Y-90 Radioembolization Treatment for Liver Tumors

Y-90 radioembolization is a procedure that combines embolization (cutting off blood supply) and internal radiation therapy. It may be called selective internal radiation therapy or radioembolization. There are also 2 brand names of this therapy: TheraSphere and SIR-Spheres.

What is Y-90?

Yttrium-90 (Y-90) is a radioactive substance. This means it gives off radiation. It is attached to tiny beads that are smaller than a human hair. These beads are injected (put) into the main artery that brings blood to the liver. The beads get trapped in the tumor and small blood vessels that bring blood to the liver tumor(s). 

How does Y-90 work?

Y-90 radioembolization (RE) works two ways:

• The beads block off blood vessels, preventing blood flow to the tumor. This is called embolization. Cutting off the blood supply helps kill cancer cells.
• The beads lodge in the tumor(s) and give off a high dose of radiation to the tumor tissue around them. This kills the tumor but limits the damage to healthy tissue that is beyond the reach of the radiation.

The beads are left in place and do not need to be removed. Most of the radiation is given off over the 10-14 days after the procedure. The radiation wears off completely by 30 days after the procedure.

What cancers can be treated with Y-90 RE?

Y-90 RE beads are used to treat hepatocellular (liver) cancer or other cancers that have spread (metastasized) to the liver.

How is the radioembolization done?

RE is done by a specialist called an interventional radiologist in the interventional radiology department or operating room. Your provider will tell you how to prepare for the procedure, what medications you cannot take before the procedure, and any restrictions you will have. Y-90 RE is usually done as an outpatient procedure and you can go home after.

Before the actual Y-90 RE procedure, you will have an arteriogram to plan the procedure. During the arteriogram, the interventional radiologist will create a map of the arteries and blood flow in your abdomen. They may place tiny coils in certain arteries to block them off from the Y-90 beads. A “tracer” is given to simulate the Y-90 procedure and scans are taken to make sure the plan is correct.

For the procedure, you will lie on your back and be connected to a monitor to track blood pressure, heart rate, and oxygen levels. You will have an IV placed and be given medication to make you sleepy and relaxed.

The doctor will numb your groin area where the catheter will be inserted. X-rays are used to guide the catheter to the hepatic artery (the main artery that feeds the liver). The Y-90 beads are injected into the catheter and make their way to the tumor. You may feel pressure when the catheter is inserted or some discomfort when the beads are inserted.

The catheter is removed, and pressure is applied to the groin area to prevent bleeding. The entire procedure takes about an hour. You will be monitored in the recovery room for a period of time before you can go home.

What can I expect after the procedure?

After the procedure some people have:

• Fatigue that lasts for several weeks after treatment.
• A low fever for a week after treatment.
• Nausea, vomiting, and loss of appetite.
• Pain from the blood supply being cut off to the area. This can be treated with pain medicines. If these symptoms continue, talk with your care team.
• If you have pain that lasts more than 6-8 hours, you may have an ulcer in your stomach or small bowel. Your doctor will give you medicines to treat this.

You will receive medications during and after the procedure to help manage these symptoms. 

What restrictions do I have after the procedure?

For the week after your procedure, you will need to limit your contact with other people. This is because they can be exposed to the radiation in your body. You should:

• Limit close contact with others for the first week.
• Not sleep in the same bed as your partner.
• Not sit next to anyone for more than 2 hours.
• Not come in close contact with children or pregnant women. 

Talk to your care team about when you can return to normal activities.

When should I call my care team?

You should call your care team after the procedure if you have:

• Bleeding, redness, or drainage from the area where the catheter went in.
• Fever greater than 100.4°F or 38.0°C.
• Pain that continues more than a week after treatment or is not relieved with pain medication.
• If you develop jaundice (yellowing of the skin or eyes) or a swollen belly (ascites) up to 3 months after treatment as this can be a sign of liver disease.