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What is Radioembolization?

Radioembolization is an important minimally-invasive treatment option for patients with cancer of the liver that cannot be effectively treated by other means. It is sometimes called Selective Internal Radiation Therapy (SIRT) or intra-arterial brachytherapy, and uses microscopic radioactive spheres containing Yttrium-90 to treat the cancer. These tiny radioactive beads are injected directly into the tumors through a catheter during a procedure called an angiogram, and there begin to emit radiation, killing the cancers.

Y-90 Explained

SIRT Procedure


Radioembolization is generally considered safer than other forms of radiation therapy because the radioactive beads remain in the tumors, blocking blood flow, shrinking it, and without exposing the rest of the body to the radiation. Healthy tissue in other areas of the liver suffers minimal damage from the radioembolization because of the precise positioning of the particles themselves. As a result, there are far fewer side effects from the radiation. Over a period of about a month, the radiation in spheres is depleted, and any leftover particles can be left in place safely.

Radioembolization is primarily used to treat cancers of the liver that have metastasized from other locations in the body, especially the colon. It can be used in conjunction with other therapies (such as surgery or chemotherapy), and can be used to shrink large tumors to allow for surgical removal. As with other forms of embolization, this therapy is not appropriate for patients with severe liver disease or who have blocked or abnormal blood flow between the liver and lungs. This procedure is performed on two separate procedure days.

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What To Expect

If your doctors decide that you are a candidate for this procedure, it is performed in a hospital by MTV IR interventional radiologists. When you arrive for your procedure, medical staff will insert IVs and other monitors to measure your vital signs. You’ll be taken to the procedure room and then your groin area will be shaved and washed with a special soap. After a numbing medication is injected into the area, the interventional radiologist insert the catheter into the artery and guide it into place in your liver using X-rays. You may feel some pressure during this procedure, but no pain.
Next, during the first procedure day, the interventional radiologist will map your liver anatomy to identify arteries that may be feeding the tumors. They also look for small arteries near the tumors that may lead to the stomach or intestines, and if they are present they block these arteries to keep radiation from reaching these organs. Finally, they inject macro aggregated albumin (MAA) particles into your liver to trace where the particles go, and a scan is performed to make sure they stay in the liver and internal to the tumors being treated.

This mapping procedure is scheduled several days prior to the actual radioembolization or treatment procedure. In the second procedure, the catheter is placed directly into the liver artery and treatment is performed. A follow-up scan will be performed to confirm the treatment was directly delivered into the tumors. Each of these treatments takes 45-120 minutes.

After each treatment, the catheter in your groin is removed and you will be asked to lie flat for a while. You may experience some nausea, fever, or pain after the procedure and for the next few days.


Results

After your release from the hospital you should avoid driving for 24 hours, limit your activities, and avoid physical exertion or heavy lifting for several days. Full recovery usually takes 7 to 10 days. Follow-up exams are performed to evaluate the treatment results. Because only one lobe of the liver can be treated at the same time with radioembolization, if you have tumors in both lobes of your liver you may need a second round of treatment, usually a month a part.

More information

For more information on Selective Internal Radiation Therapy (SIRT) for liver tumors using SIR-Spheres microspheres, please download the Patient Guide brochure below:

A Few Of Our Cases

Image A
This is a CT scan image of the liver and upper abdomen. The large dark area on the left side of the image represents a breast carcinoma metastasis in the liver. The mass measure over 10 centimeter in size.
Image B
This is an image from a PET scan of the same patient in Image A with breast cancer in the liver. The image is of the whole body from the head to the pelvis. The bright round area over the mid portion of the image represents increased PET activity in the liver corresponding to the same lesion seen on the CT scan. The brightness of the area indicates it is very metabolically active and represents viable tumor.
Image C
The patient was referred for Y90 radioembolization of the liver mass. This image is a picture of an angiogram of the right hepatic artery that supplies the tumor. The increased blood vessels or “vascularity” seen on the angiogram is a common feature of patients with certain types of liver tumors.
Image D
Approximately 14 months after the Y90 radioembolization procedure to the liver tumor, this CT scan shows that the mass in the liver has decreased significantly in size. When this is compared to the original CT scan before the procedure, the area looks smaller and does not enhance the same.
Image E
Approximately 16 months after the Y90 radioembolization procedure, a PET scan was obtained to evaluate the metabolic activity of the liver lesion. While these images were obtained in the same manner as that seen in Image B, the images are “reversed”. Everything that was black on the first image is now white and visa versa. The area in the liver now has less activity than the surrounding liver indicating an excellent response to therapy. See the red circled area.