When facing a liver cancer diagnosis, patients often assume that surgery is the only path forward. But advances in interventional radiology have opened the door to highly effective, minimally invasive alternatives that can target tumors directly — without the risks and recovery time associated with traditional surgery.
Y90 radioembolization, also known as selective internal radiation therapy (SIRT), is one of the most promising treatments available for patients with primary liver cancer (hepatocellular carcinoma) or liver metastases from other cancers such as colorectal, breast, or neuroendocrine tumors.
What Is Y90 Radioembolization?
Y90 radioembolization is a catheter-based procedure performed by an interventional radiologist. The treatment involves delivering millions of tiny radioactive microspheres — each smaller than the width of a human hair — directly into the blood vessels that feed liver tumors.
These microspheres contain yttrium-90 (Y-90), a radioactive isotope that emits high-energy beta radiation. Once lodged in the tumor’s blood supply, the microspheres deliver targeted radiation directly to the cancer cells while sparing the surrounding healthy liver tissue. The radiation has an effective range of only about 2.5 millimeters, making it remarkably precise.
How the Procedure Works
The Y90 radioembolization process typically involves two separate procedures, spaced one to two weeks apart.
Step 1: The Mapping Procedure
During the first visit, an interventional radiologist performs a detailed angiogram of the liver’s blood supply. A small catheter is inserted through a tiny incision in the groin or wrist and guided to the hepatic artery using real-time fluoroscopic imaging. A special tracer is injected to map exactly where the microspheres will travel, ensuring they reach the tumor and do not inadvertently flow to other organs such as the lungs, stomach, or intestines.
This mapping step is critical for safety and precision. It allows the interventional radiology team to plan the exact dose and delivery route for the treatment.
Step 2: The Treatment Procedure
During the second visit, the actual Y90 microspheres are delivered through the same catheter route identified during mapping. The procedure typically takes one to two hours and is performed under conscious sedation. Most patients experience minimal discomfort during the treatment itself.
Once the microspheres are in place, they continue to deliver radiation to the tumor for approximately two weeks, with most of the therapeutic dose delivered within the first few days. The microspheres remain permanently lodged in the blood vessels but become inactive after their radioactive component decays.
Who Is a Candidate for Y90 Radioembolization?
Y90 radioembolization may be recommended for patients with liver tumors who are not candidates for surgical resection or liver transplant. Common scenarios include:
- Hepatocellular carcinoma (HCC) — the most common form of primary liver cancer, particularly in patients with underlying cirrhosis
- Colorectal liver metastases — cancer that has spread to the liver from the colon or rectum
- Neuroendocrine tumor metastases — slow-growing tumors that have metastasized to the liver
- Cholangiocarcinoma — bile duct cancer involving the liver
- Other metastatic liver disease — including metastases from breast, pancreatic, or melanoma primaries
Candidates are evaluated through a multidisciplinary tumor board involving interventional radiologists, oncologists, hepatologists, and surgeons to determine the best treatment approach for each individual case.
Benefits Over Traditional Treatment Options
Y90 radioembolization offers several advantages compared to other liver cancer treatments:
Minimally invasive. The procedure requires only a small catheter insertion point — no surgical incisions, no general anesthesia, and no extended hospital stays. Most patients go home the same day or after one night of observation.
Targeted therapy. Unlike external beam radiation, which must pass through healthy tissue to reach the tumor, Y90 delivers radiation directly to the cancer from within the blood vessels. This allows for much higher radiation doses to the tumor while minimizing damage to normal liver tissue.
Preservation of liver function. Because the radiation is so precisely targeted, Y90 radioembolization preserves more healthy liver tissue than many other approaches. This is particularly important for patients with cirrhosis or limited liver reserve.
Fewer side effects. Compared to systemic chemotherapy, Y90 radioembolization typically causes fewer systemic side effects such as nausea, hair loss, or immune suppression. The most common side effect is fatigue, which usually resolves within one to two weeks.
Can be combined with other treatments. Y90 can be used alongside systemic therapies, immunotherapy, or other locoregional treatments as part of a comprehensive cancer care plan.
What to Expect During Recovery
Recovery from Y90 radioembolization is typically straightforward. Most patients experience mild fatigue for one to two weeks after the procedure. Some patients may have mild abdominal discomfort, low-grade fever, or decreased appetite during this period.
Patients can usually return to normal activities within a few days. Follow-up imaging — typically a CT scan or MRI — is performed approximately four to six weeks after treatment to assess the tumor response. In some cases, additional Y90 treatments may be recommended to target remaining or newly identified tumors.
The Role of Interventional Radiology in Cancer Care
Interventional radiology has transformed the landscape of cancer treatment. Procedures like Y90 radioembolization, tumor ablation, and chemoembolization allow specially trained physicians to treat tumors through tiny incisions using image guidance — delivering powerful therapies directly where they are needed most.
At Fabio Komlos, MD, our interventional radiology practice specializes in minimally invasive cancer treatments including Y90 radioembolization, radiofrequency ablation, microwave ablation, cryoablation, and chemoembolization. Each treatment plan is developed in collaboration with the patient’s oncology team to ensure the best possible outcomes.
Take the Next Step
If you or a loved one has been diagnosed with liver cancer or liver metastases, Y90 radioembolization may be a treatment option worth exploring. Understanding all available options — including minimally invasive approaches — empowers you to make informed decisions about your care.
Contact Fabio Komlos, MD at (650) 404-8445 to schedule a consultation and learn whether Y90 radioembolization is right for you. Our Mountain View, California office serves patients throughout the Bay Area and beyond.
