What is Yttrium-90 (Y-90) Radiotherapy?
Y-90 Radiotherapy is a special procedure that is done to treat tumors in your liver. In this type of treatment, tiny radioactive beads are injected into the vessels that supply your liver tumor with blood. The tiny beads will stay in the blood vessels around your tumor and allow radiation to reach the tumor(s) directly. Because these beads are delivered directly to your tumor, there is very little effect on the healthy parts of your liver or other tissues around your liver. The beads will put off radiation for about 10 days but they will keep working for several months after they are placed in your liver
How is Y-90 Radiotherapy done?
Y-90 radiotherapy is done by Dr. Christenson in a special procedure room in the radiology department at St. Vincent Healthcare. Treatment with Y-90 Radiotherapy is done in several steps.
Step 1: Mapping: The first step in treatment with Y-90 Radiotherapy is a called a mapping angiogram. The mapping procedure will take about 2-4 hours. Dr. Christenson will place a small plastic tube (called a catheter) into one of the vessels in your groin and direct the catheter to the blood vessels in your liver. Once the catheter reaches your liver, Dr. Christenson will take pictures with x-ray to see how the blood flows to your liver. Based on how the blood flows, Dr. Christenson will be able to tell if Y-90 Radiotherapy will work for you or not. If the procedure will work for you, Dr. Christenson will place small metal wires (coils) in blood vessels that should not get Y-90 Radiation. Dr. Christenson will also inject a special tracer agent into the vessels to map how much tracer enters the tissues around your liver.
After the tracer is injected, you will be taken down to the nuclear medicine department for a scan. The scan will allow Dr. Christenson to see how much of the tracer has left the liver and gone to other organs like your lungs. This information will also be used to determine if you are a good candidate for Y-90 Radiotherapy.
Step 2 – Y-90 Radiotherapy: Once it is decided that you would be a good candidate for Y-90 Radiotherapy, we will order the dose of Y-90 specifically for you. It takes approximately 1-2 weeks for the specific dose of Y-90 to be made for you. We will schedule you for your second procedure when we know your dose of Y-90 will be ready. In the second step of the Y-90 radiotherapy procedure you will again have a catheter placed in a blood vessel in your groin. Dr. Christenson will guide the catheter to your liver. Once the catheter is in place, he will slowly inject the beads through the catheter to your liver. This procedure takes about 1 hour.
Step 3- Additional Y-90 Radiotherapy: Step 3- If Dr. Christenson needs to treat more than one part of your liver we will schedule you for a second procedure. The second procedure can be done 4-6 weeks after Step 2. In the second procedure, Dr. Christenson will deliver more Y-90 Radiotherapy Beads to the other part of your liver.
Special Note: After placement of Y-90 Radiotherapy beads you will need to keep a minimum distance of 3 feet between you and others for 3 days. This may mean that you will need to sleep in a separate bed.
What are the risks of the Y-90 Radiotherapy?
There are some side effects associated with Y-90 Radiotherapy. These side effects may include fatigue, poor appetite, mild abdominal pain, slight fever, and nausea. These symptoms typically go away slowly over 1-2 weeks.
Getting Ready for Your Y-90 Radiotherapy
- We will contact you the day before your procedure to review important instructions and answer any questions you may have.
- It is important that we know if you have ever had a reaction to contrast (x-ray dye).
- If you take blood-thinning medicines like Coumadin, Lovenox, or Plavix, we may ask you to stop taking those medicines 3 to 9 days before your procedure. We will give you instructions on this.
- You will most likely need blood tests done before your procedure. We usually will draw your blood when you arrive for your procedure. Sometimes we need to know your blood test results beforehand, we will let you know if we need you to go in to get blood drawn before your procedure.
- Before your Mapping Procedure and your Y-90 Radiotherapy infusion you will be given a sedative medication through your IV. The medication may make you sleepy and will help to reduce any discomfort you may have during the procedure. We call this conscious sedation.
- For some people conscious sedation may be difficult or not possible. These people may need anesthesia. Let us know right away if you:
- Have needed anesthesia for basic procedures in the past
- Have sleep apnea or chronic breathing problems (you might use a CPAP or BiPAP device while sleeping)
- Use high doses of narcotic painkiller
- Have severe heart, lung, or kidney disease
- Cannot lie flat for about 2 to 3 hours because of back or breathing problems
- Have a hard time lying still during medical procedures
Preparing for Your Mapping Procedure and Y-90 Radioembolization
- Do not eat or drink starting 8 hours before your procedure is scheduled.
- Take all of your medicines on the day of your procedure. Do NOT skip them unless we instruct you do to so.
- Bring a list of all of your medicines you take with you.
- If there is a delay in getting your procedure started it is usually because we need to treat other people with unexpected or emergency problems. Thank you for your patience if this occurs.
- A nurse or medical assistant will give you a hospital gown to put on and a bag for your belongings. Please do not bring valuable items with you.
- You may use the restroom at any time, just let the nurse know.
- An intravenous (IV) line will be started. You will be given fluids and medicine through the IV Dr. Christenson will talk with you about the procedure and ask you to sign a consent form if that has not already been done. You may ask any questions you have at any time.
What happens after the procedure?
- After your procedure you will be taken to Surgery Plus where the nurses will monitor your vital signs.
- You will need to rest in bed for 2 to 6 hours. The nurses will monitor the puncture site in your groin for bleeding.
- When you are fully awake, able to eat, use the restroom and walk, you will be able to go home.
- Before you leave the hospital, your nurse will tell you what activities you can do, how to take care of your incision, and other important instructions.
- You will need to have a responsible individual to drive you home after the procedure and help you get settled at home.
When You Get Home
- Relax at home the rest of the day. Make sure you have a family member, friend or caregiver to help you.
- For 24 hours, do NOT:
- Drive a care or use machinery
- Drink alcohol
- Make important personal decisions or sign legal documents
- Be responsible for the care of another person
- You will be asked to maintain a distance of at least 3 feet from other people for 3 days after Y-90 Radiotherapy.
- You may shower or bathe the next day.
- Resume taking your usual medications as soon as you start to eat.