Y-90 Treatment

What is Y-90 treatment?

Y-90 treatment is a type of radiation therapy for liver cancer. “Y-90” is short for the radioactive substance “Yttrium-90.” During treatment, providers insert microscopic beads of Y-90 into the blood vessels supplying blood to a tumor. Once the beads reach the tumor, they release high doses of radiation that kill cancer cells with little or no damage to nearby healthy liver tissue.

Y-90 therapy doesn’t cure liver cancer, but it shrinks tumors. It can keep cancer at bay so you live longer, experience fewer symptoms and have a better quality of life.

Other names for Y-90 treatment are Y-90 radiotherapy, transarterial radioembolization (TARE) and selective internal radiation therapy (SIRT).

Who is a candidate for Y-90 treatment?

You may be a candidate for Y-90 treatment if you have cancer that started in your liver (primary cancer) or spread to your liver from other sites (metastatic cancer). Providers also use Y-90 to treat some forms of bile duct cancer.

Usually, healthcare providers recommend Y-90 treatment when surgery isn’t an option. Sometimes, tumors are so close to major blood vessels that providers can’t remove them without risking serious liver damage. In that case, Y-90 treatment can slow tumor growth while preserving your liver function.

Getting Y-90 treatment first may make you eligible for future treatments that can potentially cure the cancer, like surgery or a liver transplant.

How should I prepare for treatment?

You’ll need several tests beforehand, including a physical exam, blood tests and liver function tests, to ensure you’re healthy enough for treatment.

During your pre-procedure appointment, you and your provider will discuss:

• Your medical history, including any allergies you have and whether you may be pregnant
• What medications you’re taking and whether you should stop taking them before surgery
• Arrangements you should make for support, like having someone drive you home after treatment
• When you should stop eating or drinking before your procedure
• What will happen during Y-90 treatment

Use this time to ask any questions you have about the procedure, including how it fits into your overall treatment plan.

What happens during Y-90 therapy?

Y-90 treatment involves two major procedures: a mapping angiogram and the Y-90 infusion. They usually happen about two weeks apart. Both involve working with a care team led by an interventional radiologist. Interventional radiologists use imaging guidance to perform procedures.

Mapping angiogram

An angiogram uses imaging to show the network of blood vessels supplying blood to the tumor. Your provider will use this information to map the route the Y-90 beads should take during the infusion.

For this procedure, you’ll lie on a table. Your provider will:

1. Make a tiny cut in your groin or wrist. They’ll use this as an access point to locate the major artery that leads to your tumor. Your provider will give you anesthesia to numb the area beforehand, so there’s no pain. They may give you a sedative to help you relax.
2. Thread a tiny plastic tube (catheter) through the artery. They’ll place the catheter while watching a screen that shows its location within your artery. You may be able to see the screen, too.
3. Inject a safe dye through the catheter. The dye causes the network of blood vessels supplying the tumor to stand out on the screen. They’ll map this route, so they know exactly where to direct the Y-90 beads during the actual infusion.
4. Remove the catheter. Afterward, they’ll place a bandage over the cut to stop the bleeding. The cut is so minor that you won’t need stitches. You likely won’t have scarring.

The mapping part of Y-90 treatment usually takes between two and four hours.

Y-90 infusion

The angiogram is like a test run for the infusion. The setup will be the same as before. But this time, your provider injects the Y-90 beads.

During the procedure, millions of tiny radioactive glass or plastic beads (about the size of a grain of powdered sugar) travel through your bloodstream until they reach the tumor. Once they arrive, they build up, blocking blood flow to the tumor. Then, they release high doses of radiation over a short distance (less than half an inch). That way, they deliver maximum damage to the tumor while sparing healthy nearby tissue.

The infusion part of the procedure typically takes about an hour or two. The beads give off about 90% of the radiation over the next 10 days and slowly decay in time. The decayed beads remain completely safe within your body.

What happens after Y-90 treatment?

You’ll spend an additional four or five hours in the recovery room after treatment. Your provider may admit you to the hospital overnight to check on you, but most people go home the same day. Once you’re moving around on your own safely and your vitals look good, you should get to leave the hospital.

What comes next depends on your cancer treatment plan. For example, you may only need one Y-90 infusion, or you may need more. You may need an additional type of cancer treatment, like chemotherapy or surgery.

What are the benefits of this procedure?

Y-90 treatment can get rid of tumors without the unpleasant side effects of traditional radiation therapy. Most radiation therapy uses a machine outside your body to direct radiation toward a tumor (EBRT). Although it’s effective, the radiation can damage healthy cells, too. Since Y-90 uses your bloodstream as transport, it can deliver higher doses of radiation directly to a tumor with minimal damage to healthy cells.

It’s also minimally invasive. Your provider can deliver radiation internally without having to make big incisions (cuts). This means the recovery time is much faster than with surgery, and you likely won’t even have a scar.

How successful is Y-90 treatment?

Y-90 treatment has increased the life expectancy of people living with non-operable liver cancer from a few months to up to two to three years. And it provides symptom relief that can improve the quality of your life.

Increasingly, providers use Y-90 treatment as a first step toward curative treatments, like surgery.

What are the risks or complications of this procedure?

It’s common to feel tired for a week or two after Y-90 treatment. Sometimes, people develop symptoms collectively called post-embolization syndrome (PES). They usually start within three days of the infusion. Symptoms include:

• Nausea and vomiting
• Loss of appetite
• Belly pain
• Low-grade fever

Most people with PES start to feel better within about a week of symptoms starting. In the meantime, contact your healthcare provider if you’re experiencing symptoms of PES. They can prescribe medications that can help.

Complications after Y-90 treatment are rare, but they can happen. They include:

• An infection. Although it’s unlikely, you may develop an infection in the spot where your provider inserts the catheter. If this happens, you may need antibiotics.
• An allergic reaction. You may be allergic to materials used in the procedure, like the contrast dye. Your provider will ask you about allergies beforehand to reduce your risk of this happening.
• Stomach or duodenal ulcers. You can develop ulcers if the beads travel to your stomach or small intestine and irritate the lining. During the mapping angiogram, your provider will take care to close off blood vessel routes to these organs (if needed) to prevent this from happening.

What is the recovery time?

Try to get some rest the next few days after your procedure. And follow any activity restrictions your provider gives you. For example, it may be unsafe to drive the first 24 hours after Y-90 treatment. You may also need to steer clear of certain types of exercise for the next week or so.

But one of the benefits of Y-90 therapy is that the recovery time is fast. You may need to manage fatigue in the beginning, but you’ll likely be able to resume most parts of your routine shortly after the procedure.

Are there restrictions related to radiation exposure?

Your healthcare provider may advise you to limit close forms of contact with others over the next few days. This is because the beads will continue to release radiation even after you leave the hospital. Your provider may advise you to:

• Avoid sharing a bed with your partner for a few days
• Avoid sitting right next to someone for an extended period of time
• Limit close contact with people who are pregnant or who have weakened immune systems

Keep in mind, though, that Y-90 uses targeted doses of radiation. The tumor absorbs most of it. This prevents damage to your healthy tissue and keeps the people you come into contact with safe, too. Ask your healthcare provider when there’s a risk of radiation exposure to others.

When should I call my healthcare provider?

Contact your provider if you’re noticing side effects of PES or an infection. Symptoms to look out for include:

• Feeling feverish or chilled
• Bleeding, warmth or swelling where your provider inserted the catheter
• Belly pain or numbness in your legs

Is Y-90 the same as ablation?

Y-90 treatment and ablation are both nonsurgical treatments that target tumors directly, but they work differently. While Y-90 uses radioactive beads to destroy a tumor, ablation uses extreme heat or cold to do the job. During ablation, providers insert a needle directly into the tumor to kill the cancer cells inside.

Is treatment painful?

The anesthesia and sedative keep you from feeling any pain during Y-90 treatment. You may feel a quick sting or burning sensation when the provider injects the anesthesia. Some people feel slight discomfort when the catheter and beads go in.

But one of the pluses of Y-90 treatment is that it’s minimally invasive. There’s very little pain or discomfort during the actual procedure. You may experience pain afterward from the beads causing inflammation in your blood vessels, but your healthcare provider can give you pain medications to provide relief.