A minimally invasive procedure, radioembolization is a treatment for liver cancer that uses embolization and radiation therapy. The procedure closes off blood vessels and malformations within them to stop blood flow to the growth.
What Is Radioembolization?
As one part of radioembolization, radiation therapy utilizes ionizing radiation to kill cancer cells and reduce the size of tumors. To do this, a radioactive material is placed directly inside the body. Compared to options like the external beam therapy (EBT), radioembolization is an internal procedure.
For this to occur, millions of small glass or resin beads containing radioactive isotope yttrium Y-90 go inside the blood vessels that feed into a tumor. The spheres travel to the tumor site and, in the process, block off the blood supply feeding the cancer cells. At the same time, Y-90 targets the tumor with a high dose of radiation but does not affect the surrounding normal tissue.
Radioembolization involves X-ray imaging to guide the procedure, a catheter and the microspheres. The patient will lie down on a radiographic table while above, one or two X-ray tubes and a detector take images. Fluoroscopy converts the X-rays into video images, which are displayed on a monitor in the exam room. The patient may also be hooked up to an IV, ultrasound machine and devices to monitor heart rate and blood pressure.
Contrast material helps with visualizing the blood vessels. When one is identified, the interventional radiologist will make an incision for the catheter, which passes through the skin, along the vessel and toward the tumor. Once the catheter is in the ideal position, roughly half a teaspoon of microspheres is delivered toward the catheter, where they will pass through the blood vessel.
In terms of the liver, the radiologist will typically target the hepatic artery and its branches, which are responsible for its blood flow and often the source feeding a tumor. Closing in on this area allows the radioactive microspheres to travel directly to the tumor without damaging surrounding healthy tissue.
After delivery, the radiation gradually declines within two weeks after the procedure and is completely gone after 30 days. However, the physical spheres will remain in the liver, where they are designed to not pose any health issues.
Who Should Have This Procedure?
Doctors recommend radioembolization to treat tumors that initially formed in the liver or have metastasized and spread to other parts of the body. Yet radioembolization is not designed as a cure; it slows down the tumor’s growth and works to prevent cancer from spreading throughout the body.
Generally, radioembolization is considered for patients who are not candidates for surgery or liver transplants or have an inoperable tumor. Reducing the tumor’s growth may improve quality of life.
Beyond this benefit, radioembolization helps to extend the lives of patients in these circumstances and may, at a later date, allow for surgery or a liver transplant. The procedure also has fewer side effects compared to standard radiation therapy while allowing for a higher, more targeted dosage of radiation. In recovery, the incision for the catheter is small enough that stitches are not required.
Roughly 70 to 95 percent of all patients experience improvement, in terms of survival rates and reduced symptoms. Beyond the liver, radioembolization can help to reduce colorectal metastases and neuroendocrine tumors.
In spite of these benefits, radioembolization has a few risks patients should be aware of:
- Infection at the incision site requiring antibiotics.
- Allergic reaction to the contrast material.
- Damage to the blood vessel, infection, bruising or bleeding at the incision site from the catheter.
- The microspheres may be delivered to the wrong place, which carries the risk of ulcers in the stomach or duodenum.
Due to these risks, radioembolization is not recommended for patients with:
- Severe liver or kidney dysfunction
- Abnormal blood clotting
- Blocked bile ducts
For certain patients, radioembolization may need to be done in smaller doses over several procedure to reduce its effect on the liver.
Radioembolization is performed on an outpatient basis in an interventional radiology suite or operating room. Some patients may need to be admitted following the procedure.
Patients are advised to tell their doctor if they are or think they are pregnant and should discuss any recent illnesses, medical conditions, allergies and medications or supplements they currently use.
Your doctor may recommend you stop using NSAIDs and blood thinners several days before the procedure. Patients may need to undergo an angiogram seven to 10 days before to help identify all blood vessels feeding the tumor. A blood test may also be needed to determine how well your kidneys are functioning and if your blood clots properly.
Patients should also make a plan for returning home, including a pick-up person, and must avoid contact with adults and children for three to seven days following.
To prepare, your doctor may recommend you temporarily change your medication schedule and provide instructions for what you can eat and drink before the procedure. Patients should avoid wearing jewelry and other metal objects on the day of the procedure and arrive in loose, comfortable clothing.
On the day of the procedure, an arteriogram will first be performed for a more comprehensive view of the upper abdominal arteries. Then, arteries pointing to the stomach and duodenum will be closed with small wire coils. You may also be given medications to reduce nausea, pain and infection.
As the procedure begins, you will be lie back and have monitors for your heart rate, pulse and oxygen level attached. You may also be given a sedative via IV; certain patients may require general anesthesia. Contrast material may also be injected:
- Then, the area where the catheter will be inserted is sterilized and covered with a surgical drape. Patients report numbness and tingling, although this sensation quickly disappears.
- A small incision is made in this area. Via imaging guidance, the catheter is inserted into the femoral artery in the groin and will pass through the body until it gets close to the treatment site. The catheter will go through the hepatic artery. Patients may feel pressure as this occurs.
- In this position, the microspheres with Y-90 radiation will be injected into the catheter. Some patients feel a degree of pain when this happens, but the sensation should disappear within six to eight hours. If it doesn’t, an ulcer may have developed in the stomach or duodenum.
- After, the catheter is removed and the radiologist or technologist will apply pressure to the area to stop any bleeding. A closure device to seal a small hole made in the artery will be used. Then, a dressing will cover the incision.
- Your IV line will also be taken out before you go home.
- Patients remain in the recovery room until they are fully awake.
After the procedure, patients may experience post-embolization syndrome, a side effect characterized by nausea, vomiting and fever. Patients may have other side effects like pain, due to the microspheres cutting off the blood supply. Medication helps ease these symptoms and they generally disappear within three to five days. If they persist for seven to 10 days or longer, contact your doctor.
Patients may have a low-grade fever with lethargy and fatigue for a week after radioembolization. However, within a couple of days following the procedure, you should be able to return to your normal activities within reason.
As you recover, reduce contact with other people, especially for the first week. Avoid sleeping in the same bed as your partner, using public transportation and interacting with children and pregnant women.
Following the procedure, you may undergo a CT scan or MRI every three months to assess the size of the tumor. Other follow-up visits, for imaging and blood work may be needed. Be prepared to discuss any side effects with your doctor.
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