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Interventional Radiology: Radioembolization / Y90

The field of oncology continually evolves as we understand more about cancer and discover new approaches to treating it. In recent years, interventional oncology has joined medical treatment, radiation treatment and surgical treatment to become the fourth core pillar of cancer care. Interventional oncology is focused on the diagnosis and treatment of cancer using targeted, minimally-invasive procedures performed under image guidance. This reduces or eliminates the need for surgery, as well as the discomfort and downtime that accompanies it.

Radioembolization, also known as Y-90, is one of the interventional oncology procedures used by the physicians of IVC to give our patients better health and a better quality of life. Call us today at 503-612-0498 to schedule an appointment with an interventional radiologist.

What is Radioembolization?

Radioembolization combines embolization and radiation therapy. Though it is not a curative treatment, it can dramatically shrink tumors, provide symptom relief and extend patient survival. During the procedure, tiny glass or resin beads called microspheres containing the radioactive isotope yttrium-90 (Y-90) are positioned inside the blood vessels that feed a tumor. The microspheres obstruct the supply of blood to the cancer cells while delivering a high dose of radiation to the tumor. In the weeks following treatment, the radiation gradually disappears and the harmless microspheres are left behind.

How Does Radioembolization Work?

Two primary blood vessels deliver blood to the liver: the portal vein and the hepatic artery. The liver receives the majority of its blood supply from the portal vein and only a small percentage from the hepatic artery. When a tumor develops in the liver, it receives almost all of its blood supply from the hepatic artery. The radioactive microspheres of radioembolization are sent through the hepatic artery so they reach the tumor directly. This maximizes the effect of the treatment where it is most beneficial while sparing the surrounding healthy tissue. The portal vein continues to supply blood to the liver without interruption.

What Is the Difference Between Radioembolization and Other Radiation Therapies?
Radiation therapy utilizes high-energy particles or waves, such as protons or X-rays, to kill cancer cells. External radiation uses a machine to direct the treatment’s rays from outside the body into the tumor. Compared to external radiation therapy, radioembolization allows physicians to deliver higher doses of radiation to more specific areas of the body. This can result in fewer side effects and shorter treatment time. Other forms of radiation therapy include internal radiation (brachytherapy), in which a small radioactive vessel is implanted in a body cavity or tissue, and systemic radiation, in which radioactive drugs are given in a vein or taken by mouth.

What Kind of Cancer Can Radioembolization Treat?

Radioembolization is used to treat tumors that initially form in the liver (primary liver cancer) and tumors that spread (metastasize) to the liver from another part of the body. The most common type of primary liver cancer is hepatocellular carcinoma. As a palliative treatment, radioembolization does not provide a cure for liver cancer, but instead slows the growth of the disease and helps alleviate its symptoms.

What Are the Benefits of Interventional Radioembolization?

The benefits of radioembolization include:

  • Targeted to the tumor site, thereby reducing damage to the surrounding tissues and organs
  • Radiation can be delivered in a higher dose than external radiation treatments
  • Potentially fewer side effects than external radiation treatments
  • Procedure is relatively quick and performed on an outpatient basis
  • Only a small incision is required
  • May shrink the tumor enough to allow for a liver resection, ablation or transplant
  • Slows cancer progression and extends survival
  • Can be combined with other cancer therapies as needed

Am I a Good Candidate for Radioembolization?

Patients with inoperable liver cancer and liver metastases may be considered for radioembolization. Often, patients who receive radioembolization have exhausted other treatment options or are not candidates for surgical removal. Confirming you are a candidate for radioembolization requires an accurate assessment of your cancer by an interventional radiologist. When you visit IVC for a consultation, your doctor will discuss your medical history and perform diagnostic testing, including a CT scan and a blood test. If you appear to be a candidate, they will also perform a mapping procedure to confirm your eligibility for the Y-90 microsphere embolization and determine an appropriate radiation dose.

How Is Radioembolization Performed?

Radioembolization is performed over two to three appointments. The first appointment, scheduled seven to 10 days before the procedure date, is for an angiogram. The angiogram allows your interventional radiologist to map out the anatomy of your blood vessels. Any blood vessels passing from your liver to non-target structures, such as your stomach or lungs, will be blocked off (embolized) to prevent radiation particles from reaching them. Your interventional radiologist will then conduct a ‘test run’ by injecting particles similar to the Y-90 spheres to ensure the embolization is working properly.

Once the safety of the procedure has been established, the Y-90 treatment can be scheduled. Radioembolization is done on one half of the liver at a time. If there are tumors in only one half of your liver, the treatment can be completed in one appointment. If there are tumors in both halves of your liver, the treatment will be done over two separate days. Your interventional radiologist will perform the procedure by numbing your skin and making a small incision in your groin area. Then, using x-ray guidance, they will navigate a catheter to your liver and deposit the Y-90 microspheres into your hepatic artery. The procedure typically lasts 30-90 minutes.

What Is Recovery Like After Radioembolization?

After your radioembolization procedure, you will rest in a recovery area for two to six hours before returning home. Some patients require an overnight stay for observation, but this is rare.

Precautions must be taken in the initial days of recovery due to the radioactive nature of the treatment. For the first three days after your procedure, maintain a six-foot distance from other adults if contact will last for more than a few minutes. For the first week after your procedure, do not sleep in the same bed as your partner, avoid close contact with children and pregnant women, and do not use public transportation that will require to you sit next to someone for more than two hours.

You can resume normal activities after leaving your embolization appointment. However, you will experience fatigue for one to four weeks following the treatment. You may also experience side effects called post-embolization syndrome, including fever, nausea, vomiting, loss of appetite and abdominal pain. These side effects usually resolve within a week.

Your interventional radiologist will schedule imaging studies every three months after radioembolization to track your progress.

IVC: the Northwest’s Experts in Minimally Invasive Cancer Therapies

If you have been diagnosed with an inoperative liver tumor, radioembolization may be a treatment option. Call IVC today at 503-612-0498 to schedule an appointment for a consultation. Our experienced team of specialists will design an individualized cancer therapy plan that prioritizes your safety, personal needs and well-being.

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