Yttrium-90 hepatic radioembolization: clinical review and current techniques in interventional radiology and personalized dosimetry

Abstract

In recent years, yttrium-90 ((90)Y) microsphere radioembolization has been establishing itself as a safe and efficacious treatment for both primary and metastatic liver cancers. This extends to both first-line therapies as well as in the salvage setting. In addition, radioembolization appears efficacious for patients with portal vein thrombosis, which is currently a contraindication for surgery, transplantation and transarterial chemoembolization. This article reviews the efficacy and expanding use of (90)Y microsphere radioembolization with an added emphasis on recent advances in personalized dosimetry and interventional radiology techniques. Directions for future research into combination therapies with radioembolization and expansion into sites other than the liver are also explored.

Figure 1.

Digital subtraction angiograms (DSAs) and corresponding intra-arterial CT (IACT) showing multiple arterial supplies to a single tumour. Without IACT, it may be difficult to ensure complete lesional coverage. (a, b) DSA and IACT, respectively, with the microcatheter in the right hepatic artery. (c, d) DSA and IACT, respectively, with the microcatheter in the left hepatic artery. (e, f) DSA and IACT, respectively, with the microcatheter in the right gastroepiploic artery.

Figure 2.

(a) Digital subtraction angiogram (DSA) and (b, c) intra-arterial CT (IACT) showing usefulness of IACT for detection of extrahepatic enhancement for treatment of a large hepatocellular carcinoma. IACT acquired taken with the microcatheter at the proper hepatic artery. From this position, there is a small area of gastric enhancement (c) which would otherwise be missed on DSA alone. Eventually, the activity was split and delivered into the right and left hepatic arteries without incident.