New procedure offered for liver cancer patients
A new procedure referred to as “Y90” provides liver cancer patients an alternative treatment option. This selective internal radiation therapy (SIRT) transports a high dose of radiation while avoiding many side effects.
What is the Y90 procedure?
Yttrium-90 Microsphere Radioembolization, commonly referred to as Y90 or SIRT, involves both radiation therapy and a procedure called embolization to treat liver cancer. Radiation therapy uses a particular kind of energy, called ionizing radiation, which works to kill cancer cells and shrink tumors. Embolization is a treatment that blocks off and prevents blood flow to blood vessels. When combining these, radioembolization places microspheres inside blood vessels that feed a tumor in order to block the supply of blood to the cancer cells.
Why would you need to have it done?
Radioembolization is used to treat tumors that either began in the liver or have spread to the liver from another part of the body. This treatment does not provide a cure but helps slow down the growth of the disease, giving the patient a chance to extend their life. Radioembolization, or Y90, is also helpful in alleviating symptoms and is a good option for patients who are not candidates for other treatments, such as surgery or liver transplantation.
How does the procedure work?
The Y90 procedure uses x-ray imaging along with a contrast material to visualize blood vessels. As a result, a radiologist can insert a catheter through the skin into a blood vessel to advance it to the treatment site. From there, the radiation-filled microspheres are sent through the catheter and onto the blood vessels to supply the tumor with blood. When the microspheres have arrived to the site of the tumor, they distribute radiation directly to the cancer cells, without affecting other parts of the body. From here, the microspheres block the flow of blood to the tumor, which leaves the diseases cells without the oxygen and nutrients needed to grow.
How is the procedure performed?
This procedure is typically done on an outpatient basis. However, some patients may require admission following the procedure.
To begin, the patient will be positioned on their back while being connected to monitors to track heart rate, blood pressure and pulse throughout the procedure.
From here, a nurse or technologist will insert an IV in order for moderate sedation to be used, although general anesthesia is an alternative option.
There will be a small skin incision at the area of the body where the catheter is to be inserted and the physician will numb the area with a local anesthetic.
The catheter is then maneuvered to the treatment site and once it is situated, the microspheres are injected through the catheter to the site.
This Y90 procedure is usually completed within an hour.
What are the benefits and risks?
Benefits:
The microspheres may shrink patients’ liver tumors more than chemotherapy alone, which can lead to improving their quality of life and may increase life expectancy.
Radioembolization has fewer side effects compared to standard radiation therapy.
No surgical incision is necessary, only a small nick in the skin that does not have to be stitched closed.
Risks:
The chance of infection where the skin is penetrated.
There is also a very slight risk of an allergic reaction if contrast material is injected.
Like any other procedure that involves placement of a catheter inside a blood vessel, there is a risk that blood vessels will be damaged.
Although this only happens in approximately two percent of patients, there is a risk that microspheres will settle in the wrong place, putting the patient at risk for an ulcer in the stomach.
Jamison L. Wilson, MD, is a physician with IU Health Physicians, specializing in interventional radiology with a special interest in minimally invasive treatments of liver and kidney cancers in our community. Wilson has medical privileges at IU Health Ball Memorial Hospital. For more information, call 765-747-3049 or go to iuhealth.org/ball-memorial.