Targeted radiation therapy: Y-90 and liver cancer

The liver is the largest solid internal organ in the body and performs over 500 essential functions, ranging from filtering toxins and processing nutrients to storing glucose and regulating blood clotting.

Liver cancer may develop in the cells of the liver or spread to the liver from another area of the body. About 41,000 people in the U.S. are diagnosed with liver cancer each year, and nearly 29,000 people will die of the cancer.

Treating liver cancer depends on the stage and location of the tumors, along with the patient's overall health. Targeted radiation therapy, called Y-90, is an innovative option for select patients.

Treating liver cancer

Surgery often remains the gold standard for treating and removing tumors in the liver when it's a viable treatment. However, surgery isn't the only option. Transarterial therapy and percutaneous ablation are minimally invasive treatments that target specific areas in the liver.

Transarterial therapy involves injecting treatment directly into the tumor's blood supply. The injection can be larger particles that block or plug the blood supply and starve the tumor or smaller particles that dispense radiation treatment through the blood supply to the tumors. These methods are effective at treating localized or dispersed tumors in the liver.

Percutaneous ablation uses special needles and image guidance to deliver energy into the tumors. This energy either freezes or heats the tissue and destroys tumors. Ablation usually is limited to smaller lesions in locations favorable for treatment within the liver.

Minimally invasive treatments are completed as outpatient procedures, and patients may go home the same day. These treatments offer additional benefits, such as preserving more liver tissue, shortening recovery times and targeting smaller or more widespread lesions in the liver.

Liver cancer treatment plans are personalized for each patient and may include surgery, minimally invasive procedures or a combination of treatments. The specific plan is determined by the size and location of the tumors and if any tumors are located in the body beyond the liver.

Y-90 radioembolization

Radioembolization is a type of transarterial therapy that strategically attacks liver tumors with localized, high doses of radiation. The treatment often is called Y-90. This refers to the radioactive isotope yttrium-90 that is inserted into tiny glass beads and injected into the tumor's blood supply. The radioactive beads accumulate inside the tumors and emit radiation to suppress tumor growth. Over time, the tumor dies, but the healthy part of the liver remains unaffected.

Y-90 is a targeted way to deliver radiation to a tumor because it radiates less than half an inch into adjacent tissues. This limits the amount of the liver exposed to radiation, and spares normal liver tissue and other nearby organs from unnecessary exposure.

What to expect

After reviewing all treatment options with you, your cancer care team may recommend Y-90 treatment. The first step is to examine your liver's blood supply. A series of CT or MRI scans help map out the liver's blood vessels. These images also determine the size and location of your liver tumors.

Next, the team determines a treatment plan and identifies which vessels will be injected with Y-90. They also will recommend the number of treatments.

An interventional radiologist inserts a small tube, called a catheter, into an artery in the groin or wrist and threads it to the identified vessels that supply blood to your tumors. The radioactive beads are injected through the catheter into the blood vessels. The beads emit radiation into the tumor's blood supply for a short period.

Y-90 treatments are completed in a hospital procedure room, and you can go home the same day as the treatment. Side effects are usually limited but may include fatigue or mild abdominal pain. Multiple treatments may be necessary depending on the stage and location of your liver cancer.

Combined treatment approach

Y-90 can be used with other cancer treatments. It helps shrink large tumors that cannot be surgically removed, making surgery possible. For patients not eligible for liver transplants due to tumor size, Y-90 helps shrink tumors and improves their chances of transplantation. In select cases, having Y-90 as part of a cancer treatment plan may provide different chemotherapy options later.

Overall, Y-90 treatment is a promising option for patients with liver cancer. This safe, effective treatment can help improve patient outcomes with this challenging disease. If you or a loved one has been diagnosed with liver cancer, ask your health care team if Y-90 treatment may be right for you.

Next steps:

• Find an oncologist or cancer treatment near you.
• Attend a cancer support group.
• Read about the Albert J. and Judith A. Dunlap Cancer Center.
• Discover other cancer topics.

Jeremy McBride, M.D., is an interventional radiologist in Eau Claire, Wisconsin.