What is Radioembolization (Y-90 SIRT)?
Radioembolization, also called Y-90 Selective Internal Radiation Therapy (SIRT), is a minimally invasive liver-directed therapy for liver cancer that either arises from the liver (primary liver cancer or hepatocellular carcinoma) or has metastasized to the liver from other organs most commonly the colon or rectum (secondary liver cancer) that cannot be removed with surgery. Radioembolization combines the localized delivery of radiation therapy in the form of tiny beads and embolization to treat patients with liver cancer.
The liver is unique because it has two blood supplies—the hepatic artery and the portal vein. The normal liver receives about 75 percent of its blood supply through the portal vein and only 25 percent through the hepatic artery. But when a tumor grows in the liver, it receives almost all of its blood supply from the hepatic artery. As a result, the hepatic artery provides an ideal channel for a targeted tumor treatment.
This unique blood supply to liver tumors is what Y-90 SIRT is capitalizing on by delivering tiny glass or resin beads filled with the radioactive isotope yttrium-90 (Y-90) directly to liver tumors under image guidance. In this manner, large amount of radiation can be delivered precisely and safely to the tumor while sparing healthy tissue thereby reducing the risk of injury to the liver. After the catheter has been advanced into the artery that supplies the blood flow to the tumor(s), the radioactive microspheres are injected into the artery before reaching the tumor(s) where they will lodge and emit radiation for about two weeks.
How is Y-90 SIRT different from other radiation treatments for cancers of the liver?
The goal of Y-90 SIRT is to destroy the tumor(s) within the liver. This typically happens after one treatment but treatments can be repeated if necessary to achieve complete tumor destruction. The targeted nature and high level of precision of this therapy enable doctors to deliver more radiation to the liver tumors than would be possible using conventional external beam radiotherapy.
Because the liver is extremely sensitive to radiation damage, this highly precise method of delivering radiation to liver tumors makes it possible for patients with liver cancer to be treated in such a way without causing significant damage to the healthy liver tissue. Such Y-90 SIRT therapy has been shown through many clinical studies conducted worldwide to help extend the lives of patients with inoperable tumors and improve their quality of life.
Benefits of Y-90 SIRT Treatment
Treating liver cancer with Y-90 SIRT therapy offers patients numerous benefits including
- no hospitalization
- minimal if any side effects
- the ability to resume normal activities within a day or two
Besides offering patients an effective treatment option to control the spread of the cancer in their liver, therapy with Y-90 SIRT also helps patients maintain their quality of life. The procedure is performed on an outpatient basis allowing the patients to return home after the procedure and resume their normal activities almost immediately.
Other benefits include:
- Delays the time to tumor progression (the time it takes for a tumor to regrow)
- Extends overall survival rate
- Potentially downsizes or downstages tumors for liver resection, ablation, or transplantation giving patients a genuine chance for rehabilitation
- Provides palliation of symptoms
- Can be administered either during a chemotherapy-free interval, in a salvage setting or as an alternative to local or systemic treatments
- Can be synergistically combined with new drug therapies for maximum efficacy against the tumor(s)
Finally, another key advantage of Y-90 SIRT is that it can be synergistically combined with new drug therapies for maximum efficacy against the tumor(s).
Who is a Candidate for this Treatment?
Y-90 SIRT is approved to treat primary liver cancer (HCC) under a special dispensation from the FDA and colorectal cancer that has spread to the liver. In the United States, colorectal cancer is the second leading cause of cancer death. The liver is the most common site for the spread of this cancer which is why it is so important to treat the cancer there to prevent further spread beyond the liver.
Patients with colorectal liver cancer whose liver metastases cannot be removed by surgery are candidates for this type of treatment, which has received FDA approval. Our specialists at USA Oncology Centers can help you decide if this treatment is best suited for your condition.
What to Expect During Treatment
How to Prepare for the Treatment
About a month before your Y-90 SIRT treatment, you will have a mapping arteriogram procedure. Mapping arteriogram is done to plan for your Y-90 SIRT treatment. This mapping study will inform us on the anatomy of the liver, i.e. identify the arteries that are responsible for specifically bringing blood flow to the liver tumors and ensuring that the lungs will not be impacted negatively by the treatment with Y-90 SIRT. You will also need to have a blood test before you have your Y-90 SIRT treatment to test your liver function.
During Your Procedure
After a local anesthetic is administered to the patient, a specially trained interventional radiologist makes a small incision near the groin. Using live imaging, a catheter is then inserted through the incision and guided to the hepatic artery that feeds the liver tumors. Tiny microspheres or beads loaded with Y-90 will then be injected and released through this catheter. Once inside the tumor(s), the microspheres irradiate the tumor(s) for about two weeks destroying the tumor(s) before completely decaying or disappearing after one month. The whole procedure may take around 60–90 minutes.
After Your Y-90 SIRT Procedure
After the procedure is completed, patients may be sent to have a scan to check the level of radioactivity in the liver tumors. Patients will be monitored for a few hours after the procedure and are typically discharged the same day. Since you will have received a radioactive treatment, there are some simple precautions that need to be taken during the first 24 hours following the SIRT procedure. Very importantly, there is no danger in returning home immediately after the procedure is completed.
Side effects of Y-90 SIRT are usually very mild and the procedure is generally very well tolerated. You may have pain in your abdomen or nausea for 1-2 days. You also may experience a slight increase in your temperature, chills or a feeling of pressure in the abdomen. These side effects are usually transient and typically disappear within a few days. You may be given medication for a month after treatment to reduce gastritis (upset stomach) and peptic ulceration (stomach ulcers).
The vast majority of patients resume their normal daily activities within a day or 2 of the procedure.
We’re Here to Help
Helping our patients get the care they need to live happy, healthy lives is our top priority at US Oncology.
Call us at 855.870.4747 if you want to learn more about Y-90 SIRT treatment, or if you want to learn more about our locations, physicians, or insurance coverage. We always do our best to work with your insurance provider to maximize your coverage.
Scheduling an initial consultation at one of our oncology centers is quick and easy. If you’ve already be diagnosed, we encourage you to schedule a visit with us as soon as possible.
Concerned about your personal health and safety? We certainly understand and also offer the opportunity to conduct your appointment through telemedicine. Contact us at 855.870.4747.
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