Search Results (124)

(1) Background: This systematic literature review (SLR) and meta-analysis evaluated the comparative clinical effectiveness and safety of transarterial radioembolization (TARE) versus transarterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC). (2) Methods: Eligible studies were identified through an SLR following PRISMA guidelines using a predefined PICOS framework. PubMed and Embase were searched (2015–2025) for randomized controlled trials (RCTs) and observational studies comparing TARE and TACE. Meta-analyses were conducted for outcomes, including overall survival (OS), objective response rate (ORR), progression-free survival (PFS), and adverse events (AEs). Analyses were conducted for the overall population and predefined subgroups of interest. (3) Results: Among 1464 studies identified through database searches, 25 studies were selected for meta-analysis comprising 8146 patients with HCC. No significant difference was observed between TARE and TACE in 14 studies evaluating OS (HR: 0.99; 95% CI 0.70–1.39) or 13 studies evaluating ORR (RR: 0.94; 95% CI 0.84–1.05). Four studies reporting meta-analyzable PFS outcomes numerically favored TARE, although the difference was not statistically significant (HR: 0.54; 95% CI 0.29–1.01). Rates of any-grade and grade ≥3 AEs were comparable between the two arms. The results from subgroup analyses remained consistent with the overall findings. (4) Conclusions: TARE and TACE demonstrate comparable clinical outcomes in patients with HCC. Additional studies within specific, clinically meaningful subgroups of HCC patients will be valuable to further clarify the comparative effectiveness and safety of TARE and TACE in these populations. Full article

In recent years, reinforcement learning (RL) has been applied to frontier-based exploration to enhance a robot’s decision-making policy and improve exploration performance. In this work, we address this scenario with the aim of pushing forward the finding of the optimal frontier selection policy in unknown, unstructured environments, with RL deployed for a minimal sensing drone setup. We propose a novel policy architecture, featuring an attention module that uses the global map features captured by a convolutional neural network together with local frontier features in the form of scalar values, trained end-to-end with a scoring network using the Proximal Policy Optimization algorithm over a 2D randomized unstructured environment. Our approach demonstrates improved exploration efficiency in the evaluated scenarios, as it surpasses purely heuristic-based frontier selection strategies used as baselines for other RL methods, achieving shorter paths than the Nearest Frontier, the Hybrid Approach, and the TARE local horizon, as well as one-shot sim-to-real policy deployment. Full article

Purpose: The Cardiovascular and Interventional Radiological Society of Europe (CIRSE) conducted an international survey on the real-life application of transarterial radioembolization (TARE). This sub-analysis of the complete survey evaluates intercontinental disparities in TARE practices. Materials and Methods: A survey of 32 multiple-choice questions was distributed to CIRSE members between November and December 2022. The questions addressed steps of the TARE workflow, including treatment work-up, planning and dosimetry, intervention, follow-up and innovations. Responses were curated to remove duplicates and incomplete entries and categorised into continental groups. Analysis focused on variations between Europe and North America and impacting factors in the respective regions were identified. Data is presented using descriptive statistics. Results: Responses were obtained from 30 countries and 133 hospitals, including 87 European and 21 North American centres. Hepatocellular carcinoma was the most common indication, constituting 61% of treatments in North America and 51% in Europe. North America predominantly used ⁹⁰Y glass microspheres, whereas Europe used ⁹⁰Y resin. Procedural differences included the adoption of intra-procedural CT imaging, utilized by all North American sites, versus 89% of European sites. Outpatient treatments were favoured in North America (85%), while in Europe, most patients remained hospitalized for one night (51%). Both regions increasingly emphasized dosimetry-guided treatments, with personalized dosimetry planning in 71% and 84% of North American and European sites, respectively. Conclusions: This North America–Europe comparison highlights regional differences in radioembolization practice between the leading continents in procedure volume, based on results of the CIRSE TARE survey. Specific intercontinental differences identified in this survey included hospitalization, product utilization, and procedural techniques. Full article

Hepatocellular carcinoma (HCC) remains a major contributor to global cancer mortality, with many patients presenting beyond the bounds of upfront curative therapy (resection/transplant). Locoregional therapies, particularly transarterial chemoembolization (TACE), transarterial embolization (TAE), and transarterial radioembolization (TARE), therefore play an essential role in bridging and downstaging strategies designed to enable curative intent in otherwise ineligible patients. Bridging therapy aims to maintain transplant eligibility and reduce waitlist dropout, whereas downstaging seeks to reduce tumor burden to meet accepted criteria for resection or transplantation. This review synthesizes current evidence on TACE, TAE, and TARE for bridging to resection and transplantation, as well as for downstaging to surgical eligibility, drawing from systematic reviews and cohort studies in the recent literature. We examine modality-specific outcomes, contextualized by tumor biology, liver function, and treatment selection criteria. Comparative effectiveness and the need for standardized outcome measures will be highlighted, reflecting heterogeneity in study endpoints and patient populations. Finally, future directions in personalized locoregional therapy, integration with systemic therapies, and refined conversion strategies will be discussed, with emphasis on the need for consensus in defining treatment success. By integrating evolving clinical evidence with practical application, this review will help clarify the expanding role of locoregional therapies in enabling curative-intent strategies for HCC. Full article

This article examines the impact of intermodal wagon technical specifications and railway infrastructure parameters on electricity consumption in rail freight transport. For this purpose, a three-stage analytical model was developed. The first stage defines the core assumptions, including train length, rolling stock types, container configurations, infrastructure constraints, and the characteristics of the energy consumption model. The second stage identifies the technical constraints of specific wagons, determines representative train compositions, and performs loading simulations. The third stage evaluates energy efficiency across different loading scenarios. The case study shows that specific energy consumption varies significantly with wagon type, train mass, and route characteristics. This findings challenge the use of static energy consumption values commonly applied in the literature. The results indicate that 40-foot wagons incur high energy penalties due to their tare weight and axle count, despite offering high loading capacity. While 60-foot wagons consume less energy, they lead to a high share of empty slots under a 20 t/axle limit. In contrast, 80-foot wagons are the most energy-efficient, particularly at a 22.5 t/axle limit. Mixed consists provide a balance between operational flexibility and competitive performance. Extending train length from 600 m to 730 m increases volume but does not automatically reduce unit energy consumption. These findings highlight the need to align wagon fleet selection with infrastructure capabilities and cargo characteristics. This study therefore provides practical recommendations for planning energy-efficient intermodal operations. Full article

Magnetic Resonance Imaging (MRI) plays a pivotal role in evaluating treatment response following radiation-based therapies for hepatocellular carcinoma (HCC). As radiation modalities such as stereotactic body radiotherapy (SBRT) and transarterial radioembolization (TARE) gain prominence, understanding the underlying mechanisms of radiation-induced cellular senescence is essential for accurate interpretation of imaging. The physiological changes of radiation treatment manifest as altered diffusion characteristics and delayed regression of enhancement and tumor volumes on MRI, challenging conventional response criteria. Herein, functional and temporal imaging biomarkers are necessary. However, current imaging strategies lack standardization and robust validation, underscoring the need for prospective studies to correlate MRI findings with treatment outcomes. This review synthesizes emerging evidence on MRI-based evaluation of radiation-treated HCC, explores the physiological rationale linking senescence to imaging phenotypes, and advocates for optimized imaging protocols and criteria to enhance post-treatment surveillance and therapeutic decision-making. Full article

Hepatocellular carcinoma remains one of the most common and lethal cancers worldwide, and many patients are diagnosed at stages where curative therapy is not possible. Recent progress in systemic therapies and refinements in locoregional treatment have shifted how clinicians approach this disease. As evidence has accumulated from trials such as KEYNOTE-937, IMbrave050, and CheckMate 9DX, it has become clear that pairing immunotherapy with ablation or transarterial interventions can deepen and extend treatment responses compared with using either approach alone. This review summarizes the current landscape of these combination strategies, explains the biological and clinical principles that support their use, and highlights ongoing trials that aim to clarify optimal sequencing and patient selection. It also considers future directions for integrating locoregional and systemic therapies to expand curative opportunities and improve long-term outcomes for a broader range of patients. Full article

Background/Objectives: Liver metastases in breast cancer patients are associated with poor prognosis and limited therapeutic options. Selective Internal Radiation Therapy (SIRT), also known as transarterial radioembolization (TARE), has emerged as a loco-regional treatment modality, particularly in cases refractory to systemic therapies. Objective: To systematically review and synthesize evidence from existing systematic reviews and meta-analyses on the efficacy and safety of SIRT in breast cancer patients with liver metastases. Methods: A comprehensive literature search was conducted in PubMed using predefined keywords related to SIRT and breast cancer, restricted to systematic reviews and meta-analyses. Inclusion criteria were reviews evaluating SIRT in breast cancer patients with hepatic metastases, reporting on efficacy (e.g., objective response rate, disease control rate, overall survival) and/or safety outcomes. The quality of included reviews was assessed using AMSTAR 2. Results: Seven systematic reviews and meta-analyses were included. Reported objective response rates (ORRs) ranged from 36% to 61%, and disease control rates (DCRs) from 78 to 96%. Toxicity profiles were generally favorable, with limited grade 3–4 adverse events. Some heterogeneity was noted in patient selection, types of microspheres used (glass vs. resin), and outcome definitions. Conclusions: SIRT appears to be a promising option for breast cancer patients with liver metastases, particularly in the setting of treatment resistance. However, heterogeneity among available studies and the lack of prospective randomized trials limit definitive conclusions. Further high-quality studies are warranted. Full article

Background: Hepatocellular carcinoma (HCC) remains a major cause of cancer-related mortality. Transarterial radioembolization (TARE) has emerged as a locoregional therapy to downstage tumors and expand surgical eligibility. Methods: This retrospective study included patients with HCC who underwent TARE as a bridging treatment. The primary outcomes assessed were the efficacy of TARE in facilitating curative surgery and long-term oncological outcomes, specifically overall survival (OS) and disease-free survival (DFS). Results: This study included 25 patients. 17 patients subsequently underwent surgical resection and eight underwent living-donor liver transplantation (LDLT). At a median follow-up of 33.4 months, the median disease-free survival (DFS) was 11.2 months. Patients with recurrence had a median DFS of 3.65 months, and those without recurrence had a median DFS of 27.1 months. The median overall survival (OS) for the cohort was 33.4 months. At the last follow-up, 76% of patients were alive and disease-free. Kaplan–Meier analysis demonstrated sustained OS in the LDLT group, while resection patients gradually declined within the first two years. Conclusions: TARE is an effective bridging strategy that enables curative-intent surgery in selected patients with HCC and supports favorable long-term oncological outcomes. Careful patient selection and multidisciplinary management remain essential to optimize survival benefits. Full article

Liver function plays a pivotal role in the management of hepatocellular carcinoma (HCC). Consequently, managing HCC requires a dual focus on both tumour staging and liver function assessment to guide therapeutic decisions. Comprehensive liver function evaluation involves clinical tools such as the Child–Pugh classification and the Model for End-Stage Liver Disease (MELD) score. This is supplemented by newer metrics, including the MELD-Na score, the albumin–bilirubin (ALBI) grade and liver stiffness measurements. These assessments are integral to tailoring treatments, ranging from curative approaches such as surgical resection and liver transplantation to locoregional options (percutaneous ablation, transarterial chemoembolisation and radioembolisation), and systemic therapies. This review explores strategies for balancing the aggressiveness of cancer therapy with the need to preserve hepatic function, particularly in patients with advanced liver dysfunction. A multidisciplinary approach, incorporating expertise from hepatology, oncology, radiology and surgery, is essential for optimising outcomes. Advanced imaging techniques and biochemical markers also improve decision-making and ensure individualised care. Full article

Transarterial radioembolization (TARE) is an established therapy for primary and secondary hepatic malignancies. Outcomes depend heavily on dosimetry, which has evolved from empirical and body-surface-area methods to partition and voxel-based approaches. This review summarizes current evidence for advanced (personalized) dosimetry across tumor types, highlights emerging dose–response concepts, and outlines practical barriers and implementation strategies. A narrative review of peer-reviewed clinical studies and trials evaluating dosimetry in TARE, with emphasis on hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma (iCCA), metastatic colorectal cancer (mCRC), neuroendocrine tumor (NET), and breast cancer liver metastases, was performed with comparison of single-compartment medical internal radiation dosimetry method (MIRD), partition (multicompartment) methods, and voxel-based dosimetry methodologies. Personalized dosimetry improves outcomes in multiple tumor types. A randomized trial in HCC showed superior overall survival with partition-based dosing versus MIRD. In selective HCC treatments, voxel-derived metrics (e.g., D95) correlate with complete pathologic necrosis, suggesting benefit beyond mean dose targets. For iCCA, data associate higher tumor doses with better radiologic response, progression-free survival, and downstaging. In mCRC, voxel-based and threshold analyses link specific tumor and margin doses with metabolic/radiographic response and survival. Smaller series in NET and breast cancer indicate dose–response relationships using advanced dosimetry. Evidence supports broader adoption of advanced dosimetry in TARE. Emerging strategies that ensure adequate coverage of the “coldest” tumor regions and thoughtful particle-load planning may further optimize results. Standardized protocols, prospective validation, and scalable workflows are needed to accelerate implementation. Full article

Background/Objectives: To evaluate the efficacy of balloon occlusion trans-arterial hepatic radioembolization with Yttrium-90 (b-TARE) in optimizing dose activity in patients with large or multifocal Hepatocellular Carcinoma (HCC) lesions with heterogeneous macroaggregate distribution by retrospectively comparing outcomes with a similar cohort treated with standard TARE. Methods: This single-center restrospective study included sixty-three consecutive patients with unresectable HCC treated with TARE, of whom 24/63 had balloon-occluded TARE and 39/63 had standard TARE. Both cohorts included large or multifocal HCC lesions characterized by heterogeneous macroaggregate distribution, also in relation to the angiosome framework. The impact of b-TARE was analyzed using 2D and 3D dosimetry with dedicated software on post-procedural SPECT-CT. Dosimetric b-TARE results were retrospectively compared with standard TARE. Results: Both 2D and 3D SPECT-CT analyses demonstrated a better dosimetry profile in the b-TARE group. Concerning 2D evaluation, the activity intensity peak was significantly higher in the b-TARE group compared to the TARE group (998.6 ± 394.9 vs. 578.8 ± 313.3, p = 0.004). Regarding 3D dose analysis, the mean intra-lesion dose administered was significantly higher in the b-TARE group (162.7 ± 54.3 Gy vs. 111.2 ± 44.5 Gy, p = 0.01). There was no increase in significant complications or in the mean dose delivered to the normal liver in the b-TARE group. Conclusions: The employment of balloon occlusion in TARE was associated with a higher activity intensity peak and lesion absorbed dose on voxel-based dosimetry, compared to standard TARE, in patients with heterogeneous HCC and uneven macroaggregate distribution, without increasing mean non-tumoral liver dose. Full article

Background: Hepatocellular carcinoma (HCC) continues to pose a significant global health burden, especially when diagnosed at a symptomatic or advanced stage. In such cases, prompt and well-coordinated treatment plays a key role in improving patient outcomes. This study explores the effect of introducing the Order–Map–Treat (OMT) protocol, designed to streamline clinical decision-making and minimize treatment delays, on the survival of HCC patients undergoing transarterial radioembolization (TARE). Methods: This retrospective cohort included 185 HCC patients (69.2% males), of which 88 (47.6%) underwent TARE before the implementation of the OMT system in 2021 (Group 1) and 97 (52.4%) afterwards (Group 2). The mean age of the entire cohort was 71 ± 12 years. A significantly larger number of patients treated before 2021 had an ECOG score of 0 (p < 0.001). Group 1 had significantly more multifocal disease, while group 2 had more unilobar involvement. More patients with PVTT3 and PVTT4 were treated after the implementation of the OMT protocol (p = 0.009). Results: The OMT protocol significantly reduced the median decision to treatment period (p-value ≤ 0.001) from 37 days to 15 days and mapping to the TARE period from 21 days to 1 day, shortening the total days needed for treatment by 32 days approximately. The median survival from TARE was 1.4 years (95% CI: 1.1 to 1.6) for the entire cohort. When stratified by treatment period, patients treated before OMT had a median survival of 1.5 years (95% CI: 1.2 to 1.9), while those treated after OMT implementation had a median survival of 1.2 years (95% CI: 0.9 to 1.6). The difference was not statistically significant (p = 0.415). Conclusions: While there were no significant survival benefits, the OMT protocol offers more efficient HCC management by minimizing delays in treatment, potentially improving patient experience and cost effectiveness. Full article

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

The present study is devoted to the selection of a new criterion for the optimization of the specific volume/area of universal freight wagons. The currently used criterion—minimum of reduced costs—is practically not applied and the costs for different railway administrations and regions differ significantly. This leads to insufficient use of the effective volume/area of the wagon and to insufficient profitability when carrying out transport work. An analysis of the technical parameters of freight wagons was made, based on which the new criterion—loading tare coefficient—was proposed, depending only on the type of cargo and the wagon parameters. In the analysis, the classical methods for determining the technical parameters were used and an original method for finding the minimum of the new criterion was proposed. These methods were applied to optimize the parameters of a real wagon and the results show that it is expedient to reduce the volume of the wagon. With the optimized wagon, the same transport work can be carried out, as the number of trains for its execution is reduced. The conducted studies can be used by the designers of new freight wagons and by the companies—both the carriers or lessors of wagons. Full article