Y90 radioembolization involves placing radioactive capsules into the blood vessel feeding your tumor. It’s primarily used for cancer that can’t be treated with surgery or a liver transplant.

Each year, about 700,000 people worldwide receive a liver cancer diagnosis and about 600,000 people die from this type of cancer. Liver cancer tends to progress silently until it grows large or spreads. Most people with liver cancer are not eligible for potentially curative treatments such as surgery or a liver transplant.

Yttrium-90 (Y90) radioembolization, or selective internal radiotherapy, is an alternative treatment option for liver cancer that can’t be cured with typical treatments. The procedure involves placing radioactive beads into a blood vessel near your liver to block your tumor’s blood supply and destroy its cells.

Some research suggests that Y90 radioembolization may help increase the survival time of some people who have liver cancer that can’t be surgically removed.

Read on to learn more about how Y90 radioembolization is used to treat liver cancer.

Radioembolization is a combination of two techniques:

  • Radiation therapy: administering high energy waves to destroy cancer cells
  • Embolization: blocking a blood vessel that’s supplying a tumor

Researchers have been studying the effectiveness and safety of Y90 radioembolization since the 1960s. It has become a common treatment to help manage liver cancer or cancer that has spread to the liver that can’t be surgically removed.

Y90 radioembolization is a minimally invasive procedure that involves placing small glass or resin radioactive spheres into a blood vessel that’s supplying your tumor. Healthcare professionals insert the beads into your artery through a tube called a catheter.

These spheres travel through your blood vessel until they reach the tumor and emit radiation. This radiation travels a very short distance and primarily damages cancer cells while sparing healthy tissue.

Y90 radioembolization is a treatment option for people with liver cancer that can’t be treated with surgery or a liver transplant. It may also be administered to people who are awaiting a liver transplant to keep their cancer from spreading.

Compared to other treatments

Y90 radioembolization has emerged as an alternative treatment option to radiofrequency ablation and transarterial chemoembolization (TACE) for early stage liver cancer that can’t be treated with surgery.

Radiofrequency ablation is often the first treatment recommended for these tumors. It uses heat to destroy cancer cells. If radiofrequency ablation can’t be performed, the next treatment option is TACE, which involves blocking the hepatic artery and delivering chemotherapy medications.

TACE is also the standard of care for people with intermediate stage liver cancer. Y90 radioembolization is a potential alternative treatment.

Researchers are continuing to compare the effectiveness of Y90 radioembolization to that of other treatments. Clinical trials are ongoing.

SARAH trial

The 2017 phase 3 SARAH trial compared the effectiveness of Y90 radioembolization to that of the targeted therapy drug sorafenib for treating people with locally advanced or intermediate stage liver cancer after unsuccessful treatment with TACE.

The median overall survival didn’t significantly vary between groups. The group that received sorafenib had slightly higher rates of serious complications.

SIRveNIB trial

In a 2018 phase 3 clinical trial, researchers again compared Y90 radioembolization to sorafenib for people with locally advanced liver cancer.

As in the SARAH trial, overall survival didn’t significantly differ between the groups.

SORAMIC trial

In the phase 2 SORAMIC trial, researchers compared the effectiveness of sorafenib and Y90 radioembolization combined to the effectiveness of sorafenib alone.

They found that the addition of Y90 radioembolization didn’t improve overall survival. However, they did find evidence that it may improve survival in some of the subgroups they analyzed, such as:

  • people under 65
  • people without cirrhosis
  • people with non-alcohol-related cirrhosis

The survival rate for liver cancer in general is low. From 2012 to 2018, the 5-year relative survival rates in the United States were:

Stage5-year relative survival rate
localized36%
regional13%
distant3%
all stages21%

People who receive Y90 radioembolization tend to have low overall survival rates since they usually are not eligible for surgery. Studies have reported 1- and 2-year median survival rates around 80% and 65%, respectively, for people treated with Y90 radioembolization.

In the SARAH trial, half the people who received Y90 radioembolization with locally advanced or intermediate stage liver cancer after unsuccessful treatment with TACE survived at least 8 months. Half of those who received sorafenib lived for 9.9 months.

In the SIRveNIB trial, half the people with locally advanced liver cancer who received Y90 radioembolization survived 8.8 months, while those who received sorafenib survived 10 months.

A 2020 study found that the median survival was 27.2 months for people with metastatic liver-dominant neuroendocrine tumors who received Y90 radioembolization in the Canadian province of British Columbia.

Factors that influence liver cancer outlook

Factors linked to less favorable outcomes for people with liver cancer include:

Factors that have been associated with a less favorable outlook in people who received Y90 radioembolization include:

Y90 radioembolization is a liver cancer treatment option that involves injecting radioactive beads into a blood vessel that supplies the tumor. These beads release waves of energy that damage the cancer cells while leaving healthy cells largely undamaged.

Your doctor is most likely to recommend Y90 radioembolization if you have cancer that can’t be cured with surgery or a liver transplant. They may also recommend alternative treatments such as TACE or radiofrequency ablation.