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TheraSphere® (also called Y90 or radioembolization) is a treatment for liver cancer which is done in the Interventional Radiology Department.
What is TheraSphere® treatment?
TheraSphere® is a targeted and less invasive liver cancer treatment. It consists of injecting millions of tiny glass beads that contain radioactive Yttrium-90 into the blood vessels that feed the tumors. The beads lodge into the blood vessels of the tumor and give off radiation that destroys the cancer cells with little harm to the healthy liver. After a few days, the beads are no longer radioactive. This treatment is performed as an outpatient so you don’t need to stay in the hospital. Y90 treatment has 2 phases. The first procedure is called a “mapping angiogram” where we collect all the information we need to calculate your radiation dose. The second procedure is the “treatment” where we deliver the radiation beads to your liver.
Mapping Angiogram
A mapping angiogram of the liver is a test where we inject x-ray dye into the liver blood vessels to see how the blood flows through the liver. This test will provide a “road map” to help plan the treatment. This test takes about 2-3 hours. Smaller blood vessels may be found that could carry some of the radioactive beads away from the liver to your stomach and intestine. These small blood vessels may need to be plugged up (embolized) to prevent the beads from going to your stomach and intestine. If TheraSphere® glass beads were to go to your stomach or intestine, it could cause bleeding or an ulcer.
Before the angiogram, you will receive IV pain medicine and a sedative. We will choose an artery in your wrist or in your groin as the best artery to go into. We will numb the area over the artery. Then, we will place a small tube in your artery and guide it to your liver blood vessels. We inject dye under x-ray into the liver blood vessels and take pictures.
We will block small blood vessels that go to the stomach or bowel. Your stomach and intestines get blood from many other blood vessels, so in most cases, it is not a problem to block these small blood vessels.
After this test is complete, we will remove the tube in your artery. You will need to lie flat for 2-6 hours to allow the artery puncture site to seal up. You will not be able to drive or do heavy lifting for 24 hours after this test. Your nurse will give you more instructions.
MMA Scan
While you recover from the angiogram of your liver, you will have an MAA scan. This is also called a lung shunting scan. This scan shows how much blood flows around the liver tumors and to your lungs. This scan helps us figure out whether you are a candidate for this treatment. We will place you under a scanner for ½ hour. After this test we will take you to the recovery area until you are ready to go home.
If these tests show that it is safe for you to have this treatment, you will be set up for the first treatment within the next few weeks. The first treatment will treat liver tumors on one side of your liver. You may need a second treatment if you also have tumors on the other side of your liver or if your tumor is getting blood supply from other areas. Your treatment team will review this with you.
What to Expect During Treatment
Getting ready is the same as for the angiogram test. We will place an IV in your hand or arm to be used for IV pain and sedative medicine. We will place a small tube into your groin or wrist artery and guide it to your liver blood vessels. We use the mapping angiogram as a guide to place the tube in the correct vessels for treatment.
We use x-ray dye to make sure the tube is in the correct place. Then we will inject the TheraSphere® beads. Once this is done, we will remove the tube from the artery, and we will send you to the recovery area.
You will need to lie flat for 2-6 hours to make sure your artery puncture site seals up. You will not be able to drive or do heavy lifting for 24 hours.
Side Effects
For 2-3 weeks after the treatment, most patients feel tired, have a decreased appetite, mild nausea and may have a low-grade fever. You can relieve the fever by taking acetaminophen (Tylenol) 325 mg, 1-2 tablets every 4 hours, or ibuprofen (Advil) 200mg, 1-2 tablets, every 6 hours.
Rarely, patients have mild pain for a short time. If you are having pain, we will give you pain medicine to control this.
Future Treatments
If you need more treatment, we will schedule this 4-8 weeks after your first treatment. We’ll want to make sure that you are not too tired and that your liver function tests are good. Most of the time, you do not need to repeat the “mapping angiogram” before your next treatment.
How Treatment Works
How well the treatment works depends on the size, number and location of your tumors. We will review that with you when we meet you in our clinic before the treatment.
Please look at the list below to avoid problems after your treatment.
Diet
Drink plenty of fluids. Drink at least eight-8 oz glasses of water, juice, or soda over the next 24 hours after treatment.
You may eat whatever you like. Patients often tolerate smaller, more frequent meals during the first few days after treatment.
Do not drink any alcohol for 4 weeks after your treatment. This will give your liver the best chance of healing.
Medicine
You may restart your scheduled medicine as prescribed.
You may already be on an anti-ulcer medicine. If you are not, we will give you a dose before the treatment and a prescription for a 30-day supply. Be sure to take this medicine for 30 days after the treatment.
We will give you prescriptions for pain and nausea medicines after treatment. You do not need to fill and take these medicines if you do not feel you need them.
Site Care
You may remove the dressing over the artery after 24 hours.
Do not take a hot bath or shower for at least 24 hours.
Look at the puncture site daily for 5 days.
Activity
No strenuous physical activity of any kind.
Do not bend the leg that was used for the treatment more than needed for the next 24 hours.
Do not lift over 10 pounds for 48 hours.
Avoid sports, heavy cleaning, and stair climbing for 48 hours.
No driving for 24 hours, or while taking pain medicine.
Radiation Guidelines
The spheres used for this treatment contain a radioactive substance that takes time to become inactive. This means that for 3 days (72 hours) after your procedure, other people that you are around may be exposed to radiation from your body.
Please follow these simple guidelines:
No visitors who are pregnant.
No physical contact or extended travel with others for longer than 2 hours.
Sleep in bed alone.
Do not allow children or pets to sit on your lap.
No special plans for handling bodily fluids such as urine, stool, blood, or vomit.
If you seek medical care somewhere else within 3 months of treatment, please tell your provider that you have had treatment with a radioactive substance. Also, you should not have open abdominal surgery within 3 months after treatment.
When to Call
Call us if you have any questions or concerns, or have:
Redness, swelling, or drainage at the groin site. Some bruising at the puncture site is normal and will go away in a couple days.
Increased pain, numbness, coolness, or see blue bruising of the leg or hand where the puncture site is.
Stomach pain that gets worse over time.
Bleeding at the puncture site. Put pressure on the site to stop the bleeding and then call the clinic.
Nausea and vomiting that that you cannot control by medicine or lasts more than 24 hours.
A fever over 101°F for two readings taken 4 hours apart.
Who to Call
Interventional Radiology
Monday-Friday, 8 am-4 pm
608-263-9729, prompt 3
Toll free: 1-800-323-8924
After hours this number will give you the paging operator. Ask for interventional radiology resident on call. Give your name and number with the area code. The doctor will call you back.