Interventional oncology has rapidly developed into a significant pillar in the treatment of liver cancer. Thermal ablation is an example of an interventional oncology treatment, in which a needle... Show moreInterventional oncology has rapidly developed into a significant pillar in the treatment of liver cancer. Thermal ablation is an example of an interventional oncology treatment, in which a needle can be directly inserted into the tumor from outside the body. The tip of this needle can become extremely hot through the use of radiofrequency or microwaves, effectively burning the tumor from the inside out. Transarterial therapies are other interventional oncology treatments that can be administered through the arteries of the affected part of the liver. Small microspheres containing radioactive material or chemotherapy block the blood supply to the tumor and deliver the treatment locally.Part one of this thesis describes the research into ablation margin confirmation. Standardized pre- and post-ablation CT scans were registered and used to quantify the obtained ablation margin. This workflow was first tested in the IAMCOMPLETE study. Potentially, this software tool could identify patients at risk for local recurrent cancer.Part two of this thesis studies combined treatment regimens of early stage HCC. The HORA EST HCC study was the first clinical trial to combine thermal ablation with radioembolization. Hyperaemia around the ablation zone was found to cause radiation dose accumulation in the tissue susceptible to local residual tumor after thermal ablation.In part three of this thesis, the long-term affect after radioembolization was studied. Show less
Liver malignancies are a major burden of disease worldwide. The long-term prognosis for patients with unresectable tumors remains poor, despite advances in systemic chemotherapy, targeted agents,... Show moreLiver malignancies are a major burden of disease worldwide. The long-term prognosis for patients with unresectable tumors remains poor, despite advances in systemic chemotherapy, targeted agents, and minimally invasive therapies such as ablation, chemoembolization, and radioembolization. Thus, the demand for new and better treatments for malignant liver tumors remains high. Surgical isolated hepatic perfusion (IHP) has been shown to be effective in patients with various hepatic malignancies, but is complex, associated with high complication rates and not repeatable. Percutaneous isolated liver perfusion (PHP) is a novel minimally invasive, repeatable, and safer alternative to IHP. PHP is rapidly gaining interest and the number of procedures performed in Europe now exceeds 200. This review discusses the indications, technique and patient management of PHP and provides an overview of the available data. Show less
