Transarterial 90Yttrium Radioembolisation

The term transarteria radioembolisation includes those procedures in which intra-arterially injected radioactive microspheres are used for internal radiation purposes. This procedure aims to selectively target radiation to liver tumours and to limit the dose involving the normal liver parenchyma. The yttrium-90 microspheres delivered throught the hepatic artery are implanted into liver tumours in a ratio ranging from 3:1 to 20:1 as compared to a normal liver. A work-up, involving computed tomography scanning, contrast-enhanced magnetic resonance imaging and hepatic angiography, is essencial for assessing the appropriateness of yttrium-90 treatment for each patient. A simulation of the procedure, carried out with technetium-99 m-labelled macroaggregated albumin particles, which approximate the size of microsphere, is used to identify the shunting of microparticles to the lungs or the gastrointestinal tract, thus helping in patient selection. Excellent periprocedural care, discharge planning and follow-up are essential for assessing treatment response and ensuring thatthe short-term side effects of radioembolisation are adequately managed. The purpose of this chapter is to summarise the relevant recent results regarding technical aspect, dosimetric advanced, adverse events, safety and efficacy of radioembolisation in the treatment of hepatocellular carcinoma, intrahepatic cholangiocarcinoma and liver metastasis.