Yttrium-90 Microsphere Radioembolization

General Information | Scheduling, Insurance and Preparation | What to Expect


General information General Information

About Yttrium-90 Microsphere Radioembolization

Radioactive microspheres are deployed through a catheter into the blood vessels that feed the tumor.

Yttrium-90 microsphere radioembolization is an FDA approved, non-surgical procedure used to treat inoperable liver cancer. It is used to treat primary and secondary liver cancer in patients who cannot have the tumors surgically removed. It may also be used to shrink tumors prior to surgery. This innovative procedure delivers targeted, internal radiation therapy directly to the tumor.

With this procedure, a catheter is inserted through a tiny cut in the groin and passed through the arteries until it reaches the hepatic artery. Then millions of tiny beads, or microspheres, which contain the radioactive element yttrium-90, are released into the blood stream. These microspheres lodge into the smaller blood vessels that feed the tumor. In addition to preventing blood flow to the tumor, the microspheres emit radiation that destroys the cancerous cells. The radiation only penetrates about 1/16" of tissue, so very little healthy liver tissue is affected by the radiation.

The radiation in the yttrium-90 continually decreases over a 2 week period, at which time the radiation is essentially gone. The microspheres will remain in the liver without causing any complications.

The microspheres are released into the blood vessels at the tumor site.

With yttrium-90 microsphere radioembolization the whole liver can usually be treated in one session. In some cases the right and left lobes of the liver may need to be treated separately with one month between the treatments. A trial run and mapping procedure is performed one week before the administration of the actual treatment dose to block off vessels that go outside of the liver (e.g. to the stomach). The trial run is also includes a test dose to prove that the majority of the dose will stay in the liver and not pass through to the lungs.

This minimally-invasive treatment has few side effects. While it won’t cure the cancer, it can shrink tumors, improve the quality of life, and often extends life for people with inoperable liver cancer.

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Liver Arteries

There are two blood vessels that feed the liver – the hepatic artery and the portal vein. The hepatic artery usually supplies blood to the tumors. Consequently, yttrium-90 microspheres are administered through this artery. During the radioembolization, healthy liver tissue will continue to get blood from the portal vein, so very little healthy tissue is damaged by the procedure.

Yttrium-90 Microsphere Radioembolization vs. Other Non-Surgical Treatments

Not everyone with inoperable liver cancer is a candidate for this procedure. If you are a candidate, your doctor may recommend this procedure over other non-surgical treatments for the following reasons:

  • Treatment is regional (only affects the liver)
  • Allows a more potent radiation dose to be delivered
  • Milder side effects
  • No or very short recovery
  • Number and size of tumors does not need to be determined for treatment to be effective
  • Treats all tumors fed by the hepatic artery, including undetected tumors
  • Results have been very promising

Risks Involved in Yttrium-90 Microsphere Radioembolization

The risks involved in radiofrequency ablation include the following:

  • Bruising, bleeding, or infection at the puncture site
  • Damage to a blood vessel
  • Allergic reaction to the contrast material used during the procedure
  • Radiation exposure; however, it is well below the level that generally causes adverse affects

Serious side effects in the gastrointestinal tract or lungs are possible if the microspheres are not correctly placed in the liver. These are uncommon and usually only occur in patients who have unusual or severely damaged blood vessels in the liver.

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Scheduling, Insurance and Preparation Scheduling, Insurance and Preparation

Procedure Locations

Consultations for yttrium-90 microsphere radioembolization are done at RIA Endovascular.

The procedure is performed at the following Radiology Imaging Associates partner hospitals in the Denver, Colorado area:

Call 720-493-3406 to schedule a consultation.

Scheduling

To schedule a consultation to discuss yttrium-90 microsphere radioembolization, call 720-493-3406.

  • Littleton Adventist Hospital
  • Porter Adventist Hospital
  • Sky Ridge Medical Center
  • Swedish Medical Center

Insurance Coverage

Yttrium-90 microsphere radioembolization is usually covered by insurance. Check with your insurance company to be sure. Please bring your insurance card with you to your consultation.

Conditions to Let Us Know About

When you have your consultation for yttrium-90 microsphere radioembolization, let the radiologist or nurse know if any of the following circumstances apply to you:

  • Previous reaction to iodine/CT or X-ray contrast
  • Previous reaction to anesthesia
  • Coagulation disorder or taking blood thinning medication
  • Currently pregnant or nursing

Preparation Guidelines

If you are a candidate for yttrium-90 microsphere radioembolization, you will be given detailed preparation guidelines. Following are some of the basic guidelines; however, you may receive additional or differing guidelines based on your specific situation. Please contact us at 720-493-3406 if you have any questions.

  • Stop taking blood-thinning medications 3-5 days before the procedure (contact your doctor first to ensure it’s safe).
  • Do not eat or drink anything but clear liquids for 8 hours before the procedure; do not drink anything for 4 hours before the procedure.
  • Do take your regular medications with sips of water the morning of the procedure especially blood pressure medicines
  • Make appropriate plans to restrict close physical contact with children immediately after the procedure.
  • Arrange for someone to drive you home from the procedure.

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What to Expect What to Expect

Before the Procedure

Before scheduling the procedure, an interventional radiologist must determine if you are a good candidate for yttrium-90 microsphere radioembolization. You or your doctor will need to supply your medical records and prior test results so your eligibility can be determined.

If you appear to be a candidate, you will undergo additional exams including a blood test and a CT scan or PET scan. These exams will help the radiologist confirm your eligibility for the yttrium-90 microsphere radioembolization and determine an appropriate radiation dose for your liver.

If your eligibility is confirmed and you decide to have the procedure, you must also have an angiogram 7-10 days before the procedure date

During the Procedure

With yttrium-90 microsphere radioembolization, microsphere are released into the hepatic artery.

Here is generally what will happen during yttrium-90 microsphere radioembolization:

  1. You will change into a gown.
  2. A technologist will answer your questions then start an intravenous (IV) line in your arm.
  3. The technologist will set up various devices so your heart rate and blood pressure can be monitored throughout the procedure.
  4. You will receive intravenous conscious sedation to help you relax and eliminate discomfort. You will remain awake for the procedure.
  5. The site of the groin incision will be cleansed.
  6. A fluoroscope will be moved into position over your abdomen.
  7. The groin incision will be made and the catheter will be inserted into the femoral artery.
  8. While watching the fluoroscope images, the interventional radiologist will carefully guide the catheter to the hepatic artery in the liver.
  9. The interventional radiologist will deploy the microspheres through the catheter and into the hepatic artery. This procedure is generally painless; however, some patients experience pain when the microspheres are released. Let the radiologist known immediately if you feel any pain.
  10. After all the microspheres have been deposited, the catheter will be withdrawn.
  11. The incision will be cleaned and taped.

The procedure takes 30-90 minutes to complete. You will then spend 2-6 hours in the recovery area. Most patients go home the same day of the procedure. Rarely, a patient may require an overnight stay for observation.

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After the Procedure

Recovery

Most patients return to their normal activities after leaving the hospital. All patients will experience fatigue for 1-4 weeks following the procedure. Some patients may also experience the following:

  • Abdominal pain
  • Loss of appetite
  • Nausea
  • Vomiting
  • Low-grade fever

These side effects usually subside within 3-5 days and some may be alleviated with medication. If they last more than 7-10 days, inform your doctor.

Precautions

Following are precautions you should take for one week after your treatment for the safety of your family and other people.

  • Do not use public transportation that will require you to sit next to another person for more than two hours.
  • Do not sleep in the same bed as your partner.
  • Avoid close contact with pregnant women and children.
  • For the first three days, maintain a 6-foot distance from other adults if contact will last for more than a few minutes.

Follow-Up

Every three months after therapy, a CT scan, MRI or PET scan will be performed.

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