Yttrium-90 Radioembolization

What Is Y90 Radioembolization (Y90 Treatment for Liver Cancer)?

Y90 radioembolization is a minimally invasive liver cancer treatment that uses both embolization techniques and radiation technology to kill liver cancers, without the need for open surgery. “Embolization” refers to a procedure where an object or particle is introduced within a precise location in the bloodstream, using medical imaging equipment to guide the doctor. Radiation is the transfer of energy that certain types of material naturally emit.

Your interventional radiologist will deposit tiny radioactive beads (Y90 microspheres) into a blood vessel (artery) that carries blood into your liver. These tiny particles travel through the blood vessels and become lodged in the areas where tumors are present. Once present in the tumor, the radioactive energy emitted from the microspheres works to kill the nearby tumor cells. The radiation only travels a few millimeters from where the beads are deposited, so it causes less damage to the surrounding healthy liver tissue.

The Y90 procedure is one of the most studied and effective forms of liver cancer treatment, since it can administer radiation energy to precise areas, and often provides excellent results. It has been performed on thousands of patients in many countries around the world. Another term that is sometimes used for the Y90 procedure is radioembolization, or transarterial radioembolization (TARE).

Why Do We Need It?

Tumors in the liver are sometimes inoperable, meaning patients with liver cancer do not have a surgical option for removing the disease. Cancer is also not a condition that can be ignored — treatment is typically most successful when it begins as quickly as possible. External beam radiation, which is used to treat various forms of cancers, often does not work well on liver tumors given the damage to the surrounding liver tissue. For this reason, doctors have pioneered a creative solution to treat liver tumors called Selective Internal Radiation Therapy (SIRT), which is another name for Y90 treatment.

Am I A Candidate?

If you are someone who has liver cancer, Y90 radioembolization may be a good consideration for treatment, especially when you have attempted other forms of therapy without success. You will need to have an official assessment and consultation with our office, including one of our board-certified interventional radiologists, to ensure that this is the right move for you. Testing, including a CT scan and blood panel, may also be needed.

Y90 radioembolization can be performed for both liver cancers that originate in the liver (such as hepatocellular carcinoma and cholangiocarcinoma), as well as tumors that come from elsewhere in the body and spread to the liver (metastatic disease).

It is essential to understand that, like any treatment, Y90 radioembolization is not a guaranteed cure — it has its limits, and not everyone takes well to the procedure. Ask as many questions as you can to ensure you clearly understand what this process involves.

How Should I Prepare?

There are several tests and procedures that will need to be performed prior to your Y90 radioembolization, including:

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Office consultation with our team
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Blood panels, to assess liver and kidney function
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Angiogram
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CT scan or MRI

You should always disclose any and every preexisting condition or medication you are taking to ensure that you are taking no unnecessary risk by undergoing Y90 radioembolization. You may be asked to alter or stop certain medicines in the days or weeks leading up to your procedure to decrease the chances of a complication arising. On the day of your procedure, you should not eat or drink for 6 hours prior to your appointment, to ensure you can safely receive medical sedation.

What Should I Expect from the Procedure?

Below is a step-by-step guide to what you can expect during your Y90 radioembolization procedure. The procedure is normally performed in two parts:

Part 1) Mapping Angiogram - to ensure safety and to let your doctor plan the optimal location for delivering the radioactive beads. A “test dose” particle is injected during this procedure, and your doctor may need to take pictures with a specialized camera as you recover in the holding area.

Part 2) Y90 delivery – where your doctor injects the Y90 beads into the tumor. This is when the actual treatment particle will be introduced into your liver tumor, to kill the tumor cells.

For each of these sessions, you can expect the following:

1
You will likely be placed on your back and attached to a set of monitors to track your vitals (heart rate, pulse, blood pressure, oxygen level, etc.)
2
The area around the groin or wrist will be cleaned and sanitized in preparation for the procedure
3
You will be given a sedative through an IV line to keep you relaxed and comfortable during the procedure (general anesthesia may be provided in some cases)
4
A tiny catheter, or tube, is inserted from the hip or wrist artery. Your doctor will guide that tiny catheter to the liver arteries, using a special X-ray camera
5
An angiogram, or picture of the arteries, is performed to provide your physician with a clear understanding of the upper abdominal and liver arteries in your body
6
Small neighboring arteries are often closed with tiny coils of wire, to avoid the small beads from flowing to other areas of the body
7
Beads are released into the bloodstream, and float downstream in the arteries until they become lodged in the liver tumor
8
The catheter is removed, and your doctor will ensure there is no bleeding at the site of vessel access (closure of the artery may require a small seal or compression wristband)
9
The wound will be dressed, your IV line is removed, and you will be sent home 1-2 hours following the procedure conclusion

There is generally minimal pain associated with this procedure, other than a slight pinch from the catheter’s entry. You will likely feel a warm sensation when the contrast material is injected, but that sensation resolves quickly. The microspheres sometimes cause minor pain or discomfort around the liver, although patients usually are able to tolerate symptoms with outpatient medication. If multiple areas in the liver need treatment, you may even be asked to come back for another treatment session at a later time, to target other tumors in different parts of the liver.

What Should I Expect During Recovery?

Most patients experience minimal side effects from this procedure, but a small percentage of people develop a condition called post-embolization syndrome. The most common side effect is feeling fatigued, with people normally returning to baseline energy levels in less than 1 week. In fewer cases, patients can experience pain, vomiting, nausea, or fever. These side effects are managed with over-the-counter or prescription medications as needed, and usually only last three to five days. If you experience symptoms after your procedure lasting a week or more, you should contact your physician.

What Kind of Results Can I Expect?

Your doctor will typically order an imaging scan and more labs several weeks after your treatment. This will be to determine how successful the procedure was in killing the cancer cells in the liver. If the procedure is successful and your body responds well to treatment, you can expect to see either partial or complete removal of the cancerous tumors.

Keep in mind that Y90 radioembolization is a treatment, not a cure. Sometimes, patients can be candidates for additional treatments like surgical resection or liver transplantation, but this is only for specific scenarios. After Y90, between 75 to 95% of patients will see an improvement in the liver and prolonged survival rates. As many as 95% of patients with colorectal metastases and 97% of patients with neuroendocrine tumors benefit from Y90 radioembolization treatment.

How Much Does It Cost?

There are a lot of factors that go into the cost of your Y90 radioembolization treatment. In general, most patients with insurance will have almost all the procedure costs covered by their insurance plan. Conversely, patients who are paying cash will be spending $25,000 or more. We will conduct an insurance screening before your procedure, and make sure all your payment questions are answered.

Why Choose ViP?

When the stakes are high, the last thing you want to do is settle for the cheapest or least experienced team of professionals. You want to make sure you find a team with the best training and experience possible, to maximize the chances of success.

Fortunately, the team at ViP is highly experienced and trusted in cancer care, treating Arizona’s oncology patients for decades. Each of our doctors has completed an advanced post-residency fellowship training in interventional radiology and is Board Certified with the American Board of Radiology. Finally, our group has performed the largest number of Y90 procedures in Arizona for many years running, and our doctors currently train other physicians around the country on how to perform the Y90 procedure.

Beat Your Liver Cancer, Team Up with ViP

If you are ready to see about starting the Y90 radioembolization process, give our office a call at (480) 435-9100. You can also fill out our online contact form to have a team member reach out to you at a more convenient time. At Vascular & Interventional Partners we know that liver cancer is a challenging diagnosis, and it is important to have a caring and dedicated team standing behind you every step of the way.

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