Y-90 radioembolization

Y-90 radioembolization is a way to give a strong dose of radiation to tumors in the liver while sparing most of the healthy liver and the rest of your body. It is also called selective internal radiation therapy (SIRT) or transarterial radioembolization (TARE). "Y-90" stands for yttrium-90, the radioactive element inside the beads.

The liver has two blood supplies. Healthy liver gets most of its blood from the portal vein, but liver tumors feed almost entirely from the hepatic artery. We use that difference. Through a thin tube called a catheter, we steer the beads into the small artery branches that lead to the tumor. The beads, each thinner than a hair, lodge in the tumor's tiny blood vessels and give off radiation right there.

The radiation only travels a few millimeters, about the width of a grain of rice. Most of it is delivered over the first two weeks and it is essentially gone within a month. The beads themselves stay in the liver for good, but they are harmless once the radiation has faded.

What we see

Y-90 is used for cancer that starts in the liver, called hepatocellular carcinoma (HCC), and for cancer that has spread to the liver from somewhere else, such as the colon, rectum, or neuroendocrine tumors. It is one of several options described on our liver tumors page.

Depending on your situation, the goal can be to destroy a small tumor completely, to control a tumor that cannot be removed with surgery, to shrink a tumor so surgery or a liver transplant becomes possible, or to keep a tumor in check while you wait for a transplant. Your care team should tell you plainly which goal applies to you.

Most liver tumors can be treated in more than one way, and the options are often combined. A tumor board, where surgeons, oncologists, radiation oncologists and interventional radiologists review your scans together, helps decide the order.

Other options include surgery, liver transplant, focused external radiation (SBRT), histotripsy and medicines such as immunotherapy. See chemoembolization and microwave ablation for more on those treatments.

The procedures are done at El Camino Hospital. When you arrive, a nurse starts an IV, checks your blood work, and gives fluids and medicines, usually including an antibiotic and an anti-nausea medicine. More general tips are on before your procedure and sedation.

Y-90 is done in two stages. The first visit is a rehearsal that checks where the beads will go. The second visit is the treatment itself.

1. 1
   Mapping angiogram

   You receive moderate sedation, so you are relaxed and drowsy but breathing on your own. We numb a spot at the top of the leg or the wrist and guide a catheter to the liver arteries using X-ray. We map exactly which branches feed the tumor.

2. 2
   Protecting the stomach and bowel

   If a small artery near the tumor heads toward the stomach or bowel, we may close it with tiny metal coils. Other vessels take over its job. Not everyone needs this step.

3. 3
   Test particles and scan

   We inject a harmless tracer made of protein particles about the size of the real beads. A nuclear medicine scan then shows where they landed and how much reaches the lungs. The whole mapping day often takes 6–8 hours at the hospital, and you go home that evening.

4. 4
   Treatment day

   About one to three weeks later, we repeat the angiogram and deliver the Y-90 beads into the branches chosen on mapping day. The room time is usually about an hour. Expect 4–6 hours at the hospital in total.

5. 5
   Recovery and home

   A small plug or pressure closes the puncture. You rest for about 2 hours, sometimes longer, then eat, walk, and go home the same day with a written radiation safety sheet.

The puncture is about the size of a pencil tip and does not need stitches. You may feel pressure at the start and brief warmth when contrast dye is injected. Most people feel little else.

The most common side effect is tiredness. Many people also have mild nausea, a poor appetite, or a dull ache under the right ribs. These symptoms are usually milder than after chemoembolization. We send you home with anti-nausea medicine and often a medicine to protect the stomach.

1. First 24 hours
   Rest at home. Keep the puncture site dry and avoid bending or lifting with that leg or arm. No driving for 24 hours after sedation.
2. Days 2–7
   Fatigue, mild nausea and a low fever are common. You can shower and do light activity. Avoid lifting more than 10 pounds for about 5 days.
3. Weeks 1–2
   Energy slowly returns. Most people are back to usual activities by the end of the second week. You will see us for a check-up and blood tests.
4. About 1–3 months
   A CT, MRI or PET scan and blood tests show how the tumor is responding. The radiation keeps working for weeks, so early scans can look unchanged.

Radiation safety. You are not a danger to the people around you. The radiation stays inside your liver and very little reaches the outside of your body. As a simple precaution, for the first week or two avoid long close contact with pregnant women and young children, such as holding a child on your lap for a long time or sharing a bed. Normal time together in the same room is fine. Airport scanners can pick up tiny amounts of radiation for a few weeks, so ask us for a letter if you plan to fly within a month.

Y-90 works slowly. Tumors often shrink or stop showing active blood flow over one to three months, and sometimes keep improving for longer. Some people need a second treatment, for example to another part of the liver a few weeks later.

For small primary liver cancers treated with a concentrated dose, Y-90 can destroy the tumor completely, with results that in published studies compare well with other local treatments. For larger or spread-out tumors the aim is usually control: slowing growth, easing symptoms, and buying time, often alongside medicines. Your scans guide the next step.

Mapping day is where I do most of my thinking. I study how every artery branches toward the tumor, and I look closely at anything heading toward the stomach or bowel, because keeping the beads in the liver is what keeps Y-90 gentle. I tell patients honestly what we are aiming for, whether that is a cure, a bridge to transplant, or control, and I also tell them that feeling tired for a week or two is normal.

Fabio Komlos, MD, interventional radiologist · About Dr. Fabio Komlos

Serious problems are uncommon. The mapping step exists to lower these risks.