504 Background: This study evaluated the effectiveness, quality-of-life, safety, and dosimetry of Y90 glass microspheres for the treatment of primary and colorectal liver metastasis in a real-world clinical setting. Herein, we present the final data for patients with hepatocellular carcinoma [HCC] and intrahepatic cholangiocarcinoma [iCCA]. Methods: All patients treated with Y90 glass microspheres (TheraSphere) between 2019 and 2024 who agreed to data collection were included from 34 French institutions. Duration of follow-up and overall survival (OS) were assessed by reverse Kaplan-Meier (KM) and KM analysis, respectively. Toxicity was assessed using CTCAE v5. Pre/post-treatment dosimetry was re-assessed by central read using activity determined by the site. Results: In total, 1196 patients with PLC (989 HCC; 207 iCCA) were included. Of the HCC patients, 35.3% had portal vein thrombosis; 13.3%, 18.9%, 57.9%, and 5.8% were BCLC A, B, C, D, respectively. Among iCCA patients, 56.5% were ECOG 0; 31.9% had associated liver fibrosis or cirrhosis. At least one prior treatment was reported in 39% of PLC patients (systemic, n=194; locoregional [LRT], n=289; surgery, n=72). Personalized multicompartment dosimetry was used for 73% of patients and selective treatment administration was used for 55%. By central assessment, pretreatment mean absorbed dose to total perfused tumor was 422.1 Gy in HCC and 357.2 Gy in iCCA. Median OS [95%CI] was 21.8 months (M) [20.1 – 23.3] for HCC and 21.9M [18.2 – 24.3] for iCCA. iCCA patients treated with TARE as a first-line treatment had longer OS (23.3M) compared to patients treated as a second-line treatment (11.4M). More than half of PLC patients had subsequent treatment (54%). PLC patients who had post-Y90 surgery (12%) had the greatest OS benefit. In HCC, median OS was 48.6M with subsequent surgery (n=112), 23.3M with subsequent LRT or systemic treatment (n=424), and 14.8M with no further treatment (n=396). In iCCA, median OS was not reached in patients with subsequent surgery (n=27), 21.3M for patients with subsequent LRT or systemic treatment (n=90), and 17.4M for patients without subsequent treatment (n=76). Among all patients, 93 experienced adverse events (AEs; n=134), 88 had serious AEs (n=114), and 45 patients had related/possibly related serious treatment-emergent AEs (3.8%). Conclusions: Results from this large prospective real-world study using contemporary TARE treatment highlight its critical role as an integral component in the continuum of care for patients with PLC. In most cases, patients received personalized treatment, resulting in meaningful survival, and an acceptable adverse event profile. Importantly, TARE followed by surgery resulted in survival outcomes rarely observed in this population of patients typically not eligible for surgery. Clinical trial information: NCT04069468 .

Background/Aims:Surgical resection and percutaneous ablation are considered curative treatments for hepatocellular carcinoma (HCC). However, both approaches are associated with a high risk of recurrence. Real-world data on outcomes and post-curative management remain scarce. This study aimed to assess survival and healthcare pathways of patients treated with resection or ablation in routine clinical practice. Methods:We conducted a retrospective analysis using the French National Health Data System. Patients who underwent resection or percutaneous ablation as first-line treatment for HCC between January 2014 and December 2021 were included. The primary endpoint was overall survival (OS); secondary endpoints focused on subsequent treatment sequences and healthcare pathways. Results:Among 10,810 patients included, 5,488 underwent ablation and 5,322 resection as first-line treatment. One- and two-year OS rates were 90% and 78% after ablation (median OS [mOS] 56 months, 95% CI [54-58]) and 88% and 80% after resection (mOS 75 months, 95% CI [72-79]). Median time to next treatment or death was 20 months (95% CI [18-21]) after ablation and 29 months (95% CI [27-30]) after resection. Following initial treatment, 27% of patients in the ablation group and 39% in the resection group received no further therapy. Conclusions:This nationwide real-world study provides comprehensive data on survival and treatment sequences after curative-intent therapy for HCC in France. Despite frequent recurrence, survival outcomes remained favourable, reflecting access to repeated and effective subsequent treatments, underscoring the importance of long-term follow-up in routine care.

BACKGROUND AND AIMS:Screening endoscopy can be spared in patients with compensated cirrhosis when spleen stiffness measurement (SSM) by vibration-controlled transient elastography (VCTE) is ≤40 kPa, as they have a low probability of high-risk varices (HRV). Conversely, endoscopy is required in all patients with chronic portal vein thrombosis (PVT) without cirrhosis. The objective was to evaluate the performance of SSM-VCTE to exclude HRV in patients with chronic PVT. METHODS:We retrospectively included patients with chronic PVT without cirrhosis, who underwent an upper endoscopy within 2 years before or after SSM-VCTE in 16 VALDIG centers, divided into a derivation and a validation cohort. RESULTS:159 patients were included in the derivation cohort; 43% had HRV. 187 patients were included in the validation cohort; 32% had HRV. By univariable analysis, myeloproliferative neoplasm, ascites, hemoglobin, bilirubin, albumin, splenomegaly, portosystemic collaterals, liver stiffness - spleen diameter to platelet ratio score, liver stiffness measurement and SSM-VCTE were associated with HRV in both cohorts. By multivariable binary logistic regression analysis, only SSM-VCTE (p <0.005) remained associated with HRV in both cohorts. In the derivation cohort, SSM-VCTE ≤ 40 kPa had a sensitivity of 97% to rule out HRV, and could spare 41% of endoscopies, with 3% of HRV missed, and a 97% negative predictive value (NPV). In the validation cohort, SSM-VCTE ≤ 40 kPa could spare 43% of endoscopies, with 5% of HRV missed, and a 96% NPV. CONCLUSIONS:This study gathering a total of 346 patients with chronic PVT without cirrhosis showed that SSM-VCTE ≤ 40 kPa can be used to identify patients with a probability of HRV ≤5%, in whom endoscopy can be spared. IMPACT AND IMPLICATIONS:Patients with chronic portal vein thrombosis who do not have cirrhosis usually have low liver stiffness measurement values; the liver stiffness cut-offs used to rule out high-risk varices in patients with cirrhosis cannot therefore be used in this population. We show here that spleen stiffness measurement by vibration-controlled transient elastography ≤40 kPa is able to identify patients with chronic portal vein thrombosis with a very low probability of high-risk varices, in whom screening endoscopy can be spared. Annual surveillance of spleen stiffness measurement could reduce the need for repeated screening endoscopies throughout a person's lifetime. This approach could enhance quality of life while also reducing risks associated with endoscopic procedures, particularly those related to anesthesia.

The DOSISPHERE-01 study demonstrated a survival benefit for patients treated with 90Y radioembolization using personalised [99mTc]Tc-MAA guided versus standard dosimetry guided treatment. This ancillary analysis complements DOSISPHERE-01 by reporting post-treatment dosimetry and assessing agreement between predictive ([99mTc]Tc-MAA) and post-treatment (90Y) absorbed doses. All DOSISPHERE-01 patients with both pre-treatment [99mTc]Tc-MAA SPECT/CT and post-treatment 90Y imaging were eligible. Multicompartment dosimetry was performed using two segmentation methods: anatomic (MRI/CT) and count-threshold based (SPECT). Mean normal liver tissue and index-lesion absorbed dose, and dose volume histogram (DVH) metrics were determined using Simplicit90Y (Mirada Medical, Oxford UK). Agreement between [99mTc]Tc-MAA and 90Y absorbed doses was assessed via Bland-Altman and paired-sample analysis, with correlation assessed via linear-regression. Thirty-seven patients were included: 19 from the personalised arm and 18 from the standard dosimetry arm. Pre- and post-treatment absorbed dose differences were not statistically significant for the index lesion (241 Gy vs. 229 Gy, p = 0.15; mean difference 11.9 Gy; 95

Abstract Purpose This study evaluated the effectiveness, safety, and dosimetry of selective internal radiation therapy with Y90 in a real-world clinical setting. Herein, we present the final data for iCCA. Materials and methods All patients treated with yttrium-90 (Y90) glass microspheres (TheraSphere™) across 34 French institutions who agreed to data collection were included. Overall survival (OS) was assessed by Kaplan-Meier analysis. Adverse events (AEs) were assessed using CTCAE v5. Results Among 207 intrahepatic cholangiocarcinoma (iCCA) patients, key baseline and treatment characteristics were: fibrosis/cirrhosis (31.8%), solitary lesion (52.7%), treatment-naïve (52.2%), prior treatment (37.2%; systemic, n = 70; locoregional, n = 7; surgery, n = 10), concomitant treatment (33.8%; mainly gemcitabine and/or cisplatin); multicompartment dosimetry (68.1%), and selective treatment administration (58.9%). Median index lesion (IL) size was 7.0 cm according to RECIST 1.1 and central read. Mean pretreatment absorbed dose to the IL was 357.03 Gy. Median OS was 21.9 months (M). By subgroup, median OS was 23.3M without cirrhosis/fibrosis versus 19.8M with cirrhosis/fibrosis; 23.3M in treatment-naïve patients versus 11.4M in recurrent disease; 21.3M without concomitant treatment versus 21.9M with concomitant treatment; 22.6M in IL tumors ≤7cm versus 23.7M in > 7cm tumors. Patients with surgery had the greatest survival benefit (n = 27; median not reached) compared to patients with subsequent treatment excluding surgery (n = 90; 21.3M), and no subsequent treatment (n = 76; 17.4M). In total, 18 Grade ≥3 AEs and 18 serious AEs were reported. Conclusion This real-world study demonstrates an acceptable safety profile and meaningful survival including patients with cirrhosis and confirms that Y90 should be considered for iCCA patients.

BACKGROUND AND AIMS:Irreversible electroporation (IRE) is a non-thermal ablation technique suited for difficult-to-treat hepatocellular carcinoma (HCC) with 1-year local recurrence (LR) rates above 50%. We hypothesized that peri-procedural immunotherapy could synergize with IRE to decrease local recurrence. APPROACH AND RESULTS:NIVOLEP is a multicenter phase 2 trial evaluating nivolumab combined with IRE in patients with BCLC A HCC. Patients received 2 neoadjuvant nivolumab infusions, IRE with curative intent, and 12 monthly adjuvant nivolumab infusions. Tumor biopsies were performed at baseline and during IRE. The primary endpoint was 1-year local recurrence-free survival (LRFS). In all, 62 HCC nodules (mean size: 30.0 mm) from 43 patients (mean age: 71 y, 88% male, 81% cirrhosis) were considered. All patients received neoadjuvant nivolumab; 35 underwent curative IRE (8 others: 4 IRE failures, 3 HCC progressions, 1 death). After neoadjuvant nivolumab, radiological or pathological response was observed in 24.2% and 26.3% nodules, respectively. One-year LRFS was 70.6% (95% CI: 55.3-85.9), and 2-year overall survival was 74.2% in the intention-to-treat analysis. Grade 3 or 4 adverse events related to nivolumab occurred in 2 patients; 1 patient died due to nivolumab. RNA-sequencing analysis of the tumor after neoadjuvant nivolumab showed an enrichment of pathways associated with leukocyte migration, T cell activation, and CD8+ T and B-cell infiltration associated with pathological response. Circulating protein variations were associated with pathological or radiological responses and local recurrence. CONCLUSIONS:Neoadjuvant and adjuvant nivolumab in BCLC A HCC patients eligible for IRE lead to pathological response related to immune activation and show anti-tumoral effect.

BACKGROUND & AIMS:Transjugular intrahepatic portosystemic shunt (TIPS) improves survival in refractory ascites. A careful patient's selection is mandatory as TIPS can lead to complications. Liver volumetry is predictive of outcomes before hepatic surgery, but data on its role before TIPS placement are scarce. We aimed to evaluate whether liver and spleen volume measurements are associated with prognosis after TIPS placement in patients with ascites. METHODS:We analysed data from three French centers, treated with TIPS between 2017 and February 2022. Inclusion criteria encompassed a TIPS placement for refractory or recurrent ascites and availability of cross-sectional imaging. Exclusion criteria included non-cirrhotic portal hypertension, other indications for TIPS, hepatocellular carcinoma beyond Milan criteria, and extrahepatic malignancy. Liver and spleen volumes were measured using pre-TIPS CT or MRI scans. The primary endpoint was 1-year transplant-free survival (TFS). Secondary endpoints were overt hepatic encephalopathy (HE), recurrence of ascites, acute variceal bleeding, and jaundice. RESULTS:The 160 patients were included (median age 60 years, male gender 83.8%, alcohol-related cirrhosis 58.8%, with active alcohol consumption in 25.6%, Child-Pugh B cirrhosis in 81.2%, median MELD score was 12). The 1-year TFS was 60.1%. Multivariate analysis identified serum creatinine (HR = 1.01 95% CI [1.00-1.01], p = 0.04), total bilirubin (HR = 1.02 95% CI [1.02-1.04], p = 0.004), and portal pressure gradient (HR = 1.09 95% CI [1.01-1.18], p = 0.03) as independent factors associated with TFS. Neither liver-to-spleen volume ratios (LSVR) (p = 0.36) nor liver volume index (p = 0.92) were significantly associated with death or LT. Overall, 38.1% of patients developed overt HE after TIPS, with lower platelet count (HR = 1.01 95% CI [1.00-1.01], p = 0.04) emerging as an independent predictor. No radiological characteristics were associated with the recurrence of ascites. CONCLUSIONS:In this multicenter study, liver and spleen volumes were not associated with transplant-free survival or liver-related outcomes in patients undergoing TIPS for ascites. These findings suggest that liver volumetry should not be a determining factor in patient selection for TIPS placement.

Background Percutaneous thermal ablation (PTA), including radiofrequency and microwave ablation, has been established as a curative therapy for small malignant liver neoplasms; yet, as clinical indications expand, overall safety remains good, although the exact incidence of complications varies among studies. Purpose To determine updated benchmarks for procedure-related mortality and major adverse events (AEs) after PTA of malignant liver tumors. Materials and Methods In this systematic review and single-proportion meta-analysis of patients who underwent thermal ablation of malignant liver tumors, Cochrane, MEDLINE, and Embase were searched for prospective randomized or cohort studies published from January 2007 to September 2022 that reported AEs after radiofrequency or microwave ablation of three or fewer liver tumors measuring 5 cm or smaller, over at least 90 days of follow-up. Two reviewers independently screened the studies, extracted data, and assessed the risk of bias. Pooled proportions of significant AEs (ie, Society of Interventional Radiology grades C-E), including 90-day procedure-related mortality, were calculated with random-effects models. Results Forty-nine studies comprising 4149 patients and 4636 ablations met the inclusion criteria. The pooled proportion of significant AEs was 3.0% (86 of 3149 patients; 95% CI: 2.50, 3.67; I2 = 0%). The 90-day procedure-related mortality rate was 0.01% (one of 4149 patients; 95% CI: 0.007, 0.014). The AE rates did not differ significantly between radiofrequency and microwave ablation (3.21% vs 2.65%; P = .41) or between hepatocellular carcinoma and metastatic tumors (2.94% vs 3.91%; P = .85). Conclusion PTA of malignant liver tumors is associated with near-zero 90-day mortality and a 3% major complication rate. © RSNA, 2026 Supplemental material is available for this article. See also the editorial by Bettmann in this issue.

Background:Selective Internal Radiation Therapy with yttrium-90 (Y90) has been used for decades, yet guideline recommendations remain inconsistent. High-quality real-world data is needed to guide practice. The objectives of this study were to evaluate effectiveness, safety, and patient quality of life (QoL) with TheraSphere™ treatment in real-world clinical practice, and to identify clinical and dosimetric factors associated with survival. Methods:PROACTIF was a prospective, open label, non-interventional, all-comers cohort study that recruited patients who received Y90 glass microspheres (TheraSphere™) per local standard of care across 34 French sites (January 2019-January 2024). Co-primary endpoints were overall survival (OS) and QoL. Secondary endpoints included safety, conversion to surgery, and factors associated with OS. OS and time-to-deterioration in QoL (Functional Assessment of Cancer Therapy-Hepatobiliary) were assessed by Kaplan-Meier analysis. Adverse events were descriptively summarized using Common Terminology Criteria for Adverse Events, version 5. Trial registration: ClinicalTrials.gov Identifier, NCT04069468. Findings:Amongst 989 HCC patients, 13·3%/18·9%/57·9%/5·8% were Barcelona Clinic Liver Cancer (BCLC) A/B/C/D, respectively; 35·3% had portal-vein tumor thrombosis (PVT); 74·4% were treated using multicompartment dosimetry, and 53·6% with selective Y90 administration. Mean index lesion dose was 435·4 Gy. For all patients, median OS (mOS) [95% CI] was 21·8 months (M) [20·1-23·3]. mOS was 27·0 M [20·7-31·4] for BCLC B, 21·1 M [18·0-22·8] for BCLC C; 23·1 M [21·6-27·0] without PVT, 24·8 M [19·3-30·3] for patients with Vp1/Vp2; 16·8 M mOS for patients with a pretreatment absorbed dose to the index lesion <200 Gy versus 26·0 M with ≥200 Gy (p < 0·001); 19·7 M for <400 Gy and 30·7 M for ≥400 Gy (p < 0·001). After Y90, 106/989 (10·7%) underwent curative-intent surgery, resulting in a mOS of 48·6 M [40·6-not evaluable], versus 20·1 M [17·7-21·7] without surgery. Median time-to-deterioration in QoL was 10·6 M [9·6-11·7]. Serious adverse events occurred in 7·5% patients; serious treatment-related events in 3·7%. Interpretation:In this large real-world cohort, treatment with Y90 glass microspheres demonstrated favorable effectiveness and safety with meaningful outcomes, especially in PVT patients and following subsequent surgery. PROACTIF showed a strong dose-survival relationship as demonstrated in previous studies, and highlights the potential of a tumor absorbed dose ≥400 Gy to further increase survival. These findings support dosimetry-guided Y90 across all BCLC stages, and should inform future guideline recommendations. Funding:Boston Scientific Corporation.

To assess whether arterial computed tomography portography guidance improves early local tumor control after percutaneous thermal ablation of small colorectal cancer liver metastases compared with standard-of-care imaging guidance, hypothesizing a ≥ 20

Background:Selective internal radiation therapy (SIRT) has emerged as a promising and recent treatment for downstaging hepatocellular carcinoma (HCC) before surgical intervention. However, the potential occurrence of postoperative biliary and respiratory complications following major hepatectomy subsequent to SIRT remains unclear. We hypothesized that SIRT can increase the rate of biliary leakage and cause diaphragmatic dysfunction, especially for huge HCC in contact with the diaphragm. Methods:We conducted a retrospective study including consecutive HCC patients from January 2015 to December 2022 undergoing right hepatectomy after SIRT in the Montpellier University Hospital. Patients were compared in a 1:1 ratio with non-SIRT-treated patients based on the following criteria: same diagnosis, same surgery, same American Society of Anesthesiologists (ASA) score, Child-Turcotte-Pugh (CTP) class, and similar tumor burden. Analysis was done using either a linear or logistic regression. Outcomes were the rate of biliary leakage and of 3 diaphragm-related complications: oxygen flow on day 1, need for intensive oxygen therapy, and pleural effusion. Results:Twenty patients with comparable preoperative characteristics were included in each group. Eight patients (40%) in the SIRT group experienced a postoperative bile leak versus only 2 (10%) in the other, with a significantly increased risk [odds ratio (OR) =6; 95% confidence interval (CI): 1.1-33.3; P<0.05]. Similarly, the risk of large postoperative pleural effusion was increased after SIRT, with 6 patients (30%) against 0, respectively (OR =10.5; 95% CI: 1.8-61.4; P<0.05). Conclusions:SIRT may increase the risk of postoperative biliary leakage and respiratory complications after right hepatectomy.

INTRODUCTION:In non-intubated patients, symptomatic treatment of hypoxaemic respiratory failure is still debated, with different options: (1) standard oxygen therapy (SOT), (2) high-flow nasal cannula oxygen therapy (HFNC) and (3) non-invasive ventilation (NIV). The objective of this study is to compare the effects of HFNC and NIV on lung volumes assessed by CT scan to allow a better understanding of their effectiveness. METHODS AND ANALYSIS:The HONIVAH study (High-flow Oxygen therapy and Non-Invasive ventilation on lung Volumes and on upper Airway in Hypoxemic critically ill patients) is an investigator-initiated, prospective, single-centre, physiological, randomised, parallel-group, unblinded trial with an electronic system-based randomisation. Patients with hypoxaemic respiratory failure, defined as the need for SOT flow ≥3 L/min to maintain a pulsed oxygen saturation ≥95%, and a CT scan prescribed by the physician in charge of the patient, will be randomly assigned to the HFNC group or the NIV group. Two inspiratory thoracic CT scans will be performed, one with SOT as part of the routine patient management and a second thoracic CT scan with HFNC or NIV, depending on the allocation group. The primary outcome is the comparison of the relative variation in 'poorly aerated' and 'non-aerated' lung volumes before and after the intervention between the HFNC group and NIV group, assessed by thoracic CT scan. Secondary outcomes included the variation in tracheal cross-sectional upper airway area, lung volumes, gas exchange and patient comfort. ETHICS AND DISSEMINATION:The study project has been approved by the appropriate ethics committee (Comité de Protection des Personnes Sud-Ouest et Outre-mer 1, France, 2022-A02458-35). Informed consent is required. The results will be submitted for publication in a peer-reviewed journal and presented at one or more scientific conferences. TRIAL REGISTRATION:ClinicalTrials.gov identifier: NCT05643911.

Background & Aims Liver biopsy (LB) is the gold standard for diagnosing post-liver transplantation (LT) complications. Currently, there is no data on the value of vibration-controlled-transient elastography (VCTE) for medium- and long-term follow-up after LT compared to protocol LB in asymptomatic patients. This study aims to evaluate the correlation between VCTE-derived liver stiffness measurements (LSM) and histological abnormalities observed in protocol LB 5 to 10 years after LT, to determine the potential role of VCTE in long-term graft monitoring. Methods A prospective study was conducted at a liver transplantation center in Montpellier, France, involving adult LT recipients who underwent both VCTE and LB within 6 months between January 2022 and January 2024. Protocol LB were performed in the absence of clinical or laboratory evidence of post-LT complications. The primary endpoint was to determine the LSM threshold for predicting abnormal LB. Receiver operating characteristic (ROC) curve analysis and the Youden index were used to identify the optimal cutoff. Results Among 90 patients, 32% had abnormal LB findings, including fibrosis ≥ F1 (by Ishak) in 58.6% of abnormal biopsies. The mean LSM was significantly higher in patients with abnormal LB (12.6 ± 13.9 kPa) compared to those with normal LB (5.9 ±1.6kPa), p < 0.001. LSM (area under the ROC curve [AUC]: 0.816) was the most accurate predictor of abnormal LB. The optimal LSM threshold to predict abnormal LB was 6.90 kPa (sensitivity [Se] = 0.69, specificity [Sp] = 0.84), while values ≤5.6 kPa and >12.9 kPa respectively ruled out and predicted an abnormal LB. Conclusion These results underscore the relevance of VCTE in long-term follow-up of LT recipients to determine the need for LB. VCTE effectively predicts abnormal histology and can guide selective use of protocol liver biopsies, potentially reducing unnecessary procedures. Multicenter studies are needed to validate these findings.

Background The role of PET-CT with [18F]fluorodeoxyglucose ([18F]FDG) and [18F]fluorocholine ([18F]FCH) in staging hepatocellular carcinoma and treatment decisions has, to our knowledge, never been prospectively assessed. Methods We conducted a multicentre prospective study (PET-HCC01) in nine hospitals in France, including patients aged 18 years or older with a first diagnosis of hepatocellular carcinoma classified as Barcelona Clinic Liver Cancer (BCLC) classification A to C (without metastasis). At study inclusion, patients underwent contrast-enhanced liver MRI and liver, chest, and pelvis CT scans. Patients subsequently underwent [18F]FCH and [18F]FDG PET-CT. A first tumour staging and treatment decision was recorded by the multidisciplinary tumour board at each centre using morphological imaging, blind to the results of the PET-CTs. After the results of the PET-CTs were revealed, a second tumour staging and treatment decision was recorded. The primary endpoint was the proportion of patients whose treatment was modified by PET-CTs. Analyses were done in the intention-to-image population, consisting of all patients who had undergone at least one PET-CT and were discussed by the multidisciplinary tumour board. This study was registered with ClinicalTrials.gov, NCT04391348. Findings Between July 20, 2020, and April 27, 2023, 230 patients were enrolled. Among the 215 patients included in the intention-to-image population, the median age was 660 years (IQR 600-715), 193 (90%) were male, and 155 (73%) had cirrhosis. Hepatocellular carcinoma was classified as BCLC stage A in 140 (65%) patients, B in 48 (22%), and C without metastasis in 27 (13%) on the basis of morphological imaging. Potential new lesions were identified in 19 (9%) patients by PET-CT (eight by both tracers, six by [18F]FCH only, and five by [18F]FDG only) and in six of these patients, follow-up confirmed the diagnosis of hepatocellular carcinoma (one lesion in the adrenal gland, two in bones, two in the lymph node, and one intrahepatic). PET-CT modified BCLC stage in ten patients: disease stage for two patients moved from BCLC A to B, from BCLC A to C for two patients, from BCLC B to C for two patients, and from BCLC C without metastasis to BCLC C with metastasis for four patients. Planned treatment was modified for four patients (2% [95% CI 1-5]), below the prespecified threshold of clinical significance (10%). Interpretation [18F]FDG and [18F]FCH-PET-CTs should not be systematically performed for staging a first diagnosis of hepatocellular carcinoma, as they modified treatment decisions only in a minority of patients.

Background: Liver venous deprivation (LVD) is a recent radiological technique that has shown promising results on Future Remnant Liver (FRL) hypertrophy. The aim of this retrospective study is to compare the segmentary hypertrophy of the FRL after LVD and after portal vein embolization (PVE). Methods: Patients undergoing PVE or LVD between April 2015 and April 2020 were included. The segmentary volumes (seg 4, seg2+3 and seg1) were assessed before and after the radiological procedure. Results: Forty-four patients were included: 26 undergoing PVE, 10 LVD and 8 eLVD. Volume gain of both segment 1 and segments 2+3 was significantly higher after LVD and eLVD than after PVE (segment 1: 27.33 ± 35.37 after PVE vs. 38.73% ± 13.47 after LVD and 79.13% ± 41.23 after eLVD, p = 0.0080; segments 2+3: 40.73% ± 40.53 after PVE vs. 45.02% ± 21.53 after LVD and 85.49% ± 45.51 after eLVD, p = 0.0137), while this was not true for segment 4. FRL hypertrophy was confirmed to be higher after LVD and eLVD than after PVE (33.53% ± 21.22 vs. 68.63% ± 42.03 vs. 28.11% ± 28.33, respectively, p = 0.0280). Conclusions: LVD and eLVD may induce greater hypertrophy of segment 1 and segments 2+3 when compared to PVE.

Background: While preliminary reports on resection following downstaging using transarterial radioembolization (TARE) for intermediate or advanced hepatocellular carcinomas (HCCs) reported promising oncological outcomes, there's a notable gap in the literature concerning post operative morbidity. Contrary to post hepatectomy liver failure (PHLF), damages to the bile ducts and their potential consequences have been poorly evaluated. Thus, our aim was to explore postoperative complications in HCC patients undergoing liver resection after Y90 TARE, focusing particularly on biliary complications. Methods: Conducted from June 2015 to December 2022, this retrospective study involved 30 HCC patients undergoing liver resection post-TARE. Comprehensive data on surgical procedures, complications, and follow-up were collected. Logistic regression analyses were conducted, starting with univariate analysis followed by multivariate analysis, focusing on variables with a significance level below P<0.2. Results: The objective response rate (ORR) in the TARE-treated area was 97% at 3 months. Survival outcomes showed a median overall survival (OS) of 5.1 years and progression-free survival (PFS) of 3.5 years post-liver resection. The study found a 40% (12 out of 30 patients) rate of severe postoperative complications and a 7% (2 out of 30 patients) 90-day mortality rate. After liver resection, grade B bile leaks occurred in 20% (6 out of 30) of patients, with a third experiencing recurrence. Biliary-specific mortality was 9%. After multivariate analysis, only the interval between TARE and surgery emerged a significant risk factor for biliary complications, showing increased odds of bile leaks if surgery occurred 3-6 months post-TARE compared to after 6 months. Conclusions: This study highlights the importance of timing between TARE and surgery, suggesting a waiting period of at least 6 months. Such timing not only enhances the radiation effects of TARE but also optimizes both future liver remnant growth and patient selection.