New technology for liver cancer treatment-Y90 treatment, selective in vivo radiotherapy

Traditional liver cancer treatment relies on surgery combined with radiotherapy and chemotherapy, methods that carry significant limitations. With the advancement of medical technology, more targeted approaches are increasingly being used in clinical settings — and yttrium-90 (Y90) microsphere therapy is one of the most promising among them. First developed in Australia in 1998, Y90 was approved by the US FDA in 2002 for liver metastasis of colorectal cancer, by the EU in 2003 for surgically unresectable liver cancer patients, and by Taiwan in 2011.

Yttrium-90 microspheres are tiny spheres embedded with radioactive material capable of emitting beta rays. They can be carried in glass microspheres or lipids, with a radiation range of only 1.1 cm and a short half-life of approximately 64 hours. The microspheres are delivered through a catheter into the blood vessels supplying nutrients to the tumor, where they settle in the tiny arteries within the tumor and provide close-range, high-dose beta-ray radiation directly to the liver tumor over approximately two weeks — emitting 94% of their radiation energy within the first 11 days and less than 2.5% after 14 days.

Compared to conventional external radiation therapy, which is limited to approximately 30 gray of energy due to the risk of damaging surrounding normal tissue, transarterial radioembolization using Y90 can deliver energy as high as 150 gray directly to the tumor. Combined with angiography technology to improve positioning accuracy, this approach significantly increases local tumor lethality, reduces treatment side effects, and causes less toxic injury than chemotherapy — achieving a more effective overall treatment outcome.

One of the most significant clinical benefits of yttrium-90 therapy is its ability to serve not only as a primary treatment modality but also as an important auxiliary step in the broader liver cancer treatment journey. After receiving Y90 therapy, some liver cancer patients who were initially deemed inoperable experienced sufficient tumor shrinkage to eventually become eligible for surgical removal. In this way, Y90 in vivo radiotherapy can act as a bridge to surgery — opening a path to potentially curative treatment for patients who would otherwise have had no surgical options.

However, not all liver cancer patients are suitable candidates for yttrium-90 therapy. It is generally not recommended for patients with cholangiocarcinoma, patients with colorectal liver metastases that are not treatable by surgery and have not responded to chemotherapy, or patients with breast cancer liver metastases who have failed multiple lines of chemotherapy. As with all cancer treatments, symptomatic and individualized treatment remains the most important principle — and for the general population, strengthening the prevention of liver cancer through healthy lifestyle habits continues to be the most essential long-term strategy.