{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T23:24:10Z","timestamp":1792452250500,"version":"4.5.0"},"reference-count":27,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2024,5,18]],"date-time":"2024-05-18T00:00:00Z","timestamp":1715990400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Purpose: Hepatic Arteriography and C-Arm CT-Guided Ablation of liver tumors (HepACAGA) is a novel technique, combining hepatic\u2013arterial contrast injection with C-arm CT-guided navigation. This study compared the outcomes of the HepACAGA technique with patients treated with conventional ultrasound (US) and\/or CT-guided ablation. Materials and Methods: In this retrospective cohort study, all consecutive patients with hepatocellular carcinoma (HCC) or colorectal liver metastases (CRLM) treated with conventional US-\/CT-guided ablation between 1 January 2015, and 31 December 2020, and patients treated with HepACAGA between 1 January 2021, and 31 October 2023, were included. The primary outcome was local tumor recurrence-free survival (LTRFS). Secondary outcomes included the local tumor recurrence (LTR) rate and complication rate. Results: 68 patients (120 tumors) were included in the HepACAGA cohort and 53 patients (78 tumors) were included in the conventional cohort. In both cohorts, HCC was the predominant tumor type (63% and 73%, respectively). In the HepACAGA cohort, all patients received microwave ablation. Radiofrequency ablation was the main ablation technique in the conventional group (78%). LTRFS was significantly longer for patients treated with the HepACAGA technique (p = 0.015). Both LTR and the complication rate were significantly lower in the HepACAGA cohort compared to the conventional cohort (LTR 5% vs. 26%, respectively; p &lt; 0.001) (complication rate 4% vs. 15%, respectively; p = 0.041). Conclusions: In this study, the HepACAGA technique was safer and more effective than conventional ablation for HCC and CRLM, resulting in lower rates of local tumor recurrence, longer local tumor recurrence-free survival and fewer procedure-related complications.<\/jats:p>","DOI":"10.3390\/cancers16101925","type":"journal-article","created":{"date-parts":[[2024,5,20]],"date-time":"2024-05-20T03:36:42Z","timestamp":1716176202000},"page":"1925","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Conventional versus Hepatic Arteriography and C-Arm CT-Guided Ablation of Liver Tumors (HepACAGA): A Comparative Analysis"],"prefix":"10.3390","volume":"16","author":[{"given":"Niek","family":"Wijnen","sequence":"first","affiliation":[{"name":"Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rutger C. G.","family":"Bruijnen","sequence":"additional","affiliation":[{"name":"Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0982-0323","authenticated-orcid":false,"given":"Evert-Jan P. A.","family":"Vonken","sequence":"additional","affiliation":[{"name":"Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hugo W. A. M.","family":"de Jong","sequence":"additional","affiliation":[{"name":"Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joep","family":"de Bruijne","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4021-3823","authenticated-orcid":false,"given":"Guus M.","family":"Bol","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands"},{"name":"Department of Radiotherapy, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeroen","family":"Hagendoorn","sequence":"additional","affiliation":[{"name":"Department of Surgery, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martijn P. W.","family":"Intven","sequence":"additional","affiliation":[{"name":"Department of Radiotherapy, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maarten L. J.","family":"Smits","sequence":"additional","affiliation":[{"name":"Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,5,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"69","DOI":"10.3322\/caac.20107","article-title":"Global cancer statistics","volume":"61","author":"Jemal","year":"2011","journal-title":"CA Cancer J. Clin."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Hoshida, Y. (2019). Hepatocellular Carcinoma: Translational Precision Medicine Approaches, Humana Press. Chapter 3.","DOI":"10.1007\/978-3-030-21540-8"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Engstrand, J., Nilsson, H., Str\u00f6mberg, C., Jonas, E., and Freedman, J. (2018). Colorectal cancer liver metastases\u2014A population-based study on incidence, management and survival. BMC Cancer, 18.","DOI":"10.1186\/s12885-017-3925-x"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1038\/s41392-022-00922-2","article-title":"Colorectal liver metastasis: Molecular mechanism and interventional therapy","volume":"7","author":"Zhou","year":"2022","journal-title":"Signal Transduct. Target. Ther."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1016\/j.jhep.2021.11.018","article-title":"BCLC strategy for prognosis prediction and treatment recommendation: The 2022 update","volume":"76","author":"Reig","year":"2022","journal-title":"J. Hepatol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"iv238","DOI":"10.1093\/annonc\/mdy308","article-title":"Hepatocellular carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up","volume":"29","author":"Vogel","year":"2018","journal-title":"Ann. Oncol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"191","DOI":"10.4254\/wjh.v8.i3.191","article-title":"Ablation techniques for primary and metastatic liver tumors","volume":"8","author":"Ryan","year":"2016","journal-title":"World J. Hepatol."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Hui, T.C.H., Kwan, J., and Pua, U. (2021). Advanced Techniques in the Percutaneous Ablation of Liver Tumours. Diagnostics, 11.","DOI":"10.3390\/diagnostics11040585"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/j.carj.2017.11.001","article-title":"Percutaneous Liver Tumour Ablation: Image Guidance, Endpoint Assessment, and Quality Control","volume":"69","author":"Puijk","year":"2018","journal-title":"Can. Assoc. Radiol. J."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1007\/s10396-020-01012-y","article-title":"Current role of ultrasound in the diagnosis of hepatocellular carcinoma","volume":"47","author":"Tanaka","year":"2020","journal-title":"J. Med. Ultrason."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Mansur, A., Garg, T., Shrigiriwar, A., Etezadi, V., Georgiades, C., Habibollahi, P., Huber, T.C., Camacho, J.C., Nour, S.G., and Sag, A.A. (2022). Image-Guided Percutaneous Ablation for Primary and Metastatic Tumors. Diagnostics, 12.","DOI":"10.3390\/diagnostics12061300"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1101","DOI":"10.1016\/j.jvir.2014.02.008","article-title":"Transcatheter CT arterial portography and CT hepatic arteriography for liver tumor visualization during percutaneous ablation","volume":"25","author":"Scheffer","year":"2014","journal-title":"J. Vasc. Interv. Radiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1016\/j.jvir.2014.12.023","article-title":"Transcatheter CT hepatic arteriography-guided percutaneous ablation to treat ablation site recurrences of colorectal liver metastases: The incomplete ring sign","volume":"26","author":"Scheffer","year":"2015","journal-title":"J. Vasc. Interv. Radiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1257","DOI":"10.1007\/s00270-023-03508-9","article-title":"The Added Diagnostic Value of Transcatheter CT Hepatic Arteriography for Intraprocedural Detection of Previously Unknown Colorectal Liver Metastases During Percutaneous Ablation and Impact on the Definitive Treatment Plan","volume":"46","author":"Opperman","year":"2023","journal-title":"Cardiovasc. Interv. Radiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1365","DOI":"10.1007\/s00270-023-03545-4","article-title":"Hepatic Arteriography and C-Arm CT-Guided Ablation (HepACAGA) to Improve Tumor Visualization, Navigation and Margin Confirmation in Percutaneous Liver Tumor Ablation","volume":"46","author":"Smits","year":"2023","journal-title":"Cardiovasc. Interv. Radiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1148\/radiol.2021203715","article-title":"Consensus Guidelines for the Definition of Time-to-Event End Points in Image-guided Tumor Ablation: Results of the SIO and DATECAN Initiative","volume":"301","author":"Puijk","year":"2021","journal-title":"Radiology"},{"key":"ref_17","unstructured":"(2024, February 21). The American Association of Physicists in Medicine, Report No. 096\u2014The Measurement, Reporting, and Management of Radiation Dose in CT (2008). College Park, MD, USA, 2008. Available online: https:\/\/www.aapm.org\/pubs\/reports\/rpt_96.pdf."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"20120551","DOI":"10.1259\/bjr.20120551","article-title":"The effective dose assessment of C-arm CT in hepatic arterial embolisation therapy","volume":"86","author":"Tyan","year":"2013","journal-title":"Br. J. Radiol."},{"key":"ref_19","unstructured":"(2024, January 25). N. Cancer Institute, Common Terminology Criteria for Adverse Events (CTCAE) v5.0, Available online: https:\/\/ctep.cancer.gov\/protocoldevelopment\/electronic_applications\/docs\/CTCAE_v5_Quick_Reference_8.5x11.pdf."},{"key":"ref_20","unstructured":"R Core Team (2024, January 10). R: A Language and Environment for Statistical Computing. Vienna, Austria, 2019. Available online: http:\/\/www.R-project.org\/."},{"key":"ref_21","unstructured":"Meijerink, M.R. (2021, January 25\u201328). COLLISION trial interim results: Surgery vs. MWA. Proceedings of the CIRSE 2021 Summit, Virtual."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Puijk, R.S., Ruarus, A.H., Vroomen, L.G.P.H., van Tilborg, A.A.J.M., Scheffer, H.J., Nielsen, K., de Jong, M.C., de Vries, J.J.J., Zonderhuis, B.M., and Eker, H.H. (2018). Colorectal liver metastases: Surgery versus thermal ablation (COLLISION)\u2014A phase III single-blind prospective randomized controlled trial. BMC Cancer, 18.","DOI":"10.1186\/s12885-018-4716-8"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e580","DOI":"10.1097\/MD.0000000000000580","article-title":"Heat sink effect on tumor ablation characteristics as observed in monopolar radiofrequency, bipolar radiofrequency, and microwave, using ex vivo calf liver model","volume":"94","author":"Pillai","year":"2015","journal-title":"Medicine"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"562","DOI":"10.21037\/jgo.2019.01.34","article-title":"Percutaneous radiofrequency versus microwave ablation for management of hepatocellular carcinoma: A randomized controlled trial","volume":"10","author":"Kamal","year":"2019","journal-title":"J. Gastrointest. Oncol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1340","DOI":"10.1007\/s00268-013-1997-6","article-title":"Incidence and treatment of local site recurrences following RFA of colorectal liver metastases","volume":"37","author":"Nielsen","year":"2013","journal-title":"World J. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"912","DOI":"10.1016\/j.ejca.2013.12.008","article-title":"Local recurrence rates after radiofrequency ablation or resection of colorectal liver metastases. Analysis of the European Organisation for Research and Treatment of Cancer #40004 and #40983","volume":"50","author":"Tanis","year":"2014","journal-title":"Eur. J. Cancer"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Puijk, R.S., Dijkstra, M., van der Lei, S., Schulz, H.H., Vos, D.J.W., Timmer, F.E.F., Geboers, B., Scheffer, H.J., de Vries, J.J.J., and Smits, M.L.J. (2024). The Added Value of Transcatheter CT Hepatic Angiography (CTHA) Image Guidance in Percutaneous Thermal Liver Ablation: An Experts\u2019 Opinion Pictorial Essay. Cancers, 16.","DOI":"10.3390\/cancers16061193"}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/16\/10\/1925\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:44:33Z","timestamp":1760107473000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/16\/10\/1925"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,5,18]]},"references-count":27,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2024,5]]}},"alternative-id":["cancers16101925"],"URL":"https:\/\/doi.org\/10.3390\/cancers16101925","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,5,18]]}}}