Yttrium 90 (Y90) radioembolization is a minimally invasive treatment for cancer in the liver. It can be used for cancer that starts in the liver (hepatocellular carcinoma). And it can be used for cancer that has spread to the liver from another part of the body (liver metastases).

This treatment is often done when other treatments for liver cancer aren't a choice. For example, your tumor may be too big to take out with surgery. Or you may not be able to have a liver transplant.

Y90 radioembolization does not cure liver cancer. But it may ease your symptoms or slow the growth of the cancer.

IH-tree-ehm

NYN-tee

RAY-dee-oh-ehm-boh-lih-ZAY-shuhn

It combines embolization and radiation therapy. Embolization is when a blood vessel is blocked to stop blood flow. Radiation therapy uses beams of high-energy X-rays or other particles to kill cancer cells and shrink tumors. Radioembolization is a type of internal radiation therapy. That means the radiation source is put inside your body.

This treatment uses the radioactive isotope Y90 to kill cancer cells. Small beads (microspheres) with Y90 in them are put through a catheter into the hepatic artery. This is one of the liver's main blood vessels. Tumors in the liver get much of their blood supply from the hepatic artery.

The beads do two things. First, they block blood flow to the tumor. This starves it of the oxygen and nutrients it needs to grow. They also send cancer-killing doses of radiation directly to the cancer cells over a couple of weeks. Because the liver has two main blood vessels, the healthy liver cells can live off the unblocked vessel (portal vein).

• Infection
• Blood clots
• Allergic reaction to the contrast dye
• Stomach ulcer
• Liver damage or failure

Before you have this treatment, you will need blood tests and an angiogram. An angiogram is a type of imaging test. X-ray visible dye is injected into the bloodstream. Your doctor can then see the condition of the blood vessels sending blood to your liver.

Your doctor may tell you to not eat or drink for some time before Y90 radioembolization.

Tell your doctor:

• All prescription and over-the-counter medicines you take
• All vitamins and herbal supplements you take
• If you have any allergies
• If you may be pregnant or are breastfeeding

You may have to stop taking certain medicines before the procedure.

Talk with your doctor if you have any questions or concerns.

Y90 radioembolization is often done in a hospital outpatient setting. An interventional radiologist will do the procedure. It takes about 1 hour. During the treatment:

• You will be given a hospital gown to wear. You will lie down on your back on a table. You will be given medicine through an intravenous line (I.V.) in your hand or arm. It will help you relax and not feel pain.
• A special contrast dye will be put into your blood. X-ray images are taken and sent to a video screen. The images help the doctor see your blood vessels during the treatment.
• The doctor will clean the area of skin and numb it with a local anesthetic. They will make a small cut (incision) in your inner thigh to reach a blood vessel. They will then put a thin, flexible tube (catheter) into the blood vessel.
• Using the images on the video screen, the doctor will move the catheter up the blood vessel to the hepatic artery.
• Once there, the doctor will use the catheter to place the radioactive Y90 beads near the tumor. The beads will start to give off a steady dose of radiation into nearby tissue.
• The doctor will take out the catheter. They will put pressure on the spot to stop any bleeding. They will cover the small cut in your thigh with a bandage. Your I.V. will be taken out before you go home.

After the treatment, you will stay in the hospital for a few hours. You will likely not have to stay overnight. Plan to have an adult there to drive you home. Ask how to take care of the incision site and change the bandage.

Once you are home, you may have nausea, vomiting, a slight fever, and belly (abdominal) pain. You may also feel very tired. Ask your health care team how to manage these symptoms. Also ask when to call if your symptoms don't get better or get worse.

It may take several weeks to fully recover. Ask your doctor when you can go back to your normal activities.

It takes about 30 days for the radiation to clear from your body. During the first week, you should limit your contact with other people. Talk with your doctor about steps you need to take to protect others from the radiation. This may mean limiting close contact with children and pregnant people and not sharing a bed with a partner. You may also need to avoid contact with urine for 1 to 2 days. You may be instructed to sit down while urinating and to shut the toilet lid before flushing.

Make sure you go to all follow-up visits with your doctor. You will have other tests to see how the cancer has reacted to the treatment. The beads will be left in place to block the blood supply to the cancer. They will not cause any problems.