Y90 Treatment (Radioembolization)
A Minimally Invasive, Targeted Therapy for Cancer in the Liver
Y90 is a relatively new, safe, and highly successful treatment for cancer in the liver that targets tumors with a high dose of radiation without affecting other, healthy parts of the body. Columbia's interventional radiologists were among the first to offer this treatment, and they have performed hundreds of Y90 procedures on patients with liver cancer or other cancers that have metastasized (spread) to the liver.
Y90 refers to the radioactive isotope yttrium90, which is inserted into tiny particles and used to deliver radiation directly to tumors via long, thin tubes called catheters. The treatment is not a cure for cancer in the liver, but it has been shown to prolong lives for months or years and to greatly improve the quality of life of cancer patients. Patients experience few, if any, side effects from Y90 treatment, which is performed in an outpatient setting. Patients generally resume normal activities within one or two weeks.
Y90 treatment can be used in combination with traditional treatments for cancer, including surgery, chemotherapy, and immunotherapy. Our interventional radiologists will work with your medical oncologist to determine the proper timing of a Y90 treatment as it relates to your usual chemotherapy or immunotherapy. It is important to understand that this treatment is not a replacement for the treatments prescribed by your oncologist. In some cases, because it is performed in between your usual treatments, the Y90 procedure can be even more effective in treating the liver tumors.
Y90 Treatment at Columbia Interventional Radiology
A consultation with a Columbia interventional radiologist can help you determine if Y90 treatment can help you.
More than 20,000 cases of liver cancer are diagnosed each year in the United States and many more originate in other parts of the body and spread to the liver. For a variety of reasons, many patients may not be candidates for surgical removal of tumors in the liver. The tumors may be too big, too numerous, or they may be too close to important blood vessels.
For patients who are not candidates for surgery—or who are waiting for a liver transplant—Y90 is a treatment option that can alleviate symptoms, slow tumor growth, and extend life. If you are a candidate, our physicians will work with your oncologist or your surgeon to add Y90 treatment to your overall treatment plan.
What can I expect from the procedure?
One to two weeks before the delivery of the Y90 to the liver tumors, you will have appointments with your interventional radiologist, who will test your blood and perform an angiogram—an imaging procedure in which dye is injected into the bloodstream and X-ray images are taken. This will produce images of the blood vessels that are feeding the tumor or tumors. A map of the blood vessels is important to identify the vessels that feed liver and tumors, and not stomach, small intestine or lungs. If needed, the interventional radiologist will protect your stomach or intestines from radiation by placing a blocking coil that will prevent the particles from entering areas that would not be desired.
You will receive detailed instructions about eating, drinking, and taking medications before the procedure. You will need to arrange for someone to accompany you home and to plan for restricted contact with other people, pets, or children after the procedure due to the radiation dose you will be receiving.
On the day of the procedure, you will arrive at our outpatient offices and be escorted to our interventional radiology suite. We will administer a sedative intravenously, and you may also receive medications for nausea or pain. We will then numb your groin or wrist area with a local anesthetic and insert a needle. This needle provides access for a catheter, which we will guide to the vessels that supply blood to the liver. Your doctor will use an X-ray technique called fluoroscopy to guide the catheter into position.
Once the catheter is positioned in a blood vessel that feeds the tumor (or tumors), we will inject tiny beads or microspheres that are filled with the radioactive isotope yttrium Y-90 through the catheter and into the blood vessel. Over the next 10 to 14 days, radiation will be released from the microspheres while they are located inside the tumors, radiating the tumors from the inside out and therefore targeting the tumors without damaging surrounding tissue.
If there are multiple tumors, the procedure may need to be repeated in another blood vessel. The procedure takes about one hour to complete.
Are there any risks?
The procedure is relatively safe when performed by an experienced interventional radiologist. Major complications include:
- Post-embolization syndrome consisting of consisting of pain, nausea, and low-grade fever
- Irritation of the stomach or small intestine, including ulcers
- Fatigue, which is typically significant and can last from a few days to a few weeks
After the procedure
Most patients are scheduled early in the day in our outpatient office and recover in their own private room, going home in the afternoon. Imaging is performed on the day of the procedure to confirm the location within the liver where the radiation particles have been deposited. For the next week you may experience a low-grade fever, lethargy, or fatigue. Pain is not a common side effect of the procedure.
We will schedule a follow up appointment with you about two weeks after the procedure. Chemotherapy can typically be restarted one to two weeks after the procedure. Follow up imaging, such as CT, MRI, or PET CT, is usually performed approximately eight weeks after the procedure.
Our interventional radiologists perform Y90 treatment in a safe and comfortable outpatient office.