How Does Y-90 Treat Liver Cancer?

Imagine millions of tiny glass beads – each thinner than a strand of hair – ready to put up a fight against liver cancer. Each bead delivers a highly concentrated dose of radiation targeting solitary tumors in the liver tumors. The beads destroy the liver cancer cells and help keep your healthy liver tissue unharmed.

Franciscan Health offers an FDA-approved, minimally invasive therapy called selective internal radiation therapy, also called Y-90, which targets HCC and other liver tumors with localized, high doses of radiation.

“Sometimes patients present with a tumor that's too large to undergo surgical removal or transplant. And they don't meet that criteria,” said Carl Valentin, MD, a board-certified radiologist and independent physician who chooses to practice at Franciscan Health Munster. “Y-90 can be a treatment that shrinks the tumor size such that the patient isn't cured by that, but they then become a candidate for other therapies such as surgery and transplant, which may be curative.”

What Is Y-90 For Liver Cancer Treatment?

Y-90 radioembolization for liver cancer, or Yttrium-90, is an outpatient procedure targeting certain liver cancers or other metastasized cancers in the liver. Y-90 refers to the radioactive isotope yttrium-90 that is injected into the tumor of the liver.

Yttrium is a radioactive therapy. Instead of being targeted from outside of the body, it's targeted from inside the tumor through direct catheterization of the arteries.

“It's an evolution of techniques that have been developing for 30 or 40 years, since we developed the ability to get a small catheter into a small blood vessel and target what we put into that blood vessel,” Dr. Valentin said. “Yttrium-90 is just one step beyond that in terms of technology and efficacy. The radioactivity is a type that travels very small distances within the body, usually only a millimeter or two. But when directly injected into tumors in the liver, that very small distance multiplied by hundreds of thousands of particles, emits enough radiation to kill the liver tumors. The radiation, however, to the rest of your body is very minimal or almost nothing.”

Am I A Candidate For Y-90 Therapy?

People with liver cancer should discuss with their oncologist or their hepatologist whether Y-90 therapy is appropriate as part of their treatment plan. Patients with other cancers metastasized to the liver may also benefit from this therapy.

“The goal, of course, is to assess and address each patient's individual needs and see what their risks and benefits are, potentially of undergoing this therapy or any therapy,“ Dr. Valentin said.

Your liver cancer treatment could consist of a combination of interventions, including:

• Surgery
• Drug therapy
• Immunotherapy
• Chemotherapy
• Ablation
• Embolization
• Radioembolization.

How Long Does Y-90 Take?

The Y-90 therapy is done as an outpatient procedure that takes about two hours.

“You undergo an arterial catheterization or an angiogram in which the particles are injected. And then you typically go home the same day,” Dr. Valentin said. “So that's a relatively quick procedure.

“Typically, the liver will be divided in roughly two. We'll treat half of the liver, make sure the patient recovers from that, and about a month to six or eight weeks later, come back and do the procedure again on the other half of the liver.

How Long Is Recovery From Y-90?

“The recovery period is relatively short because of the arterial access in your leg,” Dr. Valentin said. “You have to lie flat for a couple hours. And you may feel a little bit ill for a couple of weeks as the efficacy of the tumor death and the tumor in the liver takes place, but generally it's a well-tolerated procedure.”

Some patients have a feeling similar to a bad cold or a flu after the procedure. “That's actually due to something called tumor necrosis factor,” Dr. Valentin said. “As the tumor cells die, the tumor cells release chemicals into the bloodstream that create that sense of illness. Nonetheless you do feel ill for a couple of weeks afterwards. After a couple of weeks, most patients return to their baseline overall sense of wellness.”

What Are The Risks Of Y-90 Radiotherapy?

“All therapies have risks, and they have some side effects,” Dr. Valentin said. “The actual procedural risks are relatively small, approximately 1 percent risk of complications related to the angiogram, and recovery and sedation and anesthesia if anesthesia is needed.”

Other risks of the procedure include chronic inflammation of the liver.

How Effective Is Y-90 Treatment?

“It's used in different clinical scenarios. The first scenario can be curative. If there's a localized liver tumor, the patient may not be a candidate for surgery or transplant. It's possible to have complete tumor death in that area without recurrence. So that's one of the great scenarios.

“The second setting in efficacy is that you can bridge them to other therapies. They may not be a candidate for transplant or surgery, but by shrinking the tumor, they then become a candidate, and then they can go on to a curative surgery. The next category of patients are people with advanced metastatic disease; in which cure is not typically the goal. The goal is to manage the chronic disease, keep it at bay as long as possible and maintain as healthy a life and satisfaction with your abilities in life as long as possible. So in those patients, it can vary greatly depending on patient selection and the disease process.

“But, the overall efficacy in prolonging length of life in patients with metastatic disease can be months to over a year on average.”

This Y-90 treatment is offered at Franciscan Health Indianapolis, Lafayette, Olympia Fields and Munster.