic Arterial Infusion of Nivolumab Following Transarterial Chemoembolization for Unresectable Hepatocellular Carcinoma

by Sujing Zhang, Zheng Zheng, Changwang Zhang, Xueqian Liu, Xinlei Shi and Wenhua Ma

Cancers 2026, 18(6), 978; https://doi.org/10.3390/cancers18060978 - 18 Mar 2026

Viewed by 504

Abstract

Background: Transarterial chemoembolization (TACE) is an established image-guided, minimally invasive therapy for unresectable hepatocellular carcinoma (HCC). However, post-embolization hypoxia often triggers compensatory angiogenesis and an immunosuppressive microenvironment, limiting long-term efficacy. We hypothesized that the immediate image-guided hepatic arterial infusion (HAI) of a PD-1 inhibitor following TACE could synergistically enhance local tumor control. Methods: In this retrospective, propensity-score-matched study, 226 patients with unresectable HCC (January 2021–June 2024) were analyzed. After 1:1 matching, 84 pairs were included: Study Group (TACE + HAI-nivolumab) and Control Group (TACE alone). Nivolumab (3 mg/kg) was infused via the hepatic artery under fluoroscopic guidance immediately after embolization. Primary endpoints were overall survival (OS) and progression-free survival (PFS); secondary endpoints included objective response rate (ORR) by mRECIST and changes in serum angiogenesis/immune biomarkers. Results: The Study Group demonstrated significantly longer median OS (16.2 vs. 12.8 months; HR 0.62, 95% CI: 0.44–0.88, p = 0.007) and median PFS (9.8 vs. 6.5 months; p < 0.001). ORR was higher with combination therapy (58.3% vs. 36.9%, p = 0.006). Mechanistically, HAI-nivolumab suppressed the post-TACE surge in VEGF and Ang-2 (p < 0.001) and increased the peripheral CD4+/CD8+ T-cell ratio. Grade 3/4 adverse events were comparable between groups (14.3% vs. 10.7%, p = 0.485). Conclusions: The image-guided combination of TACE with immediate HAI of nivolumab is associated with improved survival and tumor response in unresectable HCC. This strategy may counteract the adverse post-embolization microenvironment by simultaneously inhibiting angiogenesis and reactivating local immunity, representing an advanced image-guided combination therapy with strong translational relevance. Full article

(This article belongs to the Special Issue Image-Guided Treatment of Liver Tumors)

► Show Figures

Graphical abstract

15 pages, 833 KB

Open AccessArticle

Retrospective Italian Registry on DSM-TACE: Experience Beyond Current Recommendations

by Pierleone Lucatelli, Maria Giulia Travaglini, Elio Damato, Francesco Giurazza, Anna Maria Ierardi, Giacomo Luppi, Michele Citone, Roberto Cianni, Gianluca De Rubeis, Pierpaolo Biondetti, Fabio Corvino, Claudio Carrubba, Giulio Vallati, Federico Cappelli, Alessandro Posa, Marcello Lippi, Mario Corona, Valeria Panebianco, Carlo Catalano and Roberto Iezzi

Cancers 2026, 18(5), 736; https://doi.org/10.3390/cancers18050736 - 25 Feb 2026

Viewed by 454

Abstract

Background: The role of transarterial chemoembolization (TACE) in hepatocellular carcinoma (HCC) management has evolved over recent years. Although it appears that the overall number of procedures is declining, international guidelines now endorse TACE beyond the Barcelona Clinic Liver Cancer (BCLC) intermediate stage, and multiple TACE platforms allow patient-tailored treatments. In this context, degradable starch microspheres TACE (DSM-TACE) may be valuable when the goal is to preserve liver function and spare healthy parenchyma. This study reports multicenter retrospective Italian data to assess the efficacy and safety of DSM-TACE with EmboCept^® in patients with early-to advanced-stage HCC, and to evaluate whether procedural selectivity (superselective vs. lobar) influences outcomes. Methods: This retrospective multicenter study included 201 patients initially; after applying exclusion criteria, 187 patients (334 HCC nodules) treated across eight centers (2014–2024) were analyzed. Treatment indications were discussed in multidisciplinary tumor boards in all centers. Superselective DSM-TACE was performed in 48 patients (66 nodules, 19.8%), while 139 patients (268 nodules, 80.2%) underwent a lobar approach. Repeated sessions were performed on demand and recorded for lobar treatments. Tumor response was assessed using mRECIST criteria at 1, 3–6, 6–9, and 9–12 months; adverse events were classified according to the Common Terminology Criteria for Adverse Events (CTCAE). efficacy and safety outcomes were compared according to the DSM-TACE approach. Results: In terms of safety, analysis confirmed the overall good tolerability of DSM-TACE, with no grade ≥ 3 adverse events and no major complications or procedure-related deaths. No significant differences were observed in post-embolization syndrome (PES) rates between groups. With regard to efficacy, for the entire cohort, the overall response rate (ORR) was 70% at 1 month, 31.6% at 3–6 months, 20.5% at 6–9 months, and 13.5% at 9–12 months, while the disease control rate (DCR) was 91.4% at 1 month, 69% at 3–6 months, 38.6% at 6–9 months, and 27% at 9–12 months. At intermediate follow-up, superselective DSM-TACE achieved higher ORR than lobar treatment at 3–6 months (53.8% vs. 26.4%; p = 0.009) and 6–9 months (43.8% vs. 15.3%; p = 0.009). Per-nodule analysis confirmed this advantage at 3–6 months (ORR = 66.7% vs. 31.3%; p = 0.0008). Conclusions: DSM-TACE with EmboCept^® provides favorable tumor control and a good safety profile in routine clinical practice. A superselective approach is associated with improved response at intermediate follow-up compared with lobar strategy, supporting DSM-TACE as a flexible therapeutic option for localized HCC. Full article

(This article belongs to the Special Issue Image-Guided Treatment of Liver Tumors)

► Show Figures

Figure 1

13 pages, 2397 KB

Open AccessArticle

High-Dose Transarterial Radioembolization of Hepatic Metastases Using Yttrium-90 Resin Microspheres

by Charlotte C. I. Schneider, Belinda J. de Wit-van der Veen, Sanne M. A. Jansen, Kenneth F. M. Hergaarden, Margot E. T. Tesselaar, Niels F. M. Kok, Larissa W. van Golen, Arthur J. A. T. Braat, Regina G. H. Beets-Tan, Tarik R. Baetens and Elisabeth G. Klompenhouwer

Cancers 2025, 17(24), 3889; https://doi.org/10.3390/cancers17243889 - 5 Dec 2025

Viewed by 1272

Abstract

Background/Objectives: Over the past few years, high-dose radioembolization (≥150 Gy) has become widely adopted for the treatment of primary liver cancer, while evidence for its application in hepatic metastases is still limited. The aim of this study was to evaluate the safety and efficacy of high-dose transarterial radioembolization (TARE) in patients with hepatic metastases using resin Yttrium-90 (⁹⁰Y) microspheres. Methods: In this retrospective analysis, patients who were treated with high-dose TARE for hepatic metastases with ⁹⁰Y resin microspheres between May 2019 and April 2025 were included. The primary outcomes were treatment efficacy and toxicity assessed according to the National Cancer Institute Common Terminology Criteria for Adverse Events v5.0. Treatment efficacy was evaluated based on radiological response according to Response Evaluation Criteria in Solid Tumors version 1.1, time to progression and overall survival (OS). Secondary outcomes included ⁹⁰Y PET/CT post-treatment voxel-based local deposition model dosimetry and its relations to response. Results: A total of 15 patients were included, with hepatic metastases originating from colorectal cancer (n = 11, 73.3%), neuroendocrine tumor (n = 3, 20%) and breast cancer (n = 1, 6.7%). Seven patients (47.7%) had undergone one or multiple prior loco(regional) liver treatments and 13 (86.7%) patients had prior systemic therapy. The median mean tumor absorbed dose was 160.7 Gy (IQR 127.6–245.0 Gy), and the median normal liver parenchyma dose was 40.3 Gy (IQR 21.7–52.3 Gy). Disease control was achieved in all patients, with partial response in 10 patients (66.7%) and stable disease in 5 patients (33.3%) after 3 months. The median OS was 26.5 months (95% CI 24.5 months to no estimate). Two patients (13.3%) experienced grade 3 laboratory toxicity. No grade 4 or 5 toxicities were observed. Conclusions: High-dose TARE with ⁹⁰Y resin microspheres resulted in a high disease control rate and demonstrated a favorable safety profile, even in this heavily pretreated cohort. Full article

(This article belongs to the Special Issue Image-Guided Treatment of Liver Tumors)

► Show Figures

Graphical abstract

12 pages, 842 KB

Open AccessArticle

Clinical Efficacy of Percutaneous Image-Guided Ablation in Breast Cancer Metastases to the Liver

by Govindarajan Narayanan, Elizabeth Mary Ruiz, Madelon Dijkstra, Nicole T. Gentile, Danielle Donahue, Ripal T. Gandhi, Reshma L. Mahtani, Starr Mautner and Bente A. T. van den Bemd

Cancers 2025, 17(23), 3823; https://doi.org/10.3390/cancers17233823 - 28 Nov 2025

Viewed by 1242

Abstract

Objectives: This single-center retrospective study evaluates the clinical efficacy and safety of percutaneous ablation using microwave ablation (MWA) and irreversible electroporation (IRE) in patients with breast cancer liver metastases (BCLM). Methods: Between August 2018 and December 2023, 32 patients underwent 40 image-guided ablations for 57 BCLM. Mean age was 61.3 years (range: 32–85), and mean tumor size was 2.9 cm (range: 0.9–7.0 cm). Fifty lesions were treated with MWA and seven with IRE. Clinical efficacy was assessed by m-RECIST response at first follow-up imaging (after ≥1 month) and by monitoring local tumor progression (LTP), local tumor progression-free survival (LTPFS), and overall survival (OS). Safety was evaluated by adverse events according to CTCAE. Kaplan–Meier statistics were used for LTPFS and OS. Results: Median follow-up was 32.4 months (95% CI 16.6–48.0). Complete response was observed in 34 tumors (59.6%), partial response in 14 (24.6%), and progressive disease in 9 (15.8%). LTP occurred in 37 tumors (64.9%), with a median time to progression of 11.1 months (95% CI 1.4–20.8). One- and two-year LTPFS rates were 43.6% and 34.1%. Sixteen patients died during follow-up, with median OS of 27.8 months (95% CI 19.0–36.6) and 1- and 2-year OS rates of 90.1% and 55.9%. No major complications occurred. Complications included eight Grade 1 and two Grade 2 complications. Conclusions: Percutaneous ablation demonstrates clinical efficacy and a favorable safety profile in selected BCLM patients, achieving OS comparable to the current literature. Further studies should clarify its additive role within multimodality treatment. Full article

(This article belongs to the Special Issue Image-Guided Treatment of Liver Tumors)

► Show Figures

Journal Menu

Journal Browser

Image-Guided Treatment of Liver Tumors

Share This Special Issue

Special Issue Editors

Special Issue Information

Keywords

Benefits of Publishing in a Special Issue

Published Papers (5 papers)

Research

Further Information

Guidelines

MDPI Initiatives

Follow MDPI