What Is Radioembolization and How Does It Work?
Radioembolization, also known as selective internal radiation therapy (SIRT), is an image-guided interventional treatment that delivers high-dose radiation directly to tumors within the liver. Instead of relying on external beams, radioembolization uses tiny microspheres—each about one-third the diameter of a grain of sand—loaded with the radioactive isotope yttrium-90 (Y-90). During the procedure, an interventional radiologist threads a catheter through the femoral or radial artery and navigates it into the hepatic artery branches that specifically supply blood to the tumor. Once in position, the Y-90–labeled microspheres are injected, lodging preferentially in the tumor’s microvasculature, where they emit beta radiation over one to two weeks. This targeted delivery maximizes tumor cell kill while sparing healthy liver tissue, because normal liver parenchyma receives most of its blood supply from the portal vein rather than the hepatic artery. Over time, the tumor shrinks as radiation induces DNA damage, cell death, and vascular thrombosis within the lesion. By combining advanced angiographic mapping with personalized dosimetry, we optimize radiation doses to achieve maximal efficacy with minimal side effects. We coordinate every detail—from pre‐treatment planning through follow‐up imaging—to ensure you receive the full potential of this cutting‐edge therapy. Contact us to learn how we can integrate radioembolization into your comprehensive cancer care plan and get a personalized cost estimate today.
Who Is a Good Candidate for Yttrium-90 Radioembolization?
Ideal candidates for Y-90 radioembolization include patients with primary liver cancers—such as hepatocellular carcinoma (HCC)—and those with metastatic liver tumors, particularly from colorectal, neuroendocrine, or breast primaries. Candidates often share the following characteristics: unresectable disease confined predominantly to the liver, preserved liver function (Child-Pugh A or early B), adequate performance status (ECOG 0–2), and a lack of significant portal vein thrombosis or extrahepatic disease that would compromise overall outcomes. Patients who have progressed on or cannot tolerate systemic chemotherapy may also benefit from the liver-directed nature of radioembolization. Prior to treatment, we conduct comprehensive angiographic mapping—including Technetium-99m macroaggregated albumin (Tc-99m MAA) scans—to assess microsphere distribution, calculate lung shunt fractions, and rule out shunting to the gastrointestinal tract or lungs. Multidisciplinary tumor boards involving hepatologists, surgical oncologists, interventional radiologists, and radiation oncologists review each case to confirm candidacy and formulate a personalized treatment schedule. If you or a loved one meet these criteria and seek a liver-directed option with the potential to downsize tumors for resection or bridge to transplantation, reach out to our specialists for a detailed evaluation and get a quote for radioembolization therapy.
Which Cancers Can Be Treated with Radioembolization?
Radioembolization targets a spectrum of hepatic malignancies. In primary liver cancer, particularly intermediate- to advanced-stage hepatocellular carcinoma (BCLC stages B and C), Y-90 offers meaningful tumor control, improved progression-free survival, and, in some series, a survival advantage over transarterial chemoembolization (TACE). For metastatic disease, colorectal cancer metastases are the most common indication; randomized studies demonstrate that adding Y-90 to salvage chemotherapy regimens extends hepatic progression-free intervals. Neuroendocrine tumor metastases also respond favorably to radioembolization, with high rates of symptomatic relief and radiographic response. Breast cancer liver metastases, especially in patients who have exhausted systemic options, achieve partial responses and maintain quality of life after Y-90 treatment. Off-label uses include cholangiocarcinoma and melanoma metastases to the liver. Each tumor type exhibits unique vascularity and radiosensitivity, which we assess through pre-procedural imaging and dosimetry models. By tailoring particle activity and distribution to your tumor’s characteristics, we deliver a personalized approach that harnesses the full potential of radioembolization against diverse hepatic cancers—get in touch to discover how we can apply this therapy to your diagnosis and request our comprehensive pricing package.
How Is a Radioembolization Procedure Performed Step by Step?
The radioembolization journey unfolds over several carefully choreographed stages. First, you undergo angiographic mapping: under local anesthesia and conscious sedation, an interventional radiologist places a catheter via the femoral (or radial) artery and selectively injects contrast into the hepatic arterial branches to delineate your liver’s vascular anatomy. During the same session, we administer Tc-99m MAA particles and perform SPECT imaging to simulate the microsphere distribution, measure lung shunt fraction, and rule out extrahepatic deposition. Based on these data, personalized dosimetry calculations estimate the Y-90 activity needed to deliver therapeutic radiation doses to tumors while protecting normal liver and lung tissue.
One to two weeks later, you return for the treatment session. Under similar sedation, we re-access the target hepatic artery, confirm catheter position with contrast angiography, and slowly infuse the Y-90–loaded microspheres over 10–20 minutes, monitoring for vasospasm or non-target flow. Post-infusion angiography verifies that no residual microspheres remain. The catheter is withdrawn, and hemostasis is achieved with closure devices or manual compression. You spend several hours in a recovery area, where nurses monitor your vital signs, manage discomfort with mild analgesics, and counsel you on radiation safety measures—such as avoiding close contact with pregnant women or infants for 48–72 hours. Most patients go home the same day or after one night’s observation. We schedule follow-up visits at one month and three months to assess tumor response via MRI or CT and evaluate liver function tests, ensuring that radioembolization delivers durable benefits with minimal disruption to your life.
What Are the Risks and Side Effects of Radioembolization?
While radioembolization precisely targets tumor tissue, some side effects and risks merit consideration. The most common acute effect is post‐radioembolization syndrome, characterized by low-grade fever, fatigue, nausea, and abdominal discomfort, which peaks within the first week and resolves within two weeks under symptomatic management. Transient elevations in liver enzymes and bilirubin occur in up to 30 percent of patients, reflecting radiation exposure to non‐tumor liver, but these usually return to baseline within one month. Rare but serious complications include radiation-induced liver disease (RILD), presenting as ascites, jaundice, or hepatic necrosis; we mitigate this risk by careful dosimetry and ensuring adequate baseline liver function. Non-target embolization to the stomach or duodenum can cause gastritis or ulcers; preventive coil-embolization of gastroduodenal branches during mapping virtually eliminates this complication. Radiation pneumonitis is prevented by excluding patients with lung shunt fractions above 20 percent of the injected dose. Vascular complications such as arterial dissection or thrombosis are uncommon when experienced operators and meticulous technique are employed. Our interventional teams and hepatology colleagues closely monitor for these events, providing prompt supportive care or interventions—such as endoscopic treatment for GI ulcers or diuretics for RILD—to ensure your safety throughout the radioembolization process.
How Long Does Recovery Take After Radioembolization?
Recovery from radioembolization balances rapid turnaround with vigilant follow-up. Most patients are discharged within 24 hours after the treatment session once vital signs stabilize and immediate side effects subside. You may experience mild fatigue and discomfort for one to two weeks; we provide a comprehensive symptom management plan that includes antiemetics, analgesics, and hydration guidance. A gradual return to normal activities—light exercise and work—can begin after three to five days, while more strenuous tasks resume by two weeks. Dietary recommendations support liver health, emphasizing high-protein, low-sodium meals to manage any fluid retention. We schedule lab checks at one week and one month to monitor liver function and blood counts, and imaging at one and three months to evaluate tumor response. Many patients report minimal disruption to their quality of life and appreciate the outpatient nature of radioembolization compared to major surgery. Our patient navigators remain available for ongoing support, ensuring that your recovery is as smooth and efficient as possible—get in touch to receive your personalized post‐radioembolization care plan and cost information.
How Effective Is Radioembolization for Liver Metastases?
Radioembolization has emerged as a highly effective liver-directed therapy for patients with unresectable liver metastases, particularly those originating from colorectal, neuroendocrine, and breast primaries. Multiple clinical studies report objective response rates—measured by tumor shrinkage or necrosis on follow-up imaging—ranging from 50 to 80 percent, with median hepatic progression-free survival extending beyond 9 to 12 months in many series. Patients often experience significant reductions in tumor burden, translating into relief of pain, improved liver function tests, and enhanced quality of life. When combined with careful patient selection—favoring those with limited extrahepatic disease and preserved portal vein patency—radioembolization can downstage metastases, rendering some patients eligible for subsequent surgical resection or ablation.
Our interventional oncology team employs personalized dosimetry models that tailor the yttrium-90 activity to both tumor volume and normal liver tolerance, optimizing the balance between efficacy and safety—we provide expert mapping and dose calculation to maximize your outcome. By integrating radioembolization into a multidisciplinary treatment plan, many of our patients achieve durable local control that complements systemic therapies, giving you the best chance at extended survival and symptom relief.
Can Radioembolization Be Combined with Chemotherapy?
Combining radioembolization with chemotherapy is a powerful strategy to attack liver metastases on multiple fronts. In colorectal cancer liver metastases, sequential or concurrent administration of systemic regimens—such as FOLFOX or FOLFIRI—alongside Y-90 radioembolization has been shown to prolong overall and hepatic progression-free survival compared to chemotherapy alone. The radiation’s local cytotoxic effect synergizes with chemotherapeutic agents, which not only target micrometastatic disease elsewhere in the body but may also sensitize tumor cells to radiation damage.
We coordinate treatment schedules closely with medical oncology—we organize multidisciplinary case reviews to determine the optimal timing, whether that means administering chemotherapy cycles before radioembolization to shrink tumors, or delivering radioembolization mid-cycle to maintain systemic therapy momentum. Proactively managing overlapping toxicities—such as transient neutropenia or hepatotoxicity—ensures you can receive both modalities safely. This integrated approach has delivered superior outcomes in several trials, making combined radioembolization and chemotherapy a cornerstone of modern metastatic liver cancer care.
What Preparations Are Needed Before Your Radioembolization?
Successful radioembolization begins long before the treatment day, with meticulous pre-procedure planning to ensure safety and precision. Key preparatory steps include:
Diagnostic Angiography and Mapping: We perform an initial angiogram to detail your hepatic arterial anatomy, identify variant vessels, and embolize any branches—such as the gastroduodenal or right gastric arteries—that could carry microspheres to non-target organs.
Lung Shunt Assessment: A Technetium-99m macroaggregated albumin (Tc-99m MAA) scan quantifies the fraction of particles shunting to the lungs; if this exceeds 20 percent, radioembolization may need dose adjustment or alternative therapy.
Laboratory Evaluation: Comprehensive blood tests—including complete blood count, liver and renal panels, and coagulation studies—confirm that your organ function can tolerate the procedure. Any abnormalities are optimized with supportive treatments beforehand.
Medication Review: We review all medications, advising temporary discontinuation of anticoagulants or antiplatelets under close supervision to reduce bleeding risk, while ensuring essential therapies—such as antivirals or immunosuppressants—are managed appropriately.
Patient Education and Consent: Our nurse navigators provide detailed information on what to expect— from mild post-embolization syndrome symptoms to radiation safety precautions— and answer all your questions, ensuring informed consent and peace of mind.