Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer and frequently occurs in people with chronic liver disease, known as cirrhosis. While surgical resection or transplantation provide the only chance for a cure, most patients are ineligible to receive these treatments. However, individuals who are not candidates for surgery or transplantation can benefit from a range of minimally invasive therapies, including transarterial chemoembolization (TACE) and radioembolization (Y-90).
What is Transarterial Chemoembolization (TACE)?
Chemoembolization combines a procedure that decreases or completely blocks the blood flow to liver tumors (embolization) with the delivery of highly concentrated doses of chemotherapeutic agents directly and precisely to the tumors (chemo), hence the name “chemoembolization.” The procedure is performed via a small catheter which is inserted through a needle in the groin or wrist, which is then advanced under image guidance into the arteries that supply blood flow to the liver tumors. After having verified that the tip of the catheter is in close proximity to the tumors to be targeted, a mixture of chemotherapy and oily medium is slowly injected through the catheter to saturate the tumors. After the entire mixture has been delivered, particles are then injected to make sure the blood flow to the tumors is sufficiently slowed or blocked in order to prevent washing-out of the chemotherapy drugs away from the tumors. This is to ensure that the chemotherapy drugs stay as long as possible within the tumors to kill the cancer cells. The goal is to recreate conditions within the tumors that resemble those in a laboratory environment to maximize the chances of completely killing all the cancer cells in the tumors. Because the treatment is extremely precise since it is done under direct image guidance, the healthy liver – not affected by the tumors – remains intact, thereby minimizing any potential side effects and toxicities.
What is Radioembolization (Y-90)?
Radioembolization (Y-90) is very similar to chemoembolization but uses radioactive microspheres which are tiny beads instead of chemotherapy drugs as the payload to kill cancer cells. In the same manner as for chemoembolization, a catheter is inserted through a small puncture in the groin or wrist and advanced into the arteries that supply blood flow to the liver tumors under direct visualization with imaging. Once in an appropriate location, the radioactive beads are delivered directly to the tumors. Once inside the tumors, these beads exert their radioactive effect to kill the cancer cells. Because the targeting of the tumors is so precise, the healthy liver tissue is largely spared thereby minimizing side effects and potential toxicity from the treatment. This allows the patients to recover very quickly and even go home the same day without the need for an overnight stay in the hospital. Such treatments have shown great results in patients with either primary or secondary liver cancer, both in terms of prolonging patient survival and improving quality of life.
How Does the Y-90 Procedure Work?
Ont the day of the procedure, the patient will arrive at our outpatient center and be escorted to the interventional radiology suite. A nurse and anesthesiologist will administer an intravenous sedative and the patient may receive nausea or pain medications if needed. Next, the groin or wrist will be numbed using a local anesthetic. A needle is inserted to provide access into the artery for a catheter, which is guided to the vessels that supply blood flow to the liver tumor(s). This procedure is performed directly under image guidance called fluoroscopy to guide the catheter precisely until it is in close proximity to the tumor(s).
Once the catheter is positioned in the correct location, the tiny radioactive (Y-90) beads or microspheres are delivered through the catheter and into the blood vessel. Over the following 10 to 14 days, high doses of radiation will be released from the microspheres, targeting only the tumors without damaging the surrounding healthy tissue. If there are multiple tumors, the procedure may need to be repeated to target another location. Because the radiation remains largely contained within the tumor(s) due to its low penetration in tissue, it does not prevent patients from going home immediately after the procedure. In comparison to chemoembolization, the side effects of radioembolization are minimal and the procedure is generally extremely well-tolerated. Patients are able to resume their normal activities within a day or two of the procedure.
Minimally Invasive Liver Cancer Treatments in New York
At USA Oncology Centers, we recognize that no two cancer patients are exactly the same. Every patient’s care plan, from treatment to the management of side effects, is personalized to meet their unique needs and treatment goals. We strive to provide our liver cancer patients the most effective treatments in NY that maximize their chances of survival, relieve symptoms, and improve quality of life.
Our skilled, internationally known doctors are experts in providing treatments for both primary and secondary liver cancers. These minimally invasive treatments include:
- Radioembolization (Y-90 SIRT)
- Transarterial chemoembolization
- Ablation therapy
At USA Oncology Centers, our patients always come first. To learn more about our outpatient treatment options, call 855.870.4747 or schedule an appointment with one of our interventional oncologists today.