Radioembolization is the injection of very small spheres (microspheres) containing radioactive material directly into cancer tissue through cancer vessels.

What is Radioembolization?

In addition to cancer present in the liver tissue, radioembolization applied for the treatment of different cancer cases that have metastasized to the liver is also known as microsphere therapy. Radioembolization, which is mostly preferred in liver cancer cases where there is no surgical treatment option, can also be applied to reduce tumor size before surgery. 
What is Radioembolization?

Radioembolization, unlike systemic cancer treatments, directly affects cancerous cells. It does not harm healthy cells and tissues.

Microspheres containing very small amounts of radioactive material are used in radioembolization treatment. Microspheres reach the cancerous tissue with the help of the circulatory system and by emitting radioactive energy in the area of the cancerous tissue, they destroy the tumor, the mass formed by the cancerous cells. The procedure is performed with the technique described as angiography.

 The aim of the radioembolization process, in which 70% to 80% of the patients respond positively, is to improve the quality of life and prolong the life span of patients with liver cancer or liver metastasis.
By Which Method Is Radioembolization Performed?

Radioembolization can be defined as the process of injecting microspheres containing radioactive material into the artery in the region, mostly by entering the vein feeding the liver tumor from the groin with angiography procedure. The microspheres contain a radioactive substance called Y-90 radionuclide, or in other words, Yttrium-90. The procedure, which is made by depositing a large number of microspheres into the vein that feeds the liver, is an effective method in the treatment of liver cancer with low side effects.

By injecting the microspheres into the hepatic artery that feeds the liver, the radioactive material reaches the liver tumor through the liver vessels and settles in the smaller vessels that are the tumor.

Microspheres destroy cancer cells by emitting radioactive energy into cancerous tissue. Meanwhile, its effect on healthy tissue is minimal. After the cancer cells and therefore tumor tissue in the area are destroyed, the microspheres continue to emit radiation for a few weeks and become ineffective after a while. 
How is Radioembolization Treatment Planning Done?

The decision of radioembolization treatment is made with a multidisciplinary approach such as oncology, nuclear medicine, radiology, general surgery, gastroenterology and pathology. All department physicians take part in matters such as patient selection, treatment planning, patient follow-up and treatment evaluation.

Angiographic procedures performed before starting treatment are performed by an interventional radiologist. A nuclear medicine specialist is responsible for adjusting the dose of the radioactive material to be applied to the patient and evaluating the post-treatment intervention.

Radioembolization is carried out by interventional radiologists and nuclear medicine specialists. In some cases, other types of treatment are discontinued prior to radioembolization therapy. The oncologist decides to abandon other treatment options.

Before the radioembolization procedure, the person's condition and suitability for treatment are evaluated by the cancer council. If the patient is found suitable for treatment, blood tests are performed first. Radioembolization treatment planning is started with CT (Computed tomography) guided angiogram.

Thus, mapping is done by imaging all of the liver vessels of the person. The arteries feeding the tumor are detected. If it is determined that the artery feeding the liver goes to other organs such as stomach or intestine, spirals are attached to these vessels. Thus, these vessels are blocked and other organs are prevented from being damaged.

Then, imaging is performed by administering a low dose of radioactive material from the artery feeding the tumor. Thanks to this procedure, the physician determines how much the radioactive material is retained by the tumor and whether it reaches healthy tissues. Determination of the amount of passage to the lung is also made during this process.

During the planning of the radioembolization treatment, if the radioactive material reaches the tumor tissue and does not pass at a dose that will harm the lungs, treatment is started. At this stage, the physician of the nuclear medicine department determines the actual dose to be given to the patient for treatment and the microspheres are prepared.
How is Radioembolization Therapy Applied?

· Treatment is started within 15 days following the radioembolization planning process.
· Pain relieving and sedative drugs are given to relax the person.
· Then, a very small incision is made in the groin area for insertion of the catheter.
· The catheter is directed from the artery in the groin area, which is defined as the femoral artery, towards the hepatic artery in the liver area.
· Microspheres containing radioactive material are injected into the bloodstream through the catheter placed in the artery feeding the tumor and sent into the cancerous tissue.
· Microspheres settle into the fine vessels that feed the tumor and the radioactivity is released into the area at the dose previously determined by the nuclear medicine specialist.
· The radioactive material in the microspheres has an extremely limited effect on the healthy liver tissue around the tumor tissue. Therefore, it can be said that radioembolization treatment is applied completely targeted.
After Radioembolization Application
· After the application of radioembolization treatment, the patient is hospitalized for one night and kept under observation and discharged the day after the procedure.
· The radioembolization process typically takes about 1 to 1.5 hours. 2 weeks after the treatment, an outpatient clinic visit is planned and the patient is checked.
 · If the physician deems necessary, 1 month after the radioembolization treatment, other laboratory tests are performed in addition to CT, MRI and / or PET scanning.
· In the radioembolization application, the treatment is applied only to one lobe of the liver at a time. Therefore, if the other lobe of the liver needs treatment, re-planning is made. The radioembolization steps to be applied for the other lobe of the liver are the same as the previous one.
What are the Side Effects of Radioembolization Therapy?

Although the drugs given before the radioembolization procedure for the treatment of cancer cases that metastasize to the liver or liver may cause the person to feel some pain, the procedure itself is usually painless.
· After radioembolization treatment, flu-like side effects such as nausea, vomiting, low-grade fever and fatigue may occur.
· These complaints disappear completely within a week with supportive treatment.
· The patient can return to his daily activities within 1-2 days after the treatment.
· In rare cases where radioembolization is applied, more serious side effects can be seen. Preliminary evaluation, patient selection and planning steps should be carefully made to reduce such side effects.
What are the Advantages of Radioembolization Therapy?

Liver cancer cases are usually detected at an advanced stage. Since there is no definitive treatment option in advanced cases, radioembolization treatment has an extremely important place for the destruction of the tumor. The advantages of radioembolization therapy can be listed as follows:

 In cases that cannot be treated with surgical methods, it increases the life span and treatment of the patient.
· The tumor in the liver is reduced by radioembolization, allowing for surgical treatment or liver transplantation.
· Since the treatment is targeted, the dose of radiation applied to the person can be safely increased to eliminate the tumor.
· The incision made during treatment is extremely small.
· The process can be repeated when necessary.
· Compared to systemic cancer treatments, its side effects are extremely low.

You can ask the expert team of Florence Nightingale Hospitals about the topics you are interested in radioembolization, and also you can ask for suggestions on your questions. To contact us, you can use the contact form on our website or call 0850 711 60 60.