Radioembolization

Radioembolization is the delivery of radioactive microspheres to cancers using an endovascular approach. It is often performed as an outpatient procedure.

Indications

• hepatocellular carcinoma
• hepatic metastases from colorectal carcinoma

Contraindications

Absolute contraindications

• excessive hepatopulmonary shunting (results in radiation pneumonitis)
• demonstrable gastrointestinal shunting (results in gastric ulceration)

Relative contraindications

• hepatic and/or renal dysfunction
• previous hepatic irradiation
• portal vein thrombus
• portal venous hypertension

Technique

• typically a transfemoral intra-arterial catheter with the tip near the target lesion
• nuclear medicine specialists prepare the radioactive (e.g. yttrium-90) microspheres (~32 microns), which when injected are implanted in the microvascular arterial supply of the tumor where they become trapped

The spectrum of yttrium-90 is ~2.7 days, with no remaining radioactivity after one month.

Treatment and prognosis

The overall survival rate of almost 13 months with radioembolization. Mortality ranges from 0.6% to 6% at 30 and 90 days, respectively in high-risk groups.

Complications

The most common adverse events are:

• fatigue
• nausea and/or vomiting
• abdominal pain

See also

• selective internal radiation therapy