{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T19:26:00Z","timestamp":1774293960206,"version":"3.50.1"},"reference-count":32,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,8,26]],"date-time":"2025-08-26T00:00:00Z","timestamp":1756166400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,8,26]],"date-time":"2025-08-26T00:00:00Z","timestamp":1756166400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Cardiovasc Intervent Radiol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>A tumor diameter\u2009&gt;\u20093\u00a0cm is considered a relative contraindication for thermal ablation due to a significant risk of post-ablation recurrence. However, current advanced ablation techniques might allow for successful ablation of larger tumors. This study aimed to evaluate the impact of tumor size on outcomes of Hepatic Arteriography and C-Arm CT-Guided Ablation (HepACAGA).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Patients treated with HepACAGA for hepatocellular carcinoma (HCC) or colorectal liver metastases (CRLM) between January 2021 and June 2025 were analyzed. All ablations were performed with microwave ablation. Patients were stratified by tumor size:\u2009\u2264\u20092\u00a0cm, 2\u20133\u00a0cm, and 3\u20135\u00a0cm. Outcomes assessed included local tumor progression-free survival (LTPFS), local tumor progression (LTP) rate, and complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 137 consecutive patients with 265 tumors (152 HCC and 113 CRLM) were included: 187 tumors\u2009\u2264\u20092\u00a0cm, 52 tumors 2\u20133\u00a0cm, and 26 tumors 3\u20135\u00a0cm. The 1-year LTPFS was most favorable for tumors\u2009\u2264\u20092\u00a0cm (96%; 95% CI: 93\u201399), followed by 2\u20133\u00a0cm (93%; 95% CI: 85\u2013100), and 3\u20135\u00a0cm (90%; 95% CI: 78\u2013100). No significant differences in LTPFS were found (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.580). Overall, LTP occurred in 5% of tumors. Secondary LTP rates were 3% for tumors\u2009\u2264\u20092\u00a0cm and 4% for both tumors 2\u20133\u00a0cm and 3\u20135\u00a0cm (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.966). Complication rates were 4% for tumors\u2009\u2264\u20092\u00a0cm, 6% for tumors 2\u20133\u00a0cm, and 13% for tumors 3\u20135\u00a0cm (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.236).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>HepACAGA proved to be effective and safe for treating patients with HCC and CRLM across a broad range of tumor sizes. These findings suggest that intermediate-sized tumors (3\u20135\u00a0cm) could be eligible for thermal ablation without compromising post-ablation recurrence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Graphical Abstract<\/jats:title>\n                  <\/jats:sec>","DOI":"10.1007\/s00270-025-04167-8","type":"journal-article","created":{"date-parts":[[2025,8,26]],"date-time":"2025-08-26T17:43:53Z","timestamp":1756230233000},"page":"59-69","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Impact of Tumor Size on Outcomes of Hepatic Arteriography and C-Arm CT-Guided Ablation (HepACAGA):\u2009&gt;\u20093\u00a0cm Is No Absolute Contraindication"],"prefix":"10.1007","volume":"49","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-1700-6930","authenticated-orcid":false,"given":"Niek","family":"Wijnen","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emma","family":"Ruijs","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rutger C. 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Orphan Biovitrum. MS is a speaker for Medtronic and proctor for GD Medical. GB received institutional scientific grants from Bayer, Servier, Pierre Fabre and Terumo. All other authors declare that they have no conflict of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of Interest"}},{"value":"All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and\/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The data used in this study were extracted from the \u2018Minimally Invasive Thermal Ablation (MISTRAL) study\u2019 database, a registry of all thermal ablation procedures performed at the University Medical Center Utrecht (Utrecht, The Netherlands). Permission was granted by the local institutional review board (No. 21\/709).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical Approval"}},{"value":"Informed consent was obtained from all individual participants included in the study.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed Consent."}},{"value":"Consent for publication was obtained for every individual person\u2019s data included in the study.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for Publication"}}]}}