Yttrium-90 Radioembolization – SIRT

Yttrium-90 Microsphere Radioembolization – Cancer Treatment

Yttrium-90 microsphere radioembolization, also known as selective internal radiation therapy (SIRT), is a non-surgical procedure to treat inoperable liver cancer and liver metastases (lesions in the liver from other cancers) in patients who cannot have the tumors surgically removed. This innovative, life-extending and palliative SIRT procedure delivers targeted, internal radiation therapy directly to the tumor. It may also be used to shrink tumors prior to surgery. We perform both the SIR-Spheres® microsphere procedure and Theraspheres®.  See a video of the procedure.

Selective internal radiation therapy beads destroying liver tumor

Selective Internal Radiation Therapy (SIRT), also known as microsphere radioembolization, is a liver-directed therapy for inoperable liver tumors. SIRT is administered by a specially trained interventional radiologist.

How does Y90 treatment extend lives?
Why use Yttrium 90 radioembolization?
What are the treatment goals?
Does yttrium 90 radioembolization have side effects?
Can radioembolization be combined with other therapies?
Are you a candidate for this procedure?
What are the risks of the procedure?
Does insurance cover Yttrium-90 microsphere radioembolization?
Where is this procedure performed?
How do I prepare?
What is the procedure? How are SIR-Spheres administered? – video
What should I expect during recovery? Are there side effects and-or complications I might expect?
Why will my tumor markers go up at first?
Are their patient support groups and related organizations?
Who are the physicians who perform this procedure?

To schedule a consultation to discuss whether yttrium-90 microsphere radioembolization is appropriate for you, call 720.493.3406 or if you are reading this in the evening, complete this short form and we will contact you.

How does Y90 treatment work?

With yttrium-90 microsphere radioembolization, a catheter is inserted through a tiny incision in the groin and threaded through the arteries until it reaches the hepatic artery. The hepatic artery is one of two blood vessels that feed the liver; it is typically the artery that supplies blood to liver tumors. Once the catheter is properly placed in the hepatic artery, thousands of tiny beads — microspheres — containing the radioactive element yttrium-90 are released into the blood stream. See video.

The yttrium-90 microspheres lodge into the smaller blood vessels that feed the tumor. In addition to preventing blood flow to the tumor, the microspheres emit radiation that destroys the cancerous cells. The radiation only penetrates approximately 1/16″ of tissue, so very little healthy liver tissue is affected by the radiation. This often results in slowing the cancer down and extending life.

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Torso with liver cancer treatment with yttrium-90

This minimally invasive procedure can slow the cancer’s progression, extend survival, reduce the size of tumors, and provide symptomatic relief.

Why use Yttrium 90 radioembolization?

Due to the targeted nature of this approach, your interventional radiologist can deliver a much more potent dose of radiation than conventional radiation therapy. The radiation in yttrium-90 continually decreases over a 2-week period, at which time the radiation is gone. The microspheres remain in the liver without causing any complications.

In most cases, the whole liver can be treated in one session. Sometimes, the right and left lobes of the liver may need to be treated separately, with one month between treatments. A trial run and mapping procedure is performed one week before the administration of the actual treatment dose to block off vessels that go outside of the liver (for example, to the stomach or lungs) and to perform a test dose to prove that the majority of the dose will remain the liver and not pass to go other organs.

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What are the treatment goals?

In general, the goals are to:

  • Slow the progression of the cancer
  • Extend survival
  • Potentially downsize or downstage tumors for a liver resection, ablation, or transplantation
  • Provide symptom relief

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Does yttrium-90 radioembolization have side effects?

SIR-Spheres

Yttrium-90 SIR-Spheres microspheres liver cancer treatment

This minimally invasive treatment has few side effects. It can be used to treat both primary and secondary liver cancer. While it won’t cure the cancer, it can shrink tumors, improve the quality of life, and often extends life for people with inoperable liver cancer and metastatic disease.

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Can radioembolization be combined with other therapies?

Radioembolization is sometimes combined with modern chemotherapy; before, after, or between chemotherapy sessions, or administered as a monotherapy (single therapy).

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Are you a candidate for this procedure?

Not everyone with inoperable liver cancer is a candidate for this procedure. If you are a candidate, your doctor may recommend this procedure over other non-surgical treatments for the following reasons:

  • Treatment is regional (only affects the liver)
  • Milder side effects
  • No or very short recovery
  • Number and size of tumors does not need to be determined for treatment to be effective
  • Treats all tumors fed by the hepatic artery, including undetected tumors
  • Results have been very promising

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After an image-guided catheter is placed, the interventional radiologist deploys the microspheres through the catheter into the hepatic artery. After all the microspheres have been deposited, the catheter will be withdrawn and the incision cleaned and closed with a device to allow instant healing.

What are the risks of the procedure?

As with any medical procedure, there are associated risks. Some of the risks for this procedure include:

  • Risk of damage to a blood vessel, bruising or bleeding at the puncture site, or infection is possible; this is because a catheter is placed within the blood vessels.
  • You could have an allergic reaction to the contrast material used during the procedure.
  • Serious side effects in the gastrointestinal tract or lungs are possible if the microspheres are not correctly placed in the liver.

These risks are uncommon and usually only occur in patients who have unusual or severely damaged blood vessels in the liver.

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Insurance

Most insurance covers Yttrium-90 microsphere radioembolization.

Yttrium-90 microsphere radioembolization has been approved for Medicare reimbursement. The procedure is covered by most private insurance carriers, and others on a case-by-case basis.. Please check with your insurance carrier.

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Where is this procedure performed?

Consultations for yttrium-90 microsphere radioembolization are done at the RIA Endovascular office. To schedule a consultation to discuss whether yttrium-90 microsphere radioembolization is appropriate for you, call 720.493.3406 or if you are reading this in the evening, complete this short form and we will contact you.

RIA Endovascular interventional radiologists perform this procedure at five of its partner hospitals in the Denver, CO area.Nurse with Hospital Outpatient

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Preparation

How do I prepare for a Yttrium-90 Microsphere Radioembolization procedure?

Following are the general preparation guidelines for yttrium-90 microsphere radioembolization. You may receive additional or differing guidelines based on your specific situation. Please contact us at 720-493-3406 if you have any questions.

    • Stop taking blood-thinning medications 3-5 days before the procedure (contact your doctor first to ensure it’s safe).
    • Do not eat or drink anything except clear liquids for 8 hours before the procedure; do not drink anything for 4 hours before the procedure.
    • Do take your regular medications with sips of water the morning of the procedure especially blood pressure medicines.
    • Make appropriate plans to restrict close physical contact with children immediately after the procedure.

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What you should let your doctor know about before the procedure?

In advance of your exam, let your radiologist or technologist know if any of the following circumstances apply to you:

  • Previous reaction to iodine, x-ray, or CT contrast
  • Previous reaction to anesthesia
  • Coagulation disorder
  • Currently pregnant or nursing

What should you expect before the procedure?

Before scheduling the procedure, an interventional radiologist must determine if you are a good candidate for yttrium-90 microsphere radioembolization. You will need to supply RIA Endovascular with numerous medical records and test results so your eligibility can be determined.

Mapping procedure – If you appear to be a candidate, you will undergo additional exams including a blood test and a CT scan. A mapping procedure, much like the actual procedure, will be performed. These exams will help the interventional radiologist confirm your eligibility for the yttrium-90 microsphere radioembolization and determine an appropriate radiation dose for your liver. If your eligibility is confirmed and you decide to have the procedure, you must also have an angiogram 7-10 days before the procedure date.

Why will my tumor markers go up at first?

After such treatments, one would expect the signs of a tumor, as indicated by the tumor markers, to go down.  Yet, they go up at first. Dr. Peter Stratil explains in this video.

The Yttrium-90 Microsphere Radioembolization Procedure

When you come in for the procedure, you will be asked to change into a gown. After answering any questions you have, a nurse will start an intravenous (IV) line in your arm and your heart rate and blood pressure will be monitored throughout the procedure. You will remain awake for the procedure, but you will be given conscious sedation through the IV to help you relax. The procedure is essentially painless. See a video of the procedure.

Illustration of catheter in hephatic artery dispensing microspheres

Angiographic procedure for delivering microspheres

The site of the groin incision will be cleansed. A fluoroscope will be moved into position above your abdomen. The intervention radiologist will then make the incision and insert the catheter. While watching the fluoroscope images, he or she will carefully guide the catheter to the hepatic artery in the liver.

After the catheter is properly placed, the interventional radiologist will deploy the microspheres through the catheter and into the hepatic artery. After all the microspheres have been deposited, the catheter will be withdrawn and the incision cleaned and closed with a device to allow instant healing.

This procedure is generally painless; however, some patients experience pain when the microspheres are deployed. Let the doctor know immediately if you feel any pain.

The procedure takes 30 to 90 minutes to complete. You will then spend 2-6 hours in the recovery area. Most patients go home the same day of the procedure, rarely a patient may require an overnight stay for observation.

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After the Procedure

illustration of tumor treated with SIRS Spheres

After an image-guided catheter is placed, the interventional radiologist deploys the microspheres through the catheter into the hepatic artery. After the microspheres have been deposited, the catheter is withdrawn.

What to Expect During Your Recovery

Most patients return to their normal activities after leaving the hospital. All patients will experience fatigue for 1-4 weeks following the therapeutic injection. Some patients also experience a low-grade fever, nausea, vomiting, loss of appetite, and-or abdominal pain after the procedure. These side effects usually subside within 3-5 days and some may be alleviated with medication. If side effects last more than 7-10 days, inform your doctor.

There are certain precautions you should take for one week after your treatment for the safety of your family and other people. Do not use public transportation that will require you to sit next to another person for more than two hours. Do not sleep in the same bed as your partner. Avoid close contact with pregnant women and children. For the first three days, maintain a six-foot distance from other adults if contact will last for more than a few minutes.

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Why will my tumor markers go up at first?

 

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Follow-Up

Every three months after therapy, a CT scan, MRI or PET scan will be performed. One promising treatment for patients with inoperable metastatic liver cancer is a procedure known as Selective Internal Radiation Therapy (SIRT). SIRT involves the introduction of yttrium-90 containing SIR-Spheres microspheres into the liver via a catheter. Treatment is administered on an outpatient basis, and side effects are generally fewer than with alternative treatments.

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Patient Support Groups & Organizations

Support groups such as Yes! Beat Liver Tumors can be a helpful resource for both patients and caregivers, offering patient advocacy as well as encouragement, tools, and resources for patients and families. While not intended a substitute for medical care, these groups can provide information and support.

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Renown. Trusted. Minimally Invasive.

Dr, Charles Nutting

Drs. Nutting, Spencer, Stratil and Grande are interventional radiologists at RIA Endovascular who regularly perform yttrium-90 radioembolization procedures for patients with liver cancer.

At RIA Endovascular, four physicians currently perform the SIR-SPHERES® procedure. They are:

Dr. Charles Nutting was the first physician to perform the procedure in North America, and currently is a proctor world-wide teaching the procedure. His partner, Brooke Spencer, MD, started a cancer program in Arizona; after 6 years, Dr. Spencer joined Dr. Nutting in their state-of-the-art interventional oncology cancer practice, where she has built the program at Littleton Adventist Hospital as well. Other programs are in the planning as well. Today, Peter Stratil, MD and William Grande MD are also part of the RIA Endovascular team performing this innovative liver cancer procedure on a regular basis.

LEARN MORE. CONTACT RIA ENDOVASCULAR NOW.

To schedule a consultation to discuss whether yttrium-90 microsphere radioembolization is appropriate for you, call 720.493.3406 or if you are reading this after hours, complete this short form and we will contact you.

720.493.3406

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Please note:  The information presented here is not intended as a substitute for medical care. Please talk with your healthcare provider about this and other procedures.

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