From the Guidelines
Y90 radioembolization is a recommended treatment for hepatocellular carcinoma (HCC) patients, particularly those with intermediate to advanced disease, as it has been shown to improve survival rates and quality of life compared to other treatments. According to the 2022 KLCA-NCC Korea practice guidelines for the management of HCC 1, Y90 radioembolization involves the injection of implantable radioactive microspheres into tumor-feeding arteries to expose the tumor to highly concentrated radiation while protecting the normal parenchyma. The microspheres available for 90Y infusion are 20–60 μm in diameter and are made of resin or glass.
Some key points to consider when using Y90 for HCC include:
- The importance of preprocedural angiography and 99mTc-labeled macroaggregated albumin scans to determine the treatment site, radiation dose, and the degree of shunting to the lungs and any other extrahepatic organs 1
- The potential for improved outcomes with higher radiation doses, with some studies showing complete remission rates of up to 84% and 3-year survival rates of up to 86.6% when using higher doses 1
- The relatively low risk of side effects, with temporary fatigue being the most common, and the potential for fewer side effects and better quality of life compared to other treatments like TACE 1
- The importance of selecting appropriate patients for Y90 radioembolization, with further studies needed to compare this treatment to other options and to determine the best candidates for this therapy 1
Overall, Y90 radioembolization is a valuable treatment option for HCC patients, offering the potential for improved survival rates and quality of life with relatively low risk of side effects. The use of higher radiation doses and careful patient selection are key factors in optimizing outcomes with this treatment.
From the Research
Y90 for Hepatocellular Carcinoma
- Y90 radioembolization is a treatment option for patients with unresectable hepatocellular carcinoma (HCC) 2, 3, 4.
- The treatment involves the delivery of Yttrium-90 microspheres directly to the tumor through the bloodstream, resulting in radiation-induced tumor necrosis 2.
- Studies have shown that Y90 radioembolization is a safe and well-tolerated procedure, with clinical benefits including complete response, partial response, and stable disease 2, 3.
- The median overall survival after Y90 treatment has been reported to be around 8-16 months, depending on the study and patient population 2, 3, 5.
- Prognostic factors for overall survival and complications have been identified, including portal vein thrombosis, pre-treatment hemoglobin values, activity administered dose, and arterial release site 3.
Efficacy and Safety
- Y90 radioembolization has been shown to be effective in achieving disease control, with disease control rates ranging from 69.2% to 83.6% 3, 6.
- The treatment has also been associated with significant tumor necrosis, with tumor necrosis observed in 82.8% of patients in one study 5.
- Common toxicities reported after Y90 radioembolization include fatigue, alteration in liver function, diarrhea, nausea, and vomiting 2, 5.
- Grade 3 and 4 toxicities have also been reported, including liver failure, gastric ulcer, and abdominal pain 2, 5.