Minimal-invasive interventions considerably extend the therapeutic spectrum in oncology and open new dimensions in terms of survival, tolerability and patient-friendliness. Through the influence of image-guided interventions, many interdisciplinary therapy concepts have significantly evolved, and this process is by far not yet over. The rapid progression of minimal-invasive technologies offers hope for new therapeutic concepts in the short, medium and long term. Image-guided hybrid-technologies complement and even replace in selected cases classic surgery. In this newly begun era of immune-oncology, interdisciplinary collaboration and the focus on individualized and patient-friendly therapies are crucial.

Background Local nonsurgical tumor ablation currently represents a further option for the treatment of patients with liver tumors or metastases. Electrochemotherapy (ECT) is a welcome addition to the portfolio of local therapies. A retrospective analysis of patients with liver tumors or metastases treated with ECT is reported. Attention is given to the safety and efficacy of the treatment over time. Patients and methods Eighteen consecutive patients were recruited with measurable liver tumors of different histopatologic origins, mainly colorectal cancer, breast cancer, and hepatocellular cancer. They were treated with percutaneous ECT following the standard operating procedures (SOP) for ECT under general anaesthesia and muscle relaxation. Treatment planning was performed based on MRI preoperative images. The follow-up assessment included contrast-enhanced MR within at least 1–3 months after treatment and then after 5, 7, 9, 12, and 18 months until progression of the disease or death. Results Only mild or moderate side effects were observed after ECT. The objective response rate was 85.7% (complete response 61.9%, partial 23.8%), the mean progression-free survival (PFS) was 9.0 ± 8.2 months, and the overall survival (OS) was 11.3 ± 8.6 months. ECT performed best (PFS and OS) in lesions within 3 and 6 cm diameters (p = 0.0242, p = 0.0297) . The effectiveness of ECT was independent of the localization of the lesions: distant, close or adjacent to vital structures. Progression-free survival and overall survival were independent of the primary histology considered. Conclusions Electrochemotherapy provides an effective valuable option for the treatment of unresectable liver metastases not amenable to other ablative techniques.

Purpose: To evaluate local tumour control (LTC) by local ablation techniques (LAT) in liver malignancies. Materials and methods: In patients treated with LAT between January 2013 and October 2020 target lesions were characterised by histology, dimensions in three spatial axes, volume, vascularisation and challenging (CL) location. LAT used were: Radiofrequency Ablation (RFA), Microwave Ablation (MWA), Cryoablation (CRYO), Electrochemotherapy (ECT), and Interstitial Brachytherapy (IBT). Results: 211 LAT were performed in 155 patients. Mean follow-up including MRI for all patients was 11 months. Lesions treated with ECT and IBT were significantly larger and significantly more often located in CL in comparison to RFA, MWA and CRYO. Best LTC (all data for 12 months are given below) resulted after RFA (93%), followed by ECT (81%), CRYO (70%), IBT (68%) and MWA (61%), and further, entity-related for HCC (93%), followed by CRC (83%) and BrC (72%), without statistically significant differences. LTC in hypovascular lesions was worse (64%), followed by intermediate (82% p = 0.01) and hypervascular lesions (92% p = 0.07). Neither diameter (<3 cm: 81%/3–6 cm: 74%/>6 cm: 70%), nor volume (<10 cm3: 80%/10–20 cm3: 86%/>20 cm3: 67%), nor CL (75% in CL vs. 80% in non CL) had a significant impact on LTC. In CL, best LTC resulted after ECT (76%) and IBT (76%). Conclusion: With suitable LAT, similarly good local tumour control can be achieved regardless of lesion size and location of the target.

Background: Prostatic artery embolization (PAE) is an emerging minimal-invasive therapy of benign prostatic hyperplasia (BPH), able to reduce the prostatic volume (PVol) and the IPP. The presence of a true middle lobe (TML) is associated with bladder outlet obstruction (BOO), causing lower urinary tract symptoms (LUTS). In this study we investigate the effect of PAE in TML improvement in patients with LUTS. Methods: A retrospective analysis was done of 47 men treated with PAE from April 2015 to September 2021. The volume of the TML, IPP, and PUA were measured on MRI prior and 2 months after PAE. Successful devascularization of the TML was evaluated by contrast-enhanced MRI (ceMRI) 48 hours after therapy. Results: The TML was successfully embolised technically in 72%. After two months, the total volume of the prostate (PVol) was reduced by 25.8 ± 13.3% (from 72.1 ± 39.8 cc to 52.5 ± 27.9 cc; p < 0.000). Following a technically successful PAE of the TML, the TMLVol decreased by 32.1 ± 21.5% (from 10.6 ± 16.1 cc to 7.2 ± 13.1 cc; p < 0.000), and the IPP was reduced by 29.3 ± 15.5% (from 16.3 ± 7.4 mm to 11.9 ± 6.6 mm; p < 0.000). In contrast, after a technically incomplete devascularisation of the TML the TMLVol decreased by only 7.2 ± 17.7% (from 8.4 ± 9.3 cc to 7.5 ± 8.9 cc; p = 0.089), and the IPP was reduced by only 10.9 ± 8.8% (from 16.4 ± 7.3 mm to 14.6 ± 6.7 mm; p = 0.003). The currecture of the PUA after a successful and after an incomplete embolization of the TML was comparable with 11.6 ± 7.6 and 12.2 ± 9.4, respectively (in both p < 0.001). Conclusions: Our study firstly shows that PAE is able to reduce TML volume. Furthermore, PAE is able to reduce the IPP even if caused by a TML.