Choose the content to read

• Why Y-90 for liver cancer?
• What disease can Y-90 treat?
• What is the diagnosis before Y-90?
• What is the Y-90 radioembolization procedure?
• Y-90 radioembolization for liver cancer at MedPark Hospital

Y-90 radioembolization for liver cancer

Y-90 radioembolization is a minimally invasive, transarterial radioembolization treatment for liver cancer by directly delivering yttrium 90 radioactive microspheres into liver cancer or liver tumors via arterial catheter to block the tumor's blood supply and starve the liver tumor until it gradually shrinks and eventually dies. Y-90 is a selective internal radiation therapy (SIRT) that effectively treats almost every cancer stage, from primary liver cancer to metastatic liver cancer, colorectal cancer that has spread to the liver, and inoperable liver cancer. Y-90 yields good treatment results, has fewer side effects, a short-term recovery, and enables patients to resume their daily lives quickly.

Why Y-90 for liver cancer?

In metastatic liver cancer not curable by liver transplant surgery or standard surgery to resect liver cancer due to surgery leaving too little liver to function properly, oncologists may treat cancer with radiation therapy, radiofrequency ablation (RFA)/microwave ablation using a radiofrequency needle, chemotherapy, or targeted drug therapy. However, radiation therapy and radiofrequency ablation may harm adjacent healthy tissue and nearby organs, whereas chemotherapy and targeted drug therapy may not effectively manage all liver diseases and may cause patients who are physically weak to experience excessive drug-related side effects.

Y-90 radioembolization is an innovative treatment for inoperable liver cancer that combines targeted radiation therapy with Yttrium 90 radioactive microspheres and embolization to block the liver cancer's blood supply. Yttrium 90 beads have a penetrating radiation distance of approximately 11 mm. and have an appropriate microsphere size to embed in a cancer tumor to emit beta radiation that kills cancer cells in a treated tumor in a short period of time, with a half-life of approximately two and a half days without affecting healthy tissues or nearby organs. Y-90 neither requires surgery nor supplemental chemotherapy, and patients do not experience any side effects associated with chemotherapy drugs.

What disease can Y-90 treat?

• Liver cancer
• Metastatic colon cancer
• Neuroendocrine tumors (NETs)

What are the symptoms of liver cancer?

• Early-stage liver cancer often has no symptoms (Doctors recommend annual health checkups)
• Pain under the right ribcage
• Abdominal distension
• Fatigue
• Unexplained weight loss
• Sensing a lump in the abdomen
• Intermittent fever
• Cirrhosis symptoms include jaundice (yellowing of the skin and eyes) or ascites.

What is the diagnosis before Y-90?

Intervention radiologists will consider using Y-90 for treating all stages of cancer, both operable and inoperable liver cancer, and no other underlying diseases. The radiation oncologist will conduct a detailed history, physical examination, blood test, and specialized examination to assess the liver's condition, including determining the location of tumors or cancer and the stage of cancer using the following imaging studies:

• CT triple-phase liver imaging, or MRI, is used to evaluate hepatic circulation, calculate the tumor and regular liver tissue volumes, locate the hepatic portal vein, and determine the extent of cancer spread outside the liver.
• Digital subtraction angiography of the hepatic artery to evaluate hepatic artery catheter placement, including searching for blood vessels that are at risk for the backflow of radioactive beads into other organs, such as the stomach, duodenum, or gallbladder.
• SPECT CT to determine the size of the blood vessels that connect the liver to the lungs, which must not be too large to reduce the risk of radioactive beads flowing into and blocking peripheral blood vessels of the lungs and causing pulmonary fibrosis.

The amount of Yttrium 90 radioactive microspheres used by radiologists varies from person to person, depending on the severity of the disease, liver health, and the doctor's discretion.

What is the Y-90 radioembolization procedure?

Y-90 radioembolization at MedPark Hospital uses the international gold standard for the treatment, considering the utmost safety and effectiveness of the treatment as a priority. After the treatment, patients require 1 day of hospitalization and can return home after the result of the overall physical evaluation by the doctor is satisfactory and no serious complications are detected.

• The intervention radiologist will insert a small catheter through the groin artery to deliver resin coated with yttrium 90 radioactive microspheres and targeted directly at liver tumors or liver cancer. Yttrium 90 beads will be embedded at the distal ends of the hepatic arterial branches, blocking the liver arteries and preventing blood from flowing to nurture the liver tumor or cancer.
• The yttrium 90 radioactive microspheres slowly emit beta radiation over a liver tumor or liver cancer over a short period of time, destroying the liver tumor or liver cancer while not affecting adjacent healthy tissues or nearby organs. Cancer cells are gradually destroyed and eventually die. The liver tumor or liver cancer gradually shrinks in size, making it easier for doctors to continue other cancer treatments for the remaining cancer in the following step.
• After finishing the treatment, the intervention radiologist will admit the patient to the hospital for 1 day to monitor any symptoms or side effects that may arise within 24 hours. After 2-3 hours of treatment, the intervention radiologist will perform a SPECT CT on the upper abdomen to confirm the presence of yttrium 90 in the liver and assess the overall physical condition. If no serious complications are detected, the patient can return home.

What does the Y-90 discharge instructions?

• Take medications as directed by the doctor to alleviate pain, inflammation, and potential side effects.
• Wash your hands thoroughly every time after use the toilets.
• Drink 1-1.5 liters of clean water every 2-3 days after treatment to help flush the radiopaque substance out of your body.
• If there are abnormal symptoms such as nausea, vomiting, fever, pain, swelling, or bruising at the needle puncture site or unable to lie supine, see the doctor right away.

What is the advantage of Y-90?

• Alternative treatment to liver surgery for those with inoperable liver cancer
• No surgery is required, no incisions, minimally invasive, less painful
• High safety, low risk, low complications
• Less tissue damage, less internal organ injuries
• Short treatment time of only 1 hour for 1-2 sessions
• No chemotherapy uses, no side effects from chemotherapy drugs
• A higher radiation dose, unlike external beam radiation
• A short hospital stays for only 24 hours
•  A short recovery period can resume normal life quickly.
• Safe for seniors, the vulnerable, and those with underlying diseases
• Timesaving, cost-effectiveness
• Improves a patient’s quality of life
• Increase survival rates and extend lifespan

What is the side effect of Y-90?

Side effects of Y-90 radioembolization for liver cancer include post-embolized syndrome, which may cause side effects such as nausea, vomiting, loss of appetite, lethargy, fatigue, low-grade fever, gastritis, and colitis. To alleviate side effects, the doctor will prescribe pain relievers, anti-inflammatory drugs, anti-nausea medications, and stomach ulcer prevention medicine to be taken at home. Within 2-3 days, symptoms shall gradually improve, and patients will be able to resume their daily activities as usual.

Y-90 radioembolization for liver cancer at MedPark Hospital

Imaging Center at MedPark Hospital, Bangkok, Thailand, led by seasoned teaching faculty radiologists including intervention radiologists, radiation oncologists, and nucleologists (nuclear medicine physicians) with extensive experience both nationally and internationally, ready to provide seamless diagnostic and therapeutic for treating complex cancers and benign-lesions with JCI standard interventions, using state-of-the-art medical technology and FDA-approved equipment, allows for targeted treatment, preserves healthy surrounding tissues and nearby organs, aids in treatment precision, safety, and efficacy, and provides follow-up and evaluation after the treatment to reduce complications, speed up recovery, and enables patients to have a good quality of life, have stronger physical health, and can live lives at their best.

FAQ

• Radioembolization vs chemoembolization
  According to the findings of a study that compared patients with hepatocellular carcinoma who were treated for liver cancer with radioembolization and chemoembolization, both methods had the same survival rate. However, the findings of this study revealed that radioembolization is more effective in inhibiting liver cancer cell division and dissemination than chemotherapy, with lower toxicity.