Y-90 Radioembolization Treatment for Liver Tumors
Y-90 radioembolization (RE) is a procedure that combines internal (inside your body) radiation therapy and embolization (cutting off blood supply). It may also be called “selective internal radiation therapy” or “radioembolization.” There are 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 into the main artery that brings blood to the liver. The beads get trapped in the tumor and in the small blood vessels that bring blood to the tumor(s).
How does Y-90 work?
Y-90 radioembolization works in 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 get stuck 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 around the tumor.
The beads are left in place and do not need to be removed. Most of the radiation is given off over about 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 (IR) department or in the operating room (OR). 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 so that you can go home after.
Before the Y-90 RE procedure, you will have an arteriogram. During the arteriogram, the interventional radiologist will create a map of the arteries and blood flow in your abdomen (belly). They may place tiny coils in certain arteries to block them off from the Y-90 beads. A “tracer” is given to simulate (act out) 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 in your hand or arm and will be given medication to make you sleepy and relaxed.
The provider 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 whole procedure takes about an hour. You will be look after closely in the recovery room 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 (less than 100.4°F or 38.0°C) 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 don’t get better, talk with your care team.
- If you have pain in your abdomen that lasts more than 6-8 hours, you may have an ulcer in your stomach or small bowel. This can be caused by any coils that were placed to block off arteries from the Y-90 beads. Your provider will give you medicines to treat this.
You will receive medications during and after the procedure to help with 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. For about the first week, you should:
- Limit close contact with others.
- 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.
Radiologyinfo.org – Radioembolization (Y-90) - https://www.radiologyinfo.org/en/info/radioembol
Therasphere Information, Boston Scientific - https://www.bostonscientific.com/en-US/medical-specialties/interventional-radiology/interventional-oncology/cancer-therapies-ablation/therasphere.html
SIR-Spheres Information, Sirtex - https://www.sirtex.com/us/clinicians/about-sir-spheres-microspheres
Venkatanarasimha, N., Gogna, A., Tong, K. T. A., Damodharan, K., Chow, P. K. H., Lo, R. H. G., & Chandramohan, S. (2017). Radioembolisation of hepatocellular carcinoma: a primer. Clinical radiology, 72(12), 1002-1013.
Woerner AJ, Johnson GE. Advances in Y-90 radioembolization for the treatment of hepatocellular carcinoma. Hepatoma Res 2022;8:2. http://dx.doi.org/10.20517/2394-5079.2021.122
Yimin Dong, MD and others, Refractory Duodenal Ulcer and Upper Gastrointestinal Bleeding Following Yttrium-90 Transarterial Radioembolization, American Journal of Clinical Pathology, Volume 152, Issue Supplement_1, October 2019, Page S57, https://doi.org/10.1093/ajcp/aqz113.050