Yttrium-90 (Y-90) Radioembolization: A Comprehensive Guide for Liver Cancer Treatment

Yttrium-90 (Y-90) Radioembolization: A Comprehensive Guide for Liver Cancer Treatment

Summary (10 sec read)

Yttrium-90 (Y-90) radioembolization is a targeted treatment for unresectable liver cancer, delivering localized radiation directly to tumors. It offers high tumor response rates, potential downstaging for surgery, and improved survival, with fewer side effects compared to traditional therapies like chemotherapy. It's safe, effective, and widely used globally.

Yttrium-90 (Y-90) radioembolization, also known as  selective internal radiation therapy (SIRT) , is an advanced, targeted therapy used to treat  unresectable liver cancers , including  hepatocellular carcinoma (HCC)  and metastatic liver cancer. It is particularly beneficial for patients who cannot undergo surgery due to the location, size, or number of tumors in the liver. This article provides a comprehensive understanding of Y-90 treatment, supported by clinical data and expert consensus, and explains why it is considered one of the most effective options for liver cancer today.

What is Y-90 Treatment?

Y-90 radioembolization is a minimally invasive treatment that involves injecting radioactive microspheres, which contain the isotope Yttrium-90, into the arteries that feed liver tumors. These microspheres lodge in the small blood vessels surrounding the tumor and emit radiation directly to the tumor site, minimizing damage to the surrounding healthy liver tissue. The treatment is delivered as follows:

  1. Pre-Treatment Planning : A diagnostic angiogram  is performed to map the blood supply to the liver, ensuring the microspheres will target the tumor effectively. A test dose of a non-radioactive substance is administered to simulate the treatment and confirm that the spheres will not affect non-target organs like the stomach or lungs.
  1. Y-90 Microsphere Delivery : During the actual treatment, a catheter is placed in the femoral artery  and guided to the liver’s hepatic artery. The Y-90 microspheres are injected through the catheter, where they travel to the tumor site and emit beta radiation that selectively destroys cancer cells.
  1. Radiation Effect : The radiation emitted by Y-90 is highly localized, with a range of about 2.5 mm, which prevents widespread damage to healthy tissue. The radiation lasts for approximately two weeks, but the microspheres remain in the liver permanently.

 

Why Y-90 is the Best Available Treatment for Liver Cancer

Y-90 therapy has gained prominence because of its ability to deliver high-dose, localized radiation while sparing healthy tissue, offering several advantages over traditional treatments such as  transarterial chemoembolization (TACE)  and  systemic chemotherapy :

Localized Radiation : Y-90’s highly targeted approach allows for the delivery of high radiation doses directly to the tumor while minimizing systemic side effects, making it safer than traditional chemotherapy or radiation.

Tumor Downstaging : Y-90 can shrink large tumors, potentially allowing patients to become candidates for surgery or liver transplantation, making it a valuable tool for  bridging to transplantation .

Combination Therapy : Y-90 is often used in combination with other treatments, such as  sorafenib  for advanced hepatocellular carcinoma, to improve overall outcomes.

Effectiveness Across Stages : Studies have shown that Y-90 is effective in treating  intermediate  and  advanced-stage HCC . It has also been proven to prolong the time to disease progression when compared with TACE.

Prognosis and Life Expectancy After Y-90 Treatment

The prognosis for patients treated with Y-90 depends on various factors, including the stage of the cancer, liver function, and overall health. Studies have shown promising survival rates:

- For patients with  intermediate and advanced HCC , median overall survival rates after Y-90 therapy range from  12 to 24 months . Patients with well-compensated cirrhosis (Child-Pugh A) tend to have better outcomes.

- In patients with  liver metastases  from colorectal cancer, Y-90 has extended overall survival by  6-12 months  depending on the tumor burden and prior treatments.

Time to progression  is also significantly improved in Y-90-treated patients, with some studies reporting a progression-free period of up to  26 months .

Safety of Y-90 Treatment

Y-90 radioembolization is generally considered safe, but like any treatment, it comes with certain risks. The most common side effects include:

Post-Embolization Syndrome : Many patients experience fatigue, nausea, and low-grade fever for a few days after the procedure. These symptoms are typically mild and self-limiting.

Liver Dysfunction : In rare cases, Y-90 treatment can lead to  radiation-induced liver disease (RILD) , especially in patients with pre-existing liver damage (such as cirrhosis).

Non-Target Radiation : Although rare, if microspheres are misdirected, they can cause radiation damage to non-target organs such as the stomach, intestines, or lungs. Pre-procedural planning and selective embolization of non-target vessels help mitigate this risk.

Radiation Pneumonitis : This is an uncommon but serious complication that occurs if a significant amount of Y-90 microspheres migrate to the lungs.

Despite these risks, Y-90 is generally well-tolerated, with significantly fewer side effects than  systemic chemotherapy  or other liver-directed therapies.

Cost of Y-90 Treatment

Y-90 treatment is available in many countries, and the cost varies depending on the healthcare system:

- In the  United States , the cost of Y-90 therapy ranges between  $40,000 and $70,000  per treatment session.

- In Europe , the costs are slightly lower, ranging from  €30,000 to €50,000 .

- In India , Y-90 therapy is more affordable, costing between  INR 5-12 lakhs  (approximately  $6,000 to $15,000 ), depending on the hospital and region.

These cost differences are due to healthcare system structures, patient subsidies, and treatment accessibility in different regions.

Success Rate of Y-90 Treatment

Y-90 therapy has a strong record of success in treating liver cancers. Data from clinical studies show that:

Tumor Response : Y-90 therapy achieves partial or complete tumor response in 40-70% of treated patients.

Downstaging : In  30-40%  of cases, Y-90 can shrink tumors sufficiently to allow for surgical resection or liver transplantation.

Prolonged Control : Y-90 provides better local tumor control compared to TACE, with fewer repeat treatments required.

Quality of Life : Patients treated with Y-90 report improved quality of life compared to those undergoing systemic chemotherapy or TACE, with fewer side effects and a quicker recovery period.

Conclusion

Yttrium-90 (Y-90) radioembolization is a cutting-edge treatment that offers hope to patients with unresectable liver tumors. Its ability to deliver targeted radiation directly to the tumor, combined with its potential to shrink tumors, bridge patients to surgery or transplantation, and prolong survival, makes it a valuable tool in liver cancer management. With a favorable safety profile, strong clinical evidence supporting its efficacy, and the possibility for better quality of life, Y-90 is considered one of the best options for treating liver cancer today.

References

  1. Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin. 2011;61(2):69–90. doi: 10.3322/caac.20107.
  2. Carr BI. Tumors of the liver and biliary tree. In: Kasper D, Fauci A, Hauser S, Longo D, Jameson JL, Loscalzo J, editors. Harrison’s principles of internal medicine, 19e. New York: McGraw-Hill; 2015.
  3. European Association for the Study of the Liver. European Organisation for Research and Treatment of Cancer EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol. 2012;56(4):908–943. doi: 10.1016/j.jhep.2011.12.001.
  4. Salem R, Lewandowski RJ, Mulcahy MF, et al. Radioembolization for hepatocellular carcinoma using yttrium-90 microspheres: a comprehensive report of long-term outcomes. Gastroenterology. 2010;138(1):52–64. doi: 10.1053/j.gastro.2009.09.006.
  5. National Comprehensive Cancer Network. Hepatobiliary Cancers (Version 1.2016).
  6. Lewandowski RJ, Salem R. Yttrium-90 radioembolization of hepatocellular carcinoma and metastatic disease to the liver. Semin Intervent Radiol. 2006;23(1):64–72. doi: 10.1055/s-2006-939842.
  7. TheraSphere Yttrium-90 microspheres package insert. Kanata CMN.

Frequently Asked Questions

  1. What is Y-90 radioembolization?

    Yttrium-90 (Y-90) radioembolization is a minimally invasive treatment for liver cancer that involves injecting tiny radioactive microspheres into the arteries supplying the liver tumors. These microspheres emit radiation directly at the cancer cells while sparing the surrounding healthy tissue. It is particularly effective for patients with unresectable liver cancer, meaning those who cannot undergo surgery.

  2. How does Y-90 treatment work?

    Y-90 microspheres are delivered through a catheter into the liver's blood vessels. Once they reach the tumor site, they lodge in the small arteries feeding the tumor and emit localized beta radiation. This destroys cancer cells over a period of about two weeks. The microspheres themselves remain in the liver, but the radiation dissipates after two weeks.

  3. Who is a candidate for Y-90 therapy?

    Y-90 is generally used for patients with unresectable hepatocellular carcinoma (HCC) or liver metastases from other cancers (such as colorectal cancer). It is most suitable for patients who cannot undergo surgery or for whom other treatments, like chemotherapy, have failed. Patients with a good liver function (Child-Pugh A or B) and without extensive extrahepatic disease are typically the best candidates.

  4. How does Y-90 compare to other liver cancer treatments?

    Y-90 offers several advantages over traditional treatments such as transarterial chemoembolization (TACE) or systemic chemotherapy:

    • It delivers highly localized radiation directly to the tumor, reducing systemic side effects.
    • It can potentially shrink tumors (downstaging) to make patients eligible for surgical resection or liver transplantation.
    • It provides better tumor control and longer progression-free periods compared to TACE.

  5. What are the side effects of Y-90 radioembolization?

    The most common side effects include:

    • Post-embolization syndrome, which includes fatigue, nausea, and mild fever. This typically resolves within a week.
    • Liver dysfunction may occur, particularly in patients with pre-existing liver disease.
    • Rarely, non-target radiation can affect other organs, such as the lungs or stomach, leading to complications.

    However, compared to systemic chemotherapy or other forms of radiation, the side effects of Y-90 are generally milder and more localized.

  6. What is the success rate of Y-90 treatment?

    Y-90 treatment has been shown to have high success rates in terms of tumor response:

    • Partial or complete tumor response is observed in 40-70% of patients.
    • Approximately 30-40% of patients may experience downstaging, which can make them eligible for surgical removal or liver transplantation.
    • Y-90 also provides better tumor control and longer progression-free periods compared to other treatments.

  7. How long does it take to see results from Y-90 therapy?

    The therapeutic effects of Y-90 begin within a few days of treatment, with the radiation continuing to work over approximately two weeks. Tumor shrinkage can be observed within a few months during follow-up imaging studies, such as CT or MRI.

  8. What is the prognosis after Y-90 treatment?

    Prognosis varies depending on the stage of the disease and other individual factors, but clinical studies have shown that:

    • For patients with hepatocellular carcinoma (HCC), median overall survival ranges from 12 to 24 months.
    • For patients with liver metastases, particularly from colorectal cancer, Y-90 has extended survival by 6-12 months depending on tumor burden and prior treatments.

  9. How much does Y-90 therapy cost?

    Costs for Y-90 therapy vary by region:

    • In the United States, the cost is between $40,000 and $70,000 per treatment.
    • In Europe, it ranges from €30,000 to €50,000.
    • In India, the treatment is more affordable, ranging from INR 5-12 lakhs (approximately $6,000 to $15,000).

    These differences depend on healthcare systems, treatment facilities, and regional subsidies.

  10. How long is the recovery time after Y-90 radioembolization?

    Most patients experience mild post-treatment symptoms (such as fatigue or nausea) for about a week. After this, recovery is typically quick, with many patients able to resume normal activities within a few days to a week. Full effects of the treatment may take several weeks to months to evaluate.

  11. Can Y-90 therapy be combined with other treatments?

    Yes, Y-90 is often used in combination with other treatments like systemic therapies such as sorafenib for advanced hepatocellular carcinoma. Additionally, it may serve as a bridge to surgery or liver transplantation in patients who were previously considered ineligible for such procedures.

  12. Is Y-90 radioembolization safe?

    Y-90 is generally considered a safe treatment with a favorable risk-benefit profile for patients with liver tumors. Although there are some risks, such as liver dysfunction or non-target radiation affecting other organs, careful pre-treatment planning reduces these risks significantly. The overall safety profile of Y-90 is superior to systemic chemotherapy or radiation for many patients.

  13. How is Y-90 therapy administered?

    Y-90 treatment is delivered through a catheter placed in the femoral artery, which is guided to the liver’s hepatic artery. The procedure is performed by an interventional radiologist and typically requires a hospital stay of only a few hours or a day.

  14. What follow-up care is required after Y-90 treatment?

    Patients will undergo regular follow-up imaging (CT, MRI, or PET scans) to assess the treatment response. Blood tests may also be done to monitor liver function. Follow-up care is essential to evaluate the effectiveness of the therapy and to detect any potential complications.

Consult Dr Ishita B Sen

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Disclaimer: This information is intended for general knowledge and informational purposes only, and does not constitute medical advice. Please consult with a qualified healthcare professional for any medical concerns or treatment decisions.

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