What Is It?
Radioembolization is a minimally invasive outpatient procedure that involves the precise placement of microscopic radioactive spheres (microspheres) via a small catheter placed in directly in blood vessels that supply a tumor in the liver. The microspheres contain an isotope of yttrium-90, which generates therapeutic radiation for approximately two weeks before decaying away and becoming inactive.
How Is It Treated?
Radioembolization is performed by a specially trained interventional radiologist in an interventional radiology suite. Although radioembolization can be performed in one session in certain circumstances, it will commonly require two sessions. In the first session, a mapping angiogram, as described below, is performed to visualize the abdominal arteries.
This procedure is often done on an outpatient basis. Rarely, some patients may require admission following the procedure. Ask your doctor if you will need to be admitted.
You may be given medications to help prevent nausea and pain, and antibiotics to help prevent infection.
You will be positioned on your back.
You may be connected to monitors that track your heart rate, blood pressure, oxygen level and pulse.
A nurse or technologist will insert an intravenous (IV) line into a vein in your hand or arm to administer a sedative. This procedure may use moderate sedation. It does not require a breathing tube. However, some patients may require general anesthesia.
The area of your body where the catheter is to be inserted will be sterilized and covered with a surgical drape.
Your physician will numb the area with a local anesthetic. This may briefly burn or sting before the area becomes numb.
A very small skin incision is made at the site.
Using image-guidance, a catheter (a long, thin, hollow plastic tube) is inserted through the skin into the radial or femoral artery, and maneuvered to the treatment site.
A small catheter is placed within multiple arteries in the liver and a cone beam CT is performed to analyze its three-dimensional blood supply.
Your interventional radiologist will choose the arteries that are supplying tumor and prescribe a personalized radiation dose to them. Occasionally, arteries that the interventional radiologist wishes to protect from unintentional exposure to radioactive microspheres, such as those that supply stomach and bowel, will be closed with tiny metallic coils.
At the end of the procedure, a dissolvable particle made of protein containing a nuclear medicine tracer may be infused through the catheter into the liver to simulate treatment. This helps the interventional radiologist determine if you are a candidate for radioembolization based on the distribution of the simulated microspheres within the liver, abdomen, and lungs.
If you are determined to be a candidate for radioembolization after your mapping angiogram and nuclear medicine exam, you will be brought back for a second procedure within two weeks where the therapeutic radioactive microspheres will be administered in a similar procedure. In some practices, a radiation oncologist or nuclear medicine doctor will additionally be present in the room and will be performing the actual delivery of the therapeutic radioactive microspheres.
When the procedure is complete, the catheter is removed, and pressure is applied to stop any bleeding. Sometimes, your doctor may use a closure device to seal the small hole in the artery. This will allow you to move around more quickly. No stitches are visible on the skin. The tiny opening in the skin is covered with a dressing.
Your IV line is removed before you go home.
This procedure is usually completed within two hours.
How Do I Prep For The Procedure?
Several days before the procedure, you will have a clinic consultation with the interventional radiologist who will perform your procedure.
Prior to your procedure, your blood may be tested to determine how well your liver and kidneys are functioning and whether your blood clots normally.
Tell your doctor about all the medications you take, including herbal supplements. List any allergies, especially to local anesthetic, general anesthesia or to contrast materials. Your doctor may tell you to stop taking aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs) or blood thinners before your procedure.
Tell your doctor about recent illnesses or other medical conditions.
Women should always inform their physician and x-ray technologist if there is any possibility that they are pregnant. Many imaging tests are not performed during pregnancy so as not to expose the fetus to radiation. If an x-ray is necessary, precautions will be taken to minimize radiation exposure to the baby. See the Radiation Safety page for more information about pregnancy and x-rays.
You will receive specific instructions on how to prepare, including any changes that need to be made to your regular medication schedule.
You may be given a sedative prior to or during your treatments. You will receive specific instructions on eating and drinking before the procedure and will need to have a relative or friend accompany you and drive you home afterward.
You will be given a gown to wear during the procedure.
What Happens After The Procedure?
Occasionally, patients whose treatment requires a large number of microspheres experience post-embolization syndrome due to a temporary reduction in blood supply in the liver. Symptoms include nausea, vomiting, and fever. This can readily be controlled by medications given by mouth or your IV. These side effects usually subside within one to five days. You should tell your doctor if these symptoms last more than 10 days.
When larger volumes of liver are treated, patients may experience a loss of appetite and fatigue that may start within a week and last up to a month or more in severe cases. However, this is rare, and most patients will be able to resume normal activities within days following the procedure.
During the first week following your radioembolization, you will need to limit contact with others while the radiation in your body diminishes. You will be provided with specific recommendations by your doctor’s radiation safety officer, which may include warnings against:
sleeping in the same bed as your partner.
using public transportation that requires you to sit next to another person for more than two hours.
coming into close contact with children or pregnant women.
CT scans or MRIs and laboratory examinations may be performed every one to three months following the treatment to determine treatment response.
