Search Results (102)

Background/Objectives: Preoperative strategies for hepatocellular carcinoma (HCC) requiring major hepatectomy remain controversial, particularly in “borderline resectable” cases. This study aimed to evaluate the oncological benefit and perioperative safety of Yttrium-90 transarterial radioembolization (TARE) in patients undergoing right or extended right hepatectomy for HCC. Material and Methods: All consecutive patients who underwent right or extended right hepatectomy for HCC at a single tertiary center between January 2013 and December 2023 were retrospectively reviewed. Patients were grouped based on whether they received preoperative TARE or underwent upfront resection. Outcomes analyzed included perioperative morbidity and long-term oncological endpoints. Results: A total of 39 patients were included, of whom 18 received preoperative TARE and 21 underwent upfront surgery. Patients in the TARE group showed significantly greater tumor necrosis at pathology (70% vs. 10%, p = 0.002) and more frequent extended resections. Five-year cancer-specific survival (80.4% vs. 33.5%, p = 0.011), recurrence-free survival (33.8% vs. 14.0%, p = 0.047), and curative-intent disease-free survival (69.3% vs. 18.9%, p = 0.0037) were significantly higher in the TARE group. Overall survival showed a favorable trend. Intraoperative outcomes, postoperative morbidity, and 90-day mortality were comparable between groups. Conclusions: Preoperative TARE is a safe and effective neoadjuvant strategy in selected patients with HCC undergoing major hepatectomy. It may enhance long-term oncological outcomes without increasing surgical risk, supporting its potential role in the management of borderline resectable HCC. Full article

Background/Objectives: Liver metastases are common among patients with breast cancer and have a poor prognosis if left untreated. The aim of this systematic review is to evaluate and compare chemoembolization (TACE) versus radioembolization (TARE) treatments in patients with breast cancer liver-dominant metastases in terms of overall survival (OS), local tumor control (LC), and toxicity. Methods: The S.P.I.D.E.R framework was used to address the clinical question. A systematic literature search using PubMed and Scopus was performed to identify full articles evaluating the efficacy of TACE and TARE in patients with liver metastases from breast cancer. Results: The literature search resulted in 10 articles for TACE, 13 articles for TARE and 1 for combined TACE/TARE, totaling 462 patients for the TACE group and 627 for the TARE group. The median LC was 68.7% for TACE and 78.9% for TARE. The median OS was 15.3 months for TACE and 11.9 for TARE. Progression at three months was 32.5% for TACE and 20.6% for TARE. Conclusions: The included studies were heterogeneous, varying widely in design, patient selection, and therapeutic protocols. Nonetheless, this systematic review suggests that locoregional therapies are effective in the treatment of liver metastases in patients with breast cancer and may improve tumor burden, alleviate symptoms and extend overall survival. The median LC of the liver metastases at three months was higher in the TARE group compared to TACE. However, the TARE group showed lower OS rates after treatment. Full article

Purpose: Previous studies have reported that blood-based inflammatory markers are associated with prognosis in patients with various solid tumors, including colorectal cancer (CRC). The pan-immune inflammation value (PIV) is a novel prognostic biomarker based on blood count. Here, we aimed to study the association between PIV and survival following transarterial radioembolization (TARE) in patients with liver-dominant metastatic colorectal cancer (CLM). Methods: A total of 49 patients with CLM who underwent TARE at the Ankara University Department of Medical Oncology were retrospectively analyzed. The relationship between clinical and laboratory parameters with post-TARE overall survival (OS) was analyzed by multivariate analyses. Results: The median age was 60 years and 71.4% of patients had received at least two lines of chemotherapy. The objective response rate (ORR) was 59.1% following TARE. Patients with hepatic response after TARE treatment demonstrated significantly longer survival compared to non-responders (p: 0.033). The optimal PIV threshold value was calculated as 629 in ROC analyses. This PIV value had 81% sensitivity and 80% specificity for OS prediction (AUC 0.86; 95% CI: 0.75–0.98, p = 0.008). Patients with elevated PIV > 629 had significantly shorter OS (p = 0.002). In the multivariate analysis, adjusted for ECOG PS, TARE response, presence of extrahepatic disease, number of chemotherapy lines, CEA levels and post-TARE NLR and PIV, only low PIV level was associated with longer OS (>629 vs. ≤629; HR: 4.87; 95% CI: 1.32–17.92; p = 0.017). Conclusions: PIV, a blood-based inflammatory score, may reflect the host’s immune response following TARE and serve as a novel predictor of survival. Full article

Due to the limitations of current battery technologies—such as lower energy density and high cost compared to fossil fuels—electric vehicles (EVs) face constraints in applications requiring extended range or heavy payloads, such as refuse trucks. As a midterm solution, hybrid electric vehicles (HEVs) combine internal combustion engines (ICEs) and electric powertrains to enable flexible energy usage, particularly in urban duty cycles characterized by frequent stopping and idling. This study introduces a model-based energy management strategy using the Equivalent Consumption Minimization Strategy (ECMS), tailored for a retrofitted series hybrid refuse truck. A conventional ISUZU NPR 10 truck was instrumented to collect real-world driving and operational data, which guided the development of a vehicle-specific ECMS controller. The proposed strategy was evaluated over five driving cycles—including both standardized and measured urban scenarios—under varying load conditions: Tare Mass (TM) and Gross Vehicle Mass (GVM). Compared with a rule-based control approach, ECMS demonstrated up to 14% improvement in driving range and significant reductions in exhaust gas emissions (CO, NO_x, and CO₂). The inclusion of auxiliary load modeling further enhances the realism of the simulation results. These findings validate ECMS as a viable strategy for optimizing fuel economy and reducing emissions in hybrid refuse truck applications. Full article

Background: Transarterial radioembolization (TARE) with Yttrium-90 microspheres is an established therapy for unresectable hepatocellular carcinoma (HCC). However, its clinical efficacy compared to transarterial chemoembolization (TACE) remains unclear. Methods: We retrospectively reviewed 279 consecutive patients undergoing TARE (n = 104) or TACE (n = 175) at four tertiary centers. Patients with metastatic disease, locally advanced HCC, or Child–Pugh (CP) C were excluded. Data on treatment, adverse events, survival outcomes (median overall survival [mOS], and objective response rates [by modified Response Evaluation Criteria in Solid Tumors; mRECIST]) were collected. Results: The median follow-up of the cohort was 27 months (IQR 13–50), the mean age was 67.6 ± 10.1 years, and 207 (74.2%) were male. The cohort was balanced in age, performance status, CP class, and HCC etiology. Maximum tumor diameter was significantly larger in the TARE cohort compared to the TACE cohort (4.4 vs. 3.1 cm, p < 0.001), including within the BCLC 0/A (4.2 vs. 2.7 cm, p = 0.001) and BCLC B (5.0 vs. 4.0 cm, p = 0.049) subgroups. The mOS was longer with TACE (37 vs. 22 months; hazard ratio [HR] 1.65, 95% CI: 1.19–2.29, p = 0.002). In BCLC 0/A patients, TACE yielded longer mOS (60 vs. 25 months; HR 2.35, 95% CI: 1.17–4.69; p = 0.016). In BCLC B, mOS was longer with TACE (32 vs. 20 months), but was not statistically significant (HR 1.39, 95% CI: 0.96–2.03, p = 0.080). In BCLC 0/A, complete response rates were higher with TACE (43.2% vs. 34.3%, p = 0.012). Hepatic decompensation was more frequent with TARE- (26.0%) than with TACE-treated patients (13.7%, p = 0.010). Conclusions: TACE demonstrated superior survival outcomes over TARE, particularly in early-stage disease. These results advocate for a more nuanced selection of embolization therapies in these patients. Full article

Texas has abundant forest resources, and the forest sector contributes tremendously to the state economy. However, Texas has the lowest log truck weight limits among the neighboring states, which puts the state at a competitive disadvantage in the forest industry. This study examined the economic and environmental impacts of increasing log truck weight limits from 84,000 to 92,000 pounds across these supply chain sectors: forestry, logging, sawmills, and truck transportation. Economic estimation was conducted using IMPLAN with 2023 data, while the environmental impacts were assessed through a survey. Two scenarios, representing 12 and 13 percent efficiency improvements from the increased log truck weight limits, were analyzed using standard truck tare weights. The 12 percent efficiency improvement generated a total of 864 jobs, USD 56.31 million in labor income, USD 90.90 million in value added, and USD 189.91 million in industry output. While the 13 percent efficiency improvement generated a total of 936 jobs, USD 61.01 million in labor income, USD 98.52 million in value added, and USD 205.73 million in industry output. Additionally, the 12 percent and 13 percent efficiency improvements reduced annual fuel consumption by 4.69 million and 5.53 million liters and lowered carbon dioxide emissions by 12.61 thousand and 14.89 thousand tonnes, respectively. These results offer valuable insights for policymakers aiming to improve efficiency and profitability in the timber industry. Full article

Salt intake, specifically NaCl, should be reduced to prevent hypertension. Ramen often contains high-NaCl soup in Japan, but there are no reports of the actual sodium (Na) or potassium (K) contents. We visited ramen restaurants in Kyoto that had received high ratings on review sites and sampled the soups and toppings (n = 52). The Na and K concentrations were measured using ion electrodes, and the NaCl and K contents per serving and Na/K ratio were calculated. The results were compared among different types of “tare” (thick seasonings) (salt, soy sauce, and miso) and different types of broth (chicken, pork bone, and fish). The average NaCl and K contents per serving were 6.53 ± 1.48 g and 448 ± 141 mg, respectively, and Na/K was 10.7 ± 4.3 mmol/mmol. Considering the different broths, the Na/K ratio was the lowest for fish (9.6 ± 5.2), followed by chicken (10.0 ± 3.1) and pork bone (13.2 ± 4.8). Ramen dishes were high in both Na and the Na/K ratio. The low Na/K of fish soup ramen was thought to be due to the higher K content extracted from dried fish. Depending on the broth, it is possible to reduce the Na/K ratio. Full article

Background/Objectives: This systematic review and meta-analysis evaluated the effectiveness and the safety of transarterial radioembolization using Holmium-166 microspheres (Ho-166-TARE) for the treatment of primary and secondary liver tumors. The aim of the study was to offer a detailed analysis of clinical outcomes and the potential benefits of this innovative therapy. Methods: The study was conducted according to the PRISMA 2020 guidelines. The systematic search was performed in five databases in November 2023 and updated in June 2024. All 16 eligible studies were original research that evaluated Ho-166-TARE. The endpoints analyzed were disease control rate (DCR), overall survival (OS), progression-free survival (PFS), clinical and laboratory adverse events, healthy-liver- and tumor-liver-absorbed doses. The risk of bias was assessed using the MINORS checklist. Results: The pooled overall disease control rate (DCR) was 72% (95% CI, 46–89%); by mRECIST, it was 93% (95% CI, 71–99%); and by RECIST 1.1, it was 54% (95% CI, 22–83%) at 3-month follow-up. Overall survival (OS) at 3, 6, 12, and 30 months was 98%, 89%, 74%, and 39%, respectively. Severe clinical adverse events were minimal, although some patients showed elevated GGT levels and lymphocytopenia. Tumor-absorbed doses were nearly three times higher than those in healthy liver tissue. Conclusions: These findings suggest that Ho-166-TARE is a safe and effective locoregional treatment option for liver tumors, especially in cases where systemic therapy alone is insufficient or surgical resection is not feasible. Further studies are needed to investigate tumor-specific response, optimize dosimetry strategies, and establish standardized protocols for long-term outcome assessment. Full article

Systemic therapy (ST) and transarterial radioembolization (TARE) are widely used treatments for advanced-stage hepatocellular carcinoma (HCC). This study quantified the significant variability in treatment costs for unresectable HCC from payer and provider perspectives. An Excel-based price analysis model was developed to estimate the prices of ST and TARE over a 21-month time horizon using 2015–2021 data. Median prices were calculated from Medicare Average Sales Price (ASP), provider Wholesale Acquisition Cost (WAC), and Average Wholesale Price (AWP). Sensitivity analyses evaluated price fluctuations associated with a ±10% variation in treatment duration. ST prices demonstrated marked variability across perspectives, with the median ASP at $175,625, WAC at $198,719, and AWP at $262,892. However, TARE prices were stable, ranging from $21,594 to $24,052. Sensitivity analyses revealed that treatment duration variation resulted in price changes of $35,000–$50,000 for ST, compared with ~$5000 for TARE. The variability in ST pricing was driven by treatment duration and drug-specific pricing mechanisms, particularly immunotherapy-based regimens, which accounted for the higher cost range. Conversely, TARE’s consistent pricing is attributed to standardized procedural costs. Substantial variability exists in ST prices compared with the consistent costs of TARE, underscoring the economic advantage of TARE in appropriate clinical contexts. Full article

In the years 2022 to 2023, the harvesting of medium-sized round wood by the State Forests Service in Poland was estimated at between 22.2 and 23.6 million solid cubic meters per year. This is a significant amount of timber to be transported by road. It is a challenge for both transport companies and round wood buyers. The high variability of wood density depending on the species in combination with its moisture content is a significant issue in logistics operations. This study focuses on the influence of the absolute moisture content on selected parameters of wood deliveries, taking into account the differences in the seasons. The total weight of a transport set (GVW) and empty set (Tare) and the weight of the load (Net) were determined on the basis of weighing the transports on stationary scales at the recipient. The moisture content of each wood load was determined using the dryer-weigher method for sawdust taken from the cutting of several logs from the delivery. This study analyzed a total of 13,602 transports of ten tree species and two wood assortments of pulpwood (S2a) and industrial wood (S2ap) in four seasons in the years 2020–2022. Pine was the dominant species in 5352 deliveries, and spruce was the dominant species in 3161. In terms of seasons, 3983 transports were recorded in the summer, 3650 were recorded in the spring, and 3492 were recorded in the autumn. The lowest number of 2475 was in winter. The mean volume of delivered wood (from 13,602 transports) was 28.18 m³, with a range of results from 19.00 to 51.29 m³ and SD = 2.40. The mean weight of the shipment was 24.95 Mg, with SD = 3.36. The range was from 13.92 Mg to 38.20 Mg. The mean absolute moisture content (AMC) of all wood loads (regardless of species and quality) was 42.91%. The results varied significantly (SD = 6.41). The minimum value was 15.64%, and the maximum value was 66.79%. The absolute moisture content of round wood is related to the season, species and assortment of transported wood. Loads of hardwood have lower average solid cubic meter values than softwood. Full article

Hepatocellular carcinoma (HCC) is a commonly diagnosed malignancy, with the treatment for transplant-ineligible localized disease traditionally relying on locoregional therapies, such as surgical resection, transarterial chemoembolization (TACE), and transarterial radioembolization (TARE). Systemic therapy has historically been reserved for advanced, unresectable HCC. However, lenvatinib, an oral multikinase inhibitor, has recently gained traction as part of a multimodal approach for localized HCC in combination with locoregional treatments. An upfront TACE or TARE can induce tumor hypoxia, leading to the upregulation of hypoxia-inducible factor-1 alpha (HIF-1α) and vascular endothelial growth factor (VEGF), which promotes tumor angiogenesis and progression. The rationale for combining lenvatinib with a locoregional therapy is to enhance tumor shrinkage while preserving liver function before a definitive intervention. Clinical trials, such as TACTICS and LAUNCH, have demonstrated improved outcomes with this approach. Additionally, retrospective studies, including those incorporating immune checkpoint inhibitors, have reported further benefits. This review explores the combination of lenvatinib with various locoregional modalities, including TARE, microwave ablation (MWA), and radiofrequency ablation (RFA), highlighting their indications and clinical outcomes. Furthermore, we discuss the ongoing and upcoming clinical trials investigating the integration of systemic agents with locoregional therapies for intermediate-stage HCC, including EMERALD-1, EMERALD-3, LEAP-012, and CheckMate 74W. Full article

Hepatocellular carcinoma (HCC) is the fourth leading cause of cancer deaths worldwide. Despite the high incidence of HCC, mortality remains high, with an estimated 5-year survival rate of less than 20%. Surgical resection represents a potential curative treatment for HCC; however, less than 20% of patients with HCC are candidates for surgical resection. In patients with unresectable HCC, Yttrium-90 (Y90) transarterial radioembolization (TARE) has emerged as an innovative treatment option. This locoregional therapy delivers high doses of radiation directly to liver tumors via intra-arterial injection, allowing for the targeted destruction of malignant cells while sparing surrounding healthy tissue. In this review, we will explore the latest advances in Y90 TARE for the treatment of HCC, focusing on key developments such as the following: (1) improvements in radiation lobectomy and segmentectomy techniques, (2) the introduction of personalized dosimetry, (3) the integration of combination therapies, (4) the use of imageable microspheres, (5) pressure-enabled Y90 delivery systems, and (6) the application of Y90 surrogates. Full article

Background/Objectives: Studies have indicated that forgoing lung shunt fraction measurement in select patients undergoing Yttrium 90 (Y90) transarterial radioembolization (TARE) may be safe without sacrificing efficacy. This study evaluated the safety and efficacy of a streamlined treatment in patients with small hepatocellular carcinoma (HCC) receiving resin-based TARE. Methods: Patients who received single-session Y90 TARE between September 2023 and May 2024 were retrospectively evaluated. Treatment response was evaluated at the 3-month follow-up using the modified Response Evaluation Criteria in Solid Tumors (mRECIST) criteria. Adverse events (AEs) ≥ Grade 3 were recorded post-procedurally at 3 months. The time from the interventional radiology clinic visit to the procedure date was compared to patients receiving the conventional TARE treatment. Results: Ten consecutive patients were treated with 12 treatments. Each treatment targeted an isolated lesion with median size of 2.5 cm (IQR: 2.1, 2.9). Two patients received two treatments (one for treatment of a separate lesion and the other for the initial incomplete targeting of the tumor). The median delivered tumor dose was 377.7 Gy (IQR: 246.5, 570.1). No patients developed ≥ Grade 3 AEs post-TARE. Complete response was achieved in 11/12 patients (92%). The conventional cohort consisted of 60 patients, all OPTN T2 treated with radiation segmentectomy with glass microspheres. Patients undergoing SSMT had a median time from clinic visit to treatment of 26.5 days (IQR: 15.3, 39) vs. 61 days (IQR: 48, 88.8) in the conventional TARE group (p < 0.001). Conclusions: Streamlined single-session resin-based Y90-TARE in patients with OPTN T2 stage HCC is feasible, efficacious, safe, and associated with reduced time to treatment. Full article

Background: The present study aims to investigate the superiority of TARE-Y90 in the treatment of liver metastases from colorectal cancer in comparison to DEBIRI and perform a parallel resource consumption study to demonstrate a possible favorable cost-effectiveness balance. Methods: The number of subjects included in this study was 46 for TARE-Y90 and 56 in the DEBIRI group. The variables of interest in this study were collected for all selected subjects. Time-to-endpoint outcomes (overall survival, time to progression and time to extra-hepatic progression) were calculated by Kaplan–Meier analysis, reported as medians with 95% confidence intervals and compared between groups by log-rank testing. Values for median time-to-event and 95% confidence intervals were calculated using bootstrapping. Results: Categorization into overall response (OR) and no overall response (NOR) revealed a higher percentage of overall responses in the DEBIRI group (52%) compared to TARE-Y90 (24%). The numerical differences observed in certain response categories did not reach statistical significance, indicating a comparable overall response to treatment between the two cohorts based on the m-RECIST criteria. Median overall survival for the TARE-Y90 cohort was 11.3 (95% CI 10.9–18.6) months and 15.8 (95% CI 14.8–22.7) months for the DEBIRI cohort. Log-rank testing showed no statistically significant differences (p = 0.53). Median time to hepatic disease progression for the TARE-Y90 cohort was 3.5 (95% CI 3.4–8.1) months and 3.8 (95% CI 3.7–11.1) months for the DEBIRI cohort. Log-rank testing showed no statistically significant differences (p = 0.82). An important result of the resource utilization analysis is that TARE-Y90 patients had 1.33 treatments on average per patient, while DEBIRI patients had 3.16 treatments per patient. TARE-Y90 patients also needed fewer days of hospitalization than those in the DEBIRI group. The consequence is that the overall use of resources was higher for DEBIRI in comparison to TARE-Y90. Conclusions: Our analysis of the TARE-Y90 and DEBIRI treatments for CRC liver metastases contributes valuable insights into their comparative effectiveness, revealing no significant differences in radiological responses and overall survival. TARE-Y90 showed higher resource utilization, and its potential advantages in patient comfort and average resource consumption per patient warrant consideration. Full article

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