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Cancers
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Novel Approaches and Advances in Interventional Oncology
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Novel Approaches and Advances in Interventional Oncology

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Methods and Technologies Development".

Deadline for manuscript submissions: 20 June 2025 | Viewed by 7883

Special Issue Editors

Prof. Dr. Thomas Vogl

E-Mail Website
Guest Editor
Clinic for Radiology and Nuclear Medicine, University Hospital Frankfurt, Goethe University, 60590 Frankfurt am Main, Germany
Interests: head and neck tumors; liver tumors; lung tumors; interventional oncology; interventional radiology; thermal ablation; transarterial chemoembolization
Special Issues, Collections and Topics in MDPI journals
Dr. Hamzah Adwan

E-Mail Website
Guest Editor Assistant
Clinic for Radiology and Nuclear Medicine, University Hospital Frankfurt, Goethe University, 60590 Frankfurt am Main, Germany
Interests: interventional radiology; interventional oncology; liver cancer; hepatocellular carcinoma; liver metastases; thermal ablation; embolization; chemoembolization; lung cancer; pulmonary metastases

Special Issue Information

Dear Colleagues, 

Minimally invasive interventional therapies under image guidance are essential for the management of various tumors, especially primary and secondary liver and lung malignancies. Over the past few decades, significant advances have been made in the treatment of oncological patients regarding the indications and techniques of such treatments. However, this great heterogeneity of treatments has also led to an increase in the complexity of the patients’ treatment. This highlights the continuous need for studies focusing on these treatments. The main objective of this Special Issue is to discuss new findings and novel approaches for treating various solid tumors using interventional treatments. Research articles on the combination of interventional treatments with immunotherapy are welcome and highly appreciated.

Prof. Dr. Thomas Vogl
Guest Editor

Dr. Hamzah Adwan
Guest Editor Assistant

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 100 words) can be sent to the Editorial Office for announcement on this website.

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

  • interventional oncological treatments
  • combination treatments
  • hypo- and hyper-thermal ablation
  • transarterial chemoembolization
  • transarterial chemoperfusion
  • transarterial embolization
  • selective internal radiotherapy
  • immunotherapy

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Published Papers (8 papers)

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Research

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16 pages, 3770 KiB  
Article
Comparing the Prognostic Value of Quantitative Response Assessment Tools and LIRADS Treatment Response Algorithm in Patients with Hepatocellular Carcinoma Following Interstitial High-Dose-Rate Brachytherapy and Conventional Transarterial Chemoembolization
by Robin Schmidt, Christopher Rueger, Han Xu, Yubei He, Emine Yaren Yilmaz, Luisa Heidemann, Ornela Sulejmani, Yu Liu, Lasse Noack, Friederike Hesse, Richard Ruppel, Sara A. Abosabie, Charlie Alexander Hamm, Tobias Penzkofer, Bernhard Gebauer and Lynn Jeanette Savic
Cancers 2025, 17(8), 1275; https://doi.org/10.3390/cancers17081275 - 9 Apr 2025
Viewed by 295
Abstract
Background/Objectives: The aim of this study was to investigate the prognostic value of established response assessment tools for hepatocellular carcinoma (HCC) treated with high-dose-rate interstitial brachytherapy (iBT) alone or with transarterial chemoembolization (cTACE). Methods: (Non-)responders were categorized using size-based RECIST 1.1 and WHO [...] Read more.
Background/Objectives: The aim of this study was to investigate the prognostic value of established response assessment tools for hepatocellular carcinoma (HCC) treated with high-dose-rate interstitial brachytherapy (iBT) alone or with transarterial chemoembolization (cTACE). Methods: (Non-)responders were categorized using size-based RECIST 1.1 and WHO criteria, enhancement-based mRECIST and EASL criteria, and the LI-RADS Treatment Response Algorithm (LR-TRA). The outcomes were the overall survival (OS), progression-free survival (PFS), and time to progression (TTP). The statistics used included Fisher’s exact test, a t-test, the Mann–Whitney-U test, and a Kaplan–Meier analysis. The median OS, PFS, and TTP were higher in patients following iBT (26.3, 9.1, and 13.0 months) than following cTACE/iBT (23.3, 7.6, and 9.2 months). Results: The enhancement-based criteria identified more responders and predicted PFS and TTP better compared to the size-based criteria. At two months, the cTACE/iBT responders showed improved PFS (mRECIST and EASL: 11.3 vs. 2.3 and 11.0 vs. 2.3, p < 0.01) and TTP (mRECIST and EASL: 11.9 vs. 2.4 months, p < 0.01) by the enhancement-based criteria. An EASL assessment at five months predicted improved survival following both cTACE/iBT (PFS: 11.9 vs. 5.1 months, p = 0.03; TTP: 12.4 vs. 5.0, p < 0.01) and iBT (11.1 vs. 5.1 months, p = 0.04; 13.0 vs. 5.3, p < 0.01). The LR-TRA showed OS benefits at five months for cTACE/iBT responders. Size-based criteria were not prognostic. Conclusions: Extending follow-up post-iBT or post-iBT/cTACE may improve responder stratification and prognostication. Full article
(This article belongs to the Special Issue Novel Approaches and Advances in Interventional Oncology)
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11 pages, 2100 KiB  
Article
Evaluating Pre-Interventional Administration of a Liver-Specific Contrast Agent During MRI-Guided Thermal Ablation of Malignant Liver Lesions
by Antonia Ashkar, Jens Kübler, Konstantin Nikolaou, Rüdiger Hoffmann and Moritz T. Winkelmann
Cancers 2025, 17(8), 1264; https://doi.org/10.3390/cancers17081264 - 9 Apr 2025
Viewed by 273
Abstract
Background/Objectives: Hepatocyte-specific contrast agent (Gd-EOB-DTPA) can improve the detection of liver lesions during MRI-guided thermal ablation. This study aimed to assess the impact of contrast agent administration on the delineation of the ablation zone during therapy monitoring. Methods: From 2010 to 2020, 358 [...] Read more.
Background/Objectives: Hepatocyte-specific contrast agent (Gd-EOB-DTPA) can improve the detection of liver lesions during MRI-guided thermal ablation. This study aimed to assess the impact of contrast agent administration on the delineation of the ablation zone during therapy monitoring. Methods: From 2010 to 2020, 358 patients with primary and secondary hepatic malignancies underwent MRI-guided thermoablation. A total of 27 patients with 30 liver lesions received Gd-EOB-DTPA during the procedure to improve target lesion visibility (Group 1), while 30 patients with 30 lesions underwent MRI-guided thermoablation without contrast administration (Group 2). T1-weighted volumetric interpolated breath-hold examination (VIBE) sequences were used for intraprocedural imaging, and post-procedural control imaging involved intravenous Gadobutrol administration in both groups. The contrast-to-noise ratio (CNR) was assessed for three key structures: the target lesion before applicator placement, the ablation zone during unenhanced therapy monitoring, and the ablation zone in contrast-enhanced control imaging. A statistical comparison of CNR values between the two groups was performed using the non-parametric Wilcoxon test (p < 0.05). Results: The CNR of lesions in group 1 significantly increased following the administration of Gd-EOB-DTPA. During therapy monitoring, the ablation zone in group 2 exhibited a significantly higher CNR compared to group 1 (median: 7.9 vs. 2.1; p < 0.001). Similarly, at the contrast-enhanced final control, the CNR of the ablation zone remained significantly greater in group 2 than in group 1 (median: 7.7 vs. 2.0; p < 0.001). Conclusions: The administration of a hepatocyte-specific contrast agent (Gd-EOB-DTPA) prior to intervention improves the visualization of liver lesions that are poorly demarcated but significantly reduces the contrast of the ablation zone during intra- and post-procedural imaging. Therefore, its use should be reserved for cases in which the target lesion cannot be sufficiently delineated without contrast. Full article
(This article belongs to the Special Issue Novel Approaches and Advances in Interventional Oncology)
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16 pages, 1799 KiB  
Article
Integrating CT Radiomics and Clinical Features to Optimize TACE Technique Decision-Making in Hepatocellular Carcinoma
by Max Masthoff, Maximilian Irle, Daniel Kaldewey, Florian Rennebaum, Haluk Morgül, Gesa Helen Pöhler, Jonel Trebicka, Moritz Wildgruber, Michael Köhler and Philipp Schindler
Cancers 2025, 17(5), 893; https://doi.org/10.3390/cancers17050893 - 5 Mar 2025
Viewed by 657
Abstract
Background/Objectives: To develop a decision framework integrating computed tomography (CT) radiomics and clinical factors to guide the selection of transarterial chemoembolization (TACE) technique for optimizing treatment response in non-resectable hepatocellular carcinoma (HCC). Methods: A retrospective analysis was performed on 151 patients [33 conventional [...] Read more.
Background/Objectives: To develop a decision framework integrating computed tomography (CT) radiomics and clinical factors to guide the selection of transarterial chemoembolization (TACE) technique for optimizing treatment response in non-resectable hepatocellular carcinoma (HCC). Methods: A retrospective analysis was performed on 151 patients [33 conventional TACE (cTACE), 69 drug-eluting bead TACE (DEB-TACE), 49 degradable starch microsphere TACE (DSM-TACE)] who underwent TACE for HCC at a single tertiary center. Pre-TACE contrast-enhanced CT images were used to extract radiomic features of the TACE-treated liver tumor volume. Patient clinical and laboratory data were combined with radiomics-derived predictors in an elastic net regularized logistic regression model to identify independent factors associated with early response at 4–6 weeks post-TACE. Predicted response probabilities under each TACE technique were compared with the actual techniques performed. Results: Elastic net modeling identified three independent predictors of response: radiomic feature “Contrast” (OR = 5.80), BCLC stage B (OR = 0.92), and viral hepatitis etiology (OR = 0.74). Interaction models indicated that the relative benefit of each TACE technique depended on the identified patient-specific predictors. Model-based recommendations differed from the actual treatment selected in 66.2% of cases, suggesting potential for improved patient–technique matching. Conclusions: Integrating CT radiomics with clinical variables may help identify the optimal TACE technique for individual HCC patients. This approach holds promise for a more personalized therapy selection and improved response rates beyond standard clinical decision-making. Full article
(This article belongs to the Special Issue Novel Approaches and Advances in Interventional Oncology)
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19 pages, 7890 KiB  
Article
Using the Tissue Impulse Response Function to Streamline Fractionated MRgFUS-Induced Hyperthermia
by Pauline C. Guillemin, Yacine M’Rad, Giovanna Dipasquale, Orane Lorton, Vanessa Fleury, Shahan Momjian, Anna Borich, Lindsey A. Crowe, Thomas Zilli, Sana Boudabbous and Rares Salomir
Cancers 2025, 17(3), 515; https://doi.org/10.3390/cancers17030515 - 4 Feb 2025
Viewed by 727
Abstract
Background/Objectives: Combining radiation therapy with mild hyperthermia, especially via magnetic resonance-guided focused ultrasound (MRgFUS), holds promise for enhancing tumor control and alleviating symptoms in cancer patients. However, current clinical applications of MRgFUS focus primarily on ablative treatments, and using MRI guidance for [...] Read more.
Background/Objectives: Combining radiation therapy with mild hyperthermia, especially via magnetic resonance-guided focused ultrasound (MRgFUS), holds promise for enhancing tumor control and alleviating symptoms in cancer patients. However, current clinical applications of MRgFUS focus primarily on ablative treatments, and using MRI guidance for each radiation session increases treatment costs and logistical demands. This study aimed to test a streamlined workflow for repeated hyperthermia treatments that reduces the need for continuous MRI monitoring, using an approach based on impulse response function (Green’s function) to optimize acoustic power settings in advance. Methods: We implemented the Green’s function approach in a perfused, tissue-mimicking phantom, conducting 30 experiments to simulate hyperthermia delivery via MRgFUS. Pre-calculated acoustic power settings were applied to maintain a stable hyperthermia target without the need for real-time feedback control from MRI thermometry. Additionally, a retrospective analysis of patient thermometry data from MRgFUS sonications was performed to assess feasibility in clinical contexts. Results: Our experiments demonstrated consistent, stable hyperthermia (+7 °C) for 15 min across varying perfusion rates, outperforming conventional closed-loop MRI feedback methods in maintaining temperature stability. The retrospective analysis confirmed that this method is noise-robust and clinically applicable. Conclusions: This off-line approach to hyperthermia control could simplify the integration of MRgFUS hyperthermia in cancer treatment, reducing costs and logistical barriers. These findings suggest that our method may enable the broader adoption of hyperthermia in radiation therapy, supporting its role as a viable adjuvant treatment in oncology. Full article
(This article belongs to the Special Issue Novel Approaches and Advances in Interventional Oncology)
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Review

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26 pages, 386 KiB  
Review
Expanding the Scope of Interventional Oncology: Locoregional Therapies in Extrahepatic Malignancies
by Gavin Wu, Cindy Chen, Jin Chang, Farbod Fazlollahi and Mina S. Makary
Cancers 2025, 17(5), 726; https://doi.org/10.3390/cancers17050726 - 21 Feb 2025
Viewed by 799
Abstract
Background/Objectives: Locoregional therapies (LRTs), including transarterial embolization (TAE), transarterial chemoembolization (TACE), and transarterial radioembolization (TARE), have become integral in the management of hepatocellular carcinoma (HCC) in recent decades and continue to shape evolving treatment strategies. While their role in liver tumor management is [...] Read more.
Background/Objectives: Locoregional therapies (LRTs), including transarterial embolization (TAE), transarterial chemoembolization (TACE), and transarterial radioembolization (TARE), have become integral in the management of hepatocellular carcinoma (HCC) in recent decades and continue to shape evolving treatment strategies. While their role in liver tumor management is well established, their potential for treating extrahepatic malignancies is gaining increasing attention. Notably, growing research has highlighted the promising applications of TAE, TACE, and TARE in extrahepatic cancers such as glioblastoma (GBM), soft tissue sarcomas (STSs), prostate cancer (PCa), pancreatic cancer, and renal cell carcinoma (RCC). This review aims to explore these novel applications, providing a comprehensive summary of the current literature, examining clinical outcomes, and discussing future directions for integrating these techniques into broader oncologic treatment strategies. Methods: A systematic literature review was conducted focusing on LRTs such as TAE, TACE, and TARE in extrahepatic malignancies. Studies published between May 1998 and December 2024 were included, emphasizing outcomes in GBM, STS, PCa, pancreatic cancer, and RCC. Data extraction prioritized clinical outcomes, safety profiles, and procedural efficacy. Results: LRTs demonstrated significant potential in managing extrahepatic malignancies, with TAE, TACE, and TARE showing promising results in palliative management and tumor control. Across studies, these therapies exhibited varying degrees of success in improving progression-free survival and overall survival, with minimal systemic toxicity. Conclusions: The expanding application of LRTs in extrahepatic malignancies highlights their transformative potential in interventional oncology. By offering targeted, minimally invasive treatment options, these modalities bridge critical gaps in managing tumors refractory to conventional therapies. Future research should focus on standardizing protocols, optimizing patient selection, and exploring combination therapies to maximize their clinical efficacy. Full article
(This article belongs to the Special Issue Novel Approaches and Advances in Interventional Oncology)
15 pages, 1392 KiB  
Review
Unraveling the Role of Fusobacterium nucleatum in Colorectal Cancer: Molecular Mechanisms and Pathogenic Insights
by Linda Galasso, Fabrizio Termite, Irene Mignini, Giorgio Esposto, Raffaele Borriello, Federica Vitale, Alberto Nicoletti, Mattia Paratore, Maria Elena Ainora, Antonio Gasbarrini and Maria Assunta Zocco
Cancers 2025, 17(3), 368; https://doi.org/10.3390/cancers17030368 - 23 Jan 2025
Cited by 1 | Viewed by 2362
Abstract
Fusobacterium nucleatum, a gram-negative anaerobic bacterium, has emerged as a significant player in colorectal cancer (CRC) pathogenesis. The bacterium causes a persistent inflammatory reaction in the colorectal mucosa by stimulating the release of pro-inflammatory cytokines like IL-1β, IL-6, and TNF-α, creating an [...] Read more.
Fusobacterium nucleatum, a gram-negative anaerobic bacterium, has emerged as a significant player in colorectal cancer (CRC) pathogenesis. The bacterium causes a persistent inflammatory reaction in the colorectal mucosa by stimulating the release of pro-inflammatory cytokines like IL-1β, IL-6, and TNF-α, creating an environment conducive to cancer progression. F. nucleatum binds to and penetrates epithelial cells through adhesins such as FadA, impairing cell junctions and encouraging epithelial-to-mesenchymal transition (EMT), which is associated with cancer advancement. Additionally, the bacterium modulates the host immune system, suppressing immune cell activity and creating conditions favorable for tumor growth. Its interactions with the gut microbiome contribute to dysbiosis, further influencing carcinogenic pathways. Evidence indicates that F. nucleatum can inflict DNA damage either directly via reactive oxygen species or indirectly by creating a pro-inflammatory environment. Additionally, it triggers oncogenic pathways, especially the Wnt/β-catenin signaling pathway, which promotes tumor cell growth and longevity. Moreover, F. nucleatum alters the tumor microenvironment, impacting cancer cell behavior, metastasis, and therapeutic responses. The purpose of this review is to elucidate the molecular mechanisms by which F. nucleatum contributes to CRC. Understanding these mechanisms is crucial for the development of targeted therapies and diagnostic strategies for CRC associated with F. nucleatum. Full article
(This article belongs to the Special Issue Novel Approaches and Advances in Interventional Oncology)
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Other

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16 pages, 1551 KiB  
Systematic Review
A Comparison of the Efficacy and Safety of US-, CT-, and MR-Guided Radiofrequency and Microwave Ablation for HCC: A Systematic Review and Network Meta-Analysis
by Hao Li, Thomas J. Vogl, Kuei-An Chen and Hamzah Adwan
Cancers 2025, 17(3), 409; https://doi.org/10.3390/cancers17030409 - 26 Jan 2025
Cited by 1 | Viewed by 892
Abstract
Objectives: The aim of this study was to compare the efficacy and safety of thermal ablation, focusing on radiofrequency ablation (RFA) and microwave ablation (MWA), for hepatocellular carcinoma (HCC) using US-, CT-, and MR-guidance. Methods: PubMed, EMBASE, Cochrane Library, and Web of Science [...] Read more.
Objectives: The aim of this study was to compare the efficacy and safety of thermal ablation, focusing on radiofrequency ablation (RFA) and microwave ablation (MWA), for hepatocellular carcinoma (HCC) using US-, CT-, and MR-guidance. Methods: PubMed, EMBASE, Cochrane Library, and Web of Science were searched for studies comparing US, CT, and MR guidance in thermal ablation for HCC. Observational studies and randomized controlled trials (RCTs) were included. Overall survival (OS), local tumor recurrence (LTR), primary technique effectiveness (PTE), and major complications were assessed with network meta-analysis. Results: One RCT and 13 retrospective cohort studies reporting on 2349 patients were included. For OS at 3 years, compared to CT, US had hazard ratios (HRs) of 0.98 (95%CI: 0.77–1.26), and MR had HRs of 1.60 (95%CI: 0.51–5.00); For OS at 5 years, US had HRs of 0.80 (95%CI: 0.64–1.01), and MR had HRs of 1.23 (95%CI: 0.52–2.95) compared to CT. LTR rates, PTE, and major complications did not show statistical significance among the three guidance modalities (LTR: RR = 0.29 (95%CI: 0.08–1.14), p = 0.97 MR vs. CT; RR = 0.25 (95%CI: 0.06–1.02), p = 0.97 MR vs. US; PTE: RR = 1.06 (95%CI: 0.96–1.17), p = 0.90 MR vs. CT; RR = 1.08 (95%CI: 0.98–1.20), p = 0.90 MR vs. US. Major complications: RR = 0.27 (95%CI: 0.13–0.59), p = 0.94 MR vs. CT; RR = 0.41 (95%CI: 0.10–1.74), p = 0.94 MR vs. US). Conclusions: CT-, US-, and MR-guided RFA and MWA are equally effective and safe for HCC patients. Full article
(This article belongs to the Special Issue Novel Approaches and Advances in Interventional Oncology)
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11 pages, 503 KiB  
Systematic Review
The Role of Transarterial Embolization Plus Radiotherapy Compared to Radiotherapy or Transarterial Embolization Alone in the Management of Painful Bone Metastases: Results of a Systematic Review
by Antonio Vizzuso, Matteo Renzulli, Valentina Lancellotta, Alessandro Posa, Patrizia Cornacchione, Bruno Fionda, Ciro Mazzarella, Davide De Leoni, Luca Tagliaferri, Emanuela Giampalma and Roberto Iezzi
Cancers 2024, 16(24), 4183; https://doi.org/10.3390/cancers16244183 - 15 Dec 2024
Viewed by 1080
Abstract
This study systematically reviews the efficacy and safety of combining transarterial embolization (TAE) with radiotherapy (RT) for managing bone metastases (BM), assessing clinical response (CR), and local control (LC). A literature search using PubMed, Scopus, Web of Science, Medline Plus, and the Cochrane [...] Read more.
This study systematically reviews the efficacy and safety of combining transarterial embolization (TAE) with radiotherapy (RT) for managing bone metastases (BM), assessing clinical response (CR), and local control (LC). A literature search using PubMed, Scopus, Web of Science, Medline Plus, and the Cochrane Library identified three relevant studies with 74 patients and 103 BM. One study included local chemotherapy infusion with TAE. All studies reported CR rates, though one used skeletal-related events as a surrogate, while only one study provided LC rates. Adverse events were noted across all studies. A quantitative analysis of CR rates showed a relative risk (RR) of 0.15 (confidence interval (CI): 0.03–0.69) favoring TAE plus RT over RT alone, while no significant differences were observed between TAE plus RT and TAE alone (RR: 0.91; CI: 0.51–1.63). The combined TAE and RT approach demonstrated effectiveness in local tumor control and produced faster, longer-lasting pain relief than RT alone, although TAE was associated with a mild, transient increase in side effects. While TAE plus RT shows potential benefit and acceptable toxicity, the current evidence is of low quality. Full article
(This article belongs to the Special Issue Novel Approaches and Advances in Interventional Oncology)
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