What Is Transarterial Radioembolization?
Transarterial Radioembolization is a cancer treatment that uses imaging to guide the procedure. A doctor inserts a small tube into an artery in your groin or wrist, then delivers tiny radioactive beads (usually Yttrium-90) into the liver arteries that feed the tumor. These beads become lodged in the tumor’s small blood vessels and deliver radiation over several days or weeks, targeting cancer cells while sparing nearby healthy tissue.
Key characteristics:
- Outpatient or short stay procedure with relatively quick recovery
- Targeted arterial delivery to the tumor-rich blood supply
- Internal radiation with a short penetration range
- Can be combined with systemic therapies
How Transarterial Radioembolization Works (Mechanism) ?
Transarterial Radioembolization takes advantage of how liver tumors get their blood supply:
- Liver tumors often rely more on arterial blood flow than normal liver tissue.
- Pre-procedural angiography maps the arterial branches feeding the tumor.
- Doctors may block blood vessels that supply other organs, such as the stomach, to prevent radiation from reaching areas outside the tumor.
- Y-90 beads are placed into the chosen arteries, where they get stuck in the tumor’s tiny blood vessels and release radiation right at the tumor site.
- Tumor control or shrinkage is assessed over several weeks or months. Doctors check if the tumor has shrunk or is under control by doing scans and lab tests over the next several weeks or months. or control liver tumors, especially when:
- Surgery (resection) or ablation is not feasible.
- As a bridge to liver transplant or to downstage the disease
- As part of a combination therapy with systemic treatments (chemotherapy, targeted therapy, immunotherapy)
- For palliation: relieving symptoms and maintaining quality of life when a cure isn’t possible
Common tumor settings:
- Hepatocellular carcinoma (HCC)
- Secondary (metastatic) liver tumors, such as colorectal liver metastases (mCRC), and others, where appropriate
Causes, Symptoms, and When Transarterial Radioembolization Is Considered
This section explains why and when doctors might recommend Transarterial Radioembolizationin easy to understand terms.
Causes
- Primary liver cancer (HCC) often arises due to chronic liver disease: hepatitis B/C, alcohol-related liver disease, nonalcoholic steatohepatitis (NASH), and Metastatic liver tumors happen when cancer spreads to the liver through the blood. This is most often from colorectal cancer, but can also come from neuroendocrine tumors, breast cancer, or other types of primaries.
Symptoms
Liver tumors may be asymptomatic early. Possible symptoms include:
- Fatigue, decreased appetite, and unintentional weight loss
- Right upper abdominal pain or fullness
- Nausea, early satiety
- Jaundice, dark urine, pale stools (in advanced cases)
- Itching, swelling in the belly (ascites), or fevers. Note: Having these symptoms does not by itself mean you are a candidate for Transarterial Radioembolization. Doctors also look at scans and liver function tests.
When Transarterial Radioembolization Is Considered ?
- Tumors confined to the liver or liver-dominant disease.
- Preserved liver function (assessed by labs and scores like Child-Pugh)
- Adequate performance status
- Arterial anatomy suitable for selective catheterization
- As downstaging or bridging to definitive surgery/transplant, or for palliation
Treatment: Step by Step Transarterial Radioembolization Procedure
Transarterial Radioembolization is done in several planned steps, following a set process.
1) Workup and Planning
- Imaging: multiphase CT/MRI to define tumor burden and vascular anatomy
- Labs: liver function, blood counts, kidney function, tumor markers (e.g., AFP for HCC, CEA for CRC)
- Angiographic mapping: diagnostic angiography to identify tumor-feeding vessels
- Protective steps: coil embolization of vessels that could shunt beads to the stomach/duodenum if needed
- Lung shunt assessment: measures potential microsphere flow to lungs to ensure safety and dose planning
2) Treatment Session
- Access via the femoral or radial artery under local anesthesia and sedation
- The microcatheter advanced to the targeted hepatic arterial branches.
- Infusion of Y-90 microspheres into tumor-feeding arteries
- Post-infusion checks; catheter removal; brief monitoring period
3) Aftercare and Follow-Up
- Observation for several hours; many patients go home. Common short-term symptoms include fatigue, mild stomach discomfort, low-grade fever, and nausea. These usually go away on their own and are usually self-limited.
- Follow-up imaging (CT/MRI ± PET) at ~6–12 weeks to evaluate response
- Ongoing lab monitoring and clinic visits
Benefits and Expected Outcomes
- Selective tumor targeting with relative sparing of normal liver
- Can downstage or bridge to surgery/transplant in selected HCC cases
- Compatible with systemic therapy sequences
- Symptom relief and disease control for many patients who are not surgical candidates
- Generally, there are fewer systemic side effects than with traditional chemotherapy.
How well Transarterial Radioembolization works depends on the type of tumor, the amount of cancer present, the blood supply, and how well the liver is functioning. The goals can be to shrink the tumor for a possible cure, keep the disease under control, or relieve symptoms.
Risks and Side Effects
Most side effects are mild to moderate and transient:
- Fatigue, nausea, low-grade fever, abdominal discomfort
- Some people may feel unwell, have pain, or see a temporary rise in liver enzymes after the procedure. Less common risks include:
- Gastric or duodenal ulcer (from non-target microsphere deposition)
- Radiation induced liver disease (rare; risk increases with poor baseline liver function)
- Vascular complications at the access site (hematoma, bruising)
- Biliary injury, cholecystitis (if cystic artery is affected)
- Non-target microsphere deposition to lungs if shunt is high (screened for during planning)
Your care team works carefully to lower risks by mapping your blood vessels, blocking off certain arteries if needed, planning the right dose, and following up closely after treatment.
How Long Does It Take?
- Mapping session: typically 1–2 hours
- Treatment infusion: roughly 1–3 hours, depending on. Most people can return to light activities in a few days, though feeling tired may last for 1 to 2 weeks. gue potentially lasting 1–2 weeks
Patient Journey: What to Expect ?
- Before: fasting instructions, medication review (e.g., anticoagulants), transportation planning
- During the procedure, you will get local anesthesia and medicine to help you relax. You will be awake, but should feel comfortable.
- Afterward, you will be observed for a short time and given instructions on the activity, wound care, and any symptoms.
- Follow-up includes scans at 6 to 12 weeks, regular lab tests, and meetings with your doctor to adjust your treatment plan as needed.
Care Setting and Team
Transarterial Radioembolization is performed by a multidisciplinary team:
Nursing and supportive care for pre-/post-procedural guidancetient's condition and tumor size, but it generally takes between 1 and 3 hours. Prior to the procedure, local anesthesia is applied to the groin area. The liver artery is then accessed by making a small incision over the femoral artery.
Interventional radiology for planning and catheter-directed therapy
Nuclear medicine/medical physics for dosimetry and isotope handling
Hepatology/oncology/surgery for overall treatment planning and combination strategies
Special Topics and Practical Questions
The following topics cover common questions and important terms related to Transarterial Radioembolization.
Effectiveness
- “How effective is radioembolization?” Effectiveness depends on tumor type, size, number, liver function, and prior treatments. Many patients achieve disease control, and selected HCC cases may be downstaged to curative options. Response is typically evaluated at 6–12 weeks.
Tumor Size Considerations
- “Can radioembolization get rid of a 4 cm tumor?” A single ~4 cm lesion may respond well depending on location, arterial supply, and liver function. Complete response is possible in some cases; in others, partial response or stable disease is the realistic goal. Your team will review imaging to set expectations.
Kidney Effects
- “Can radioembolization affect kidneys?” Direct kidney radiation exposure is not expected, as delivery is to the hepatic arteries. Kidney concerns are usually related to the contrast dye used during angiography. Hydration and kidney-safe protocols mitigate this risk.
Procedure Technicalities
- “How often does Y-90 get stuck in the catheter?” Y-90 delivery systems are designed to prevent catheter occlusion; this is an uncommon technical issue. Teams use standardized protocols and flushing techniques to maintain safe, smooth delivery.
Indication Context
- “Is radioembolization for liver cancer considered palliative care?” It can be palliative in advanced disease, relieving symptoms and improving quality of life. It can also be used with curative intent as a bridge to transplant or surgery in selected patients. The intent depends on the clinical context.
Modality Clarifications
- “Is radioembolization a radioisotope therapy?” Yes. It uses radioactive microspheres (radioisotopes) delivered intra-arterially.
- “Is radioembolization SABR/SBRT?” No. SABR/SBRT is external beam radiation from outside the body. Transarterial Radioembolization is internal, catheter-directed radiotherapy.
Terminology
- TARE = Transarterial Radioembolization
- Y-90 radioembolization = the most common isotope used for Transarterial Radioembolization
Combining Transarterial Radioembolization With Other Therapies
- May be integrated with systemic chemotherapy, targeted agents, or immunotherapy
- Can follow or precede other liver-directed therapies (resection, ablation)
- The timing of treatments is tailored for each person to reduce side effects and get the best results.
Treatment Planning Elements That Influence Outcomes
- Liver function (e.g., bilirubin, albumin, portal hypertension, Child-Pugh)
- Tumor burden and distribution (segmental/lobar, uni- vs bilobar disease)
- Vascular anatomy and lung shunt fraction
- Prior therapies and overall performance status
Symptom Management After Transarterial Radioembolization
Common, usually temporary:
- Fatigue, decreased appetite, mild nausea.
- Dull right upper quadrant ache
- Low-grade fever. Supportive care includes:
- Short courses of anti-nausea medicines and pain control
- Hydration and light activity as tolerated
- You will get clear instructions on when to contact your care team, such as if you have more pain, ongoing fever, vomiting, yellowing of the skin or eyes, or bleeding.
Evidence Snapshot (Plain-Language)
Outcomes depend on selection and dosimetry; individualized planning is essential.nd resolve on their own.
For HCC, Transarterial Radioembolization provides local control and can downstage some patients to curative therapies.
For colorectal liver metastases, Transarterial Radioembolization can achieve disease control in liver-dominant cases, often as part of multimodal care.
TARE Treatment at Liv Hospital
At our hospital, TARE therapy is administered by a team of highly skilled nuclear medicine and interventional radiology specialists utilizing the latest technologies. Each treatment plan is thoroughly designed by a multidisciplinary team, ensuring personalized care tailored to every patient's needs. This innovative approach provides our patients with both effective and comfortable cancer treatment.
* Liv Hospital Editorial Board has contributed to the publication of this content .
* Contents of this page is for informational purposes only. Please consult your doctor for diagnosis and treatment. The content of this page does not include information on medicinal health care at Liv Hospital .
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