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Treating Liver Cancer With Radioembolization (Y90)

Header image for radioembolization of hepatocellular carcinoma (HCC)

Hepatocellular Carcinoma (HCC) is one of the most common types of liver cancer. Typically caused by long-term damage and scarring of the liver, HCC originates in the liver. For various reasons, HCC sometimes can’t be treated with surgery. Unfortunately, even when it’s inoperable, HCC still causes symptoms and progresses as a disease. Radioembolization offers hope to people suffering from inoperable liver cancer.

Article reviewed by Luke Wilkins, MD


What is Radioembolization?

Radioembolization is an interventional radiology procedure designed to treat HCC and other inoperable liver cancers. Radioembolization is a palliative procedure, which means it doesn’t cure the cancer. Rather, the goal of this procedure is to relieve HCC symptoms, limit the cancer’s growth, and extend the life expectancy of patients, sometimes long enough time to receive a liver transplant.

As an interventional radiology procedure, radioembolization is minimally invasive. Interventional radiologists use medical imaging to see inside the patient, allowing them to guide their movements in real time.

In a radioembolization procedure, the interventional radiologist uses radiation-filled glass or resin beads, called microspheres, to block the blood flow to the cancerous growth while delivering radiation to the tumor. The microspheres are about one-third the width of a human hair and filled with yttrium-90 (Y90), a radioactive material. When the microspheres are released in the blood vessel, they deliver a focused, intense amount of radiation to the tumor with little or no radiation delivered to healthy, surrounding tissues, which also results in fewer side effects than typical radiation therapy.

Preparing for the Procedure

Preparing for radioembolization begins with a consultation with an interventional radiologist. This consultation usually involves having a blood test done to test kidney health and how well your blood responds to clotting. Also, make sure to inform your doctor about any medications and herbal supplements you are taking, as well as any known allergies to anaesthesia and contrast dye used for x-rays.

After your initial consultation and testing, the next step is to have an angiogram done the week before the procedure. An angiogram is a map of the blood vessels in your body, in this case, the ones that are connected to the tumor.

A stylized graphic of an angiogram

An example of what an angiogram looks like

As your procedure date approaches, patients are advised to make plans for transport to and from the procedure. Depending on your health, you may go home the same day as your radioembolization, or you may have to stay in the hospital for one or two days.

Because of the radioactive material used in a radioembolization, you will likely be required to limit contact with others after the procedure, especially women who are pregnant and children. Talk with your doctor about specific guidelines, but most patients will have contact restricted for 3-7 days.

Steps of A Radioembolization Procedure

An infographic that explains the 7 steps of a radioembolization procedure

At the beginning of the radioembolization procedure you may receive a moderate amount of anaesthesia or general anaesthesia. After that, the interventional radiologist makes a small incision in the groin. Using fluoroscopy, a continuous x-ray to see inside the patient, the interventional radiologist inserts a catheter into the incision and guides it to the femoral artery, the leg’s largest blood vessel.

Once accessing the artery, the catheter is guided to the blood vessel in the liver connected to the tumor. The interventional radiologist then releases the microspheres where they go to work blocking blood flow and delivering radiation to the tumor. The catheter is then removed and the incision is bandaged–stitches aren’t even necessary.

After the procedure, some possible side effects include mild abdominal pain, loss of appetite, nausea, fatigue, and fever. These feelings are usually mild and will disappear over time. Most patients are able to return to normal activities within 1-2 days after their procedure. The interventional radiologist may also schedule follow-up CT or MRI scans to assess the size of the tumor after the procedure and discuss any further treatment options.

 

Radioembolization has been shown to shrink the size of liver cancers and a majority of patients will see improvements in the liver, a longer life expectancy, and a reduction in symptoms. Talk to your doctor about your eligibility for radioembolization or contact UVA today at 434-924-9401.

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