YTTRIUM-90 (Y-90)
RADIOEMBOLISATION
Internal radiation therapy for primary liver cancer and liver metastases โ access leading Y-90 SIRT programmes in China at a fraction of Western cost.
analyticsAt a Glance
- check_circleYttrium-90 (Y-90) TARE delivers radiation-loaded microspheres directly to liver tumours via the hepatic artery
- check_circleApproved for hepatocellular carcinoma (HCC) and colorectal cancer liver metastases
- check_circleMinimally invasive catheter-based procedure โ performed under local anaesthesia or light sedation
- check_circleAvailable at advanced interventional oncology centres in India, China, the US, and Europe
What Is Yttrium-90 Radioembolisation?
Y-90 radioembolisation โ also called Selective Internal Radiation Therapy (SIRT) โ delivers millions of microscopic radioactive beads directly into the hepatic artery to treat liver tumours with high-dose internal radiation, while largely sparing healthy liver tissue and the rest of the body.
โY-90 concentrates radiation precisely in the tumour โ not systemically โ making it one of the most targeted liver-directed treatments available.โ
The Selectivity Principle
Liver tumours draw most blood from the hepatic artery; healthy liver relies on the portal vein. Y-90 microspheres injected into the hepatic artery concentrate in tumour vasculature, sparing surrounding parenchyma.
How Radiation Is Delivered
Each microsphere (~red blood cell size) carries Y-90 with a 64-hour half-life and ~2.5 mm tissue penetration. Microspheres lodge permanently in tumour vessels, delivering radiation over ~11 days, after which radioactivity is negligible.
How Y-90 SIRT Works โ Mechanism of Action
Y-90 beta radiation damages tumour cell DNA, triggering cell death. Microspheres simultaneously embolise the small arterial vessels feeding the tumour โ combining radiation and ischaemic kill for a more potent effect than either alone.
Beta Radiation Cell Kill
High-energy beta particles damage tumour DNA directly. Short tissue penetration (mean 2.5 mm, max 11 mm) limits dose to healthy liver beyond the tumour margin.
Vascular Embolisation
Microspheres occlude small arterial vessels feeding the tumour, adding an ischaemic component that amplifies tumour destruction. This dual mechanism is more potent than radiation alone.
Types of Y-90 Microspheres โ SIR-Spheres vs TheraSphere
Two Y-90 microsphere products are used internationally. Both are available at China's leading centres and differ in composition, specific activity, and approved indications.
| Feature | SIR-Spheres (Resin) | TheraSphere (Glass) |
|---|---|---|
| Material | Resin (polymer) | Glass |
| Manufacturer | Sirtex Medical, Australia | Boston Scientific / BTG, USA |
| Sphere diameter | 20โ60 ฮผm | 20โ30 ฮผm |
| Specific activity per sphere | Lower (more spheres per vial) | Higher (fewer spheres per vial) |
| Primary approved indication | Colorectal liver metastases (FDA/CE) | HCC (FDA humanitarian device exemption; CE mark) |
| Embolisation effect | Moderate embolic effect | Minimal embolic โ radiation-dominant |
| Availability in China | Yes โ major interventional centres | Yes โ major interventional centres |
Primary Indications โ Hepatocellular Carcinoma (HCC)
HCC is Y-90's most established indication. China contributes ~50% of global HCC incidence (~410,000 new cases annually), creating significant demand for liver-directed therapies including SIRT.
Unresectable HCC
Local control strategy for patients ineligible for surgery or ablation. Y-90 delivers meaningful tumour control as an outpatient procedure without systemic chemotherapy.
Bridge to Liver Transplant
Controls disease and prevents waitlist dropout while awaiting organ availability. PREMIERE trial demonstrated Y-90 superiority over TACE for downstaging to transplant criteria.
Downstaging to Resection (REILH)
Y-90 induces lobar hypertrophy in the future liver remnant (REILH), converting ineligible patients to surgical candidates while treating tumour disease simultaneously.
Salvage After TACE Failure
Active option when repeated TACE has failed or is contraindicated. Critically, portal vein tumour thrombus (PVTT) is NOT an absolute contraindication for Y-90 โ unlike TACE.
Y-90 for Liver Metastases โ Colorectal, Neuroendocrine, and Others
Y-90 SIRT is established across multiple primary tumour types with liver-dominant metastatic disease.
| Primary Tumour | Y-90 Role and Evidence Summary |
|---|---|
| Colorectal cancer liver metastases (CRCLM) | SIR-Spheres FDA-approved. SIRFLOX/FOXFIRE/FOXFIRE-Global (n=1,103): significant hepatic PFS benefit with Y-90 + FOLFOX. Used chemo-naive and refractory. |
| Neuroendocrine tumour liver metastases (NET-LM) | 80โ90% disease control rates in large registries. High tumour vascularity enhances delivery. Used alongside somatostatin analogues. |
| Breast cancer liver metastases | Emerging evidence in heavily pre-treated, liver-dominant disease. Used within compassionate or trial frameworks at selected centres. |
| Intrahepatic cholangiocarcinoma (iCCA) | Active area of investigation. Disease stabilisation and tumour response reported in unresectable iCCA in prospective institutional series. |
| Other primaries (lung, melanoma, gastric) | Selected use in liver-dominant disease refractory to systemic therapy. Limited but reported institutional experience. |
China's Y-90 Programme โ Leading Centres
China's interventional oncology infrastructure has expanded significantly. Y-90 SIRT is now available at major academic cancer centres with dedicated hepatobiliary and interventional radiology programmes.
| Centre | City | Programme Notes |
|---|---|---|
| FUSCC โ Fudan University Shanghai Cancer Centre | Shanghai | Comprehensive liver cancer programme; Y-90 alongside resection, ablation, TACE, systemic therapy; large international patient volume. |
| Zhongshan Hospital (Fudan University) | Shanghai | One of China's leading HCC centres; high-volume Y-90 with advanced dosimetric planning; hepatobiliary surgery and transplant integration. |
| Sun Yat-sen University Cancer Centre (SYSUCC) | Guangzhou | Major South China cancer centre; HCC and liver metastases Y-90 programme; clinical trials integration. |
| West China Hospital | Chengdu | Interventional oncology with Y-90; hepatobiliary and GI cancer focus; comprehensive multidisciplinary team. |
| Beijing Cancer Hospital | Beijing | Y-90 SIRT available; liver cancer and GI metastases; strong systemic therapy integration. |
| Changhai Hospital | Shanghai | Active interventional radiology and Y-90 programme; hepatobiliary focus. |
Y-90 Treatment Process โ Step by Step
Y-90 SIRT requires two separate visits 1โ3 weeks apart. Total China stay including both visits and observation is approximately 3โ4 weeks.
- 1
Pre-Treatment Workup
MRI or CT imaging defines tumour burden and extrahepatic disease. Liver function tests, AFP/CEA/chromogranin, Child-Pugh score, and ALBI grade confirm hepatic reserve.
- 2
Mapping Angiogram (Visit 1)
Catheter-based procedure identifying tumour feeding vessels, coil-embolising non-target vessels (gastric, duodenal, pancreatic branches), and measuring lung shunt fraction via Tc-99m MAA scintigraphy. Lung shunt >20% may exclude treatment.
- 3
Dosimetric Planning
Partition model dosimetry personalises Y-90 activity based on tumour volume, liver function, and lung shunt fraction โ optimising tumour dose while sparing normal tissue.
- 4
Y-90 Microsphere Infusion (Visit 2)
Catheter placed in the hepatic artery matching the mapping angiogram position. Y-90 vial connected; microspheres infused over 10โ30 minutes under fluoroscopic monitoring.
- 5
Post-Procedure Distribution Imaging
Bremsstrahlung scintigraphy or PET-CT performed same day to confirm microsphere distribution and adequacy of tumour delivery.
- 6
Discharge, Precautions & Follow-Up
Most patients discharged within 4โ6 hours or next morning. Standard radiation precautions for 7 days. Return imaging (MRI/CT) at 4โ6 weeks to assess tumour response.
Evidence Base โ Key Clinical Trials
Y-90 SIRT has one of the most extensive evidence bases among liver-directed therapies, with multiple Phase III trials and large registries across HCC and liver metastases.
| Trial / Study | Key Finding and Relevance |
|---|---|
| SIRFLOX / FOXFIRE / FOXFIRE-Global (CRC LM, n=1,103) | Three Phase III RCTs: SIR-Spheres + FOLFOX vs FOLFOX alone. Significant hepatic PFS improvement with Y-90. Meaningful subgroup benefit identified in CRC liver metastases. |
| SARAH (HCC) | Phase III: SIR-Spheres vs sorafenib in unresectable HCC. Similar OS; improved tolerability and QoL with Y-90. Established Y-90 as a valid sorafenib alternative. |
| SIRveNIB (HCC, Asia-Pacific) | Phase III in Asian HCC population โ directly relevant to CancerFax patients. Y-90 numerically superior to sorafenib; established as active and tolerable in Asian patients. |
| PREMIERE Trial (HCC downstaging) | Prospective US study: Y-90 superior to TACE for HCC downstaging to transplant criteria. Landmark result supporting Y-90 as preferred bridge/downstaging tool. |
| NET Liver Metastases Registries (European & Asian) | 80โ90% disease control rates and meaningful symptom reduction with Y-90 SIRT in progressive NET-LM across large prospective registries. |
Key Clinical Numbers
- 80โ90%Disease Control Rate in NET-LMAcross large European and Asian prospective registries for neuroendocrine liver metastases.
- ~50%China's Share of Global HCCApproximately 410,000 new HCC cases annually in China โ the world's highest burden. Largest Y-90 SIRT opportunity.
- 64 hrsY-90 Physical Half-LifeRadiation delivered over ~11 days (five half-lives), then negligible. Minimal whole-body radiation exposure.
- 3โ4 wksTotal China StayMapping angiogram visit + Y-90 treatment visit (1โ3 weeks apart). CancerFax coordinates scheduling to minimise overall travel time.
Benefits vs Limitations of Y-90 SIRT
Benefits
- Valid in portal vein tumour thrombus (PVTT)Unlike TACE, Y-90 can be delivered safely with PVTT โ expanding the eligible patient population significantly.
- Outpatient or short-stay procedureMost patients discharged within 24 hours. No chemotherapy-related bone marrow suppression, hair loss, or severe nausea.
- Proven bridge and downstaging to surgery or transplantPREMIERE trial confirmed superiority over TACE. Y-90 simultaneously induces liver remnant hypertrophy (REILH) while treating disease.
- Combination potential with immunotherapyY-90-induced immunogenic cell death may synergise with checkpoint inhibitors โ active investigation at Chinese and global centres.
Limitations
- Mandatory mapping angiogram โ separate visitCannot be skipped. Confirms lung shunt fraction, anatomy, and safe delivery. Adds 1โ3 weeks to the treatment timeline.
- Requires adequate liver functionChild-Pugh C (severely decompensated) is a contraindication. Bilirubin must typically be below 2 mg/dL.
- Lung shunt fraction may exclude some patientsShunt fraction >20% on mapping significantly increases pulmonary radiation risk and may make treatment unsafe.
- Liver-directed only โ systemic disease needs separate managementY-90 controls liver disease only. Uncontrolled extrahepatic disease reduces the overall clinical benefit.
Y-90 SIRT Cost: China vs USA / Europe
China's Y-90 packages represent 30โ50% of Western pricing for comparable SIR-Spheres or TheraSphere procedures at leading academic centres.
Mapping Angiogram (Pre-Treatment)
Y-90 Microspheres (SIR-Spheres or TheraSphere)
Treatment Procedure + Hospitalisation
Total Estimated Package (All-In)
Related Guides & Treatments
Explore complementary liver-directed therapies and patient access guides.
Frequently Asked Questions โ Y-90 SIRT
Eligibility & Patient Selection
Procedure & Side Effects
Cost & Access via CancerFax
How CancerFax Helps
CancerFax is a specialist cancer access and patient-navigation platform. We help patients and families understand their options, organise medical records, coordinate hospital communication, and support cross-border treatment planning where appropriate.
We help collect and organise reports, scans, pathology, biomarker results, and treatment history for structured case review.
We communicate with hospitals or trial teams to assess whether a case may be suitable for further screening.
We support appointment coordination, document submission, translation, and direct communication with international departments.
For international patients, we help with practical coordination โ travel planning, hospital admission guidance, and local support.
If this option is not suitable, we help explore other relevant treatments, clinical trials, or advanced care pathways.
From inquiry through to follow-up, our coordinators provide a single point of contact for the family.
CancerFax does not guarantee treatment access, eligibility, or clinical outcome. Our role is to help patients access accurate information, structured review, and appropriate specialist pathways.
Is Y-90 Radioembolisation Right for Your Liver Cancer?
Upload your medical reports for a free Y-90 eligibility review โ CancerFax will assess your suitability and connect you with the most appropriate Chinese interventional oncology centre.
This content is for informational purposes only and does not constitute medical advice. Always consult a qualified oncologist before making treatment decisions.