Last reviewed by Dr. Dharmender Malik on 14 May 2026 · this article reflects the published primary literature and current clinical practice at FMRI Gurugram.
Introduction
Yttrium-90 (Y-90) is a beta-emitting radioisotope used in a procedure called transarterial radioembolization (TARE) — also known as selective internal radiation therapy (SIRT). The procedure delivers millions of microscopic radioactive spheres directly into the hepatic arterial supply of liver tumours, allowing a very high local radiation dose to be delivered to the tumour while sparing surrounding liver tissue. Y-90 TARE has been studied across hepatocellular carcinoma (HCC), liver metastases from colorectal cancer, and neuroendocrine tumour (NET) liver metastases. This article sets out, with primary-literature sourcing, how Y-90 works, who it's offered to, what the workup and procedure-day experience look like, and the expected side-effect profile.
The physics of Y-90 — why it works for liver tumours
AI Overview · short answer
Yttrium-90 (Y-90) is a beta-emitting radioisotope (half-life ~64 hours) delivered as microscopic resin or glass microspheres into the hepatic artery to treat liver tumours by transarterial radioembolization (TARE). Because primary liver tumours and most liver metastases are preferentially supplied by hepatic arterial blood (whereas normal liver is supplied mostly by the portal vein), Y-90 microspheres lodge selectively in tumour microvasculature and deliver a high local radiation dose[1]. The most-studied indications are hepatocellular carcinoma (HCC), neuroendocrine tumour (NET) liver metastases, and colorectal liver metastases. Major published trials include LEGACY (HCC), DOSISPHERE-01 (HCC dosimetry), SIRFLOX, FOXFIRE, FOXFIRE-Global (colorectal liver metastases), and SARAH (HCC)[2][3].
Yttrium-90 is a beta-emitter with a half-life of approximately 64 hours and a mean tissue penetration of 2.5 mm (maximum 11 mm)[1]. The short range of the beta particles means radiation deposited in tumour tissue does not extend deeply into surrounding normal liver parenchyma, allowing very high local doses to be delivered safely. The half-life is long enough to deliver a sustained dose over approximately two weeks of decay but short enough that the patient is no longer radioactive after that.
The clinical rationale for hepatic-arterial delivery is anatomical. Healthy liver receives most of its blood supply from the portal vein. Liver tumours — both primary HCC and metastatic deposits — derive most of their blood supply from the hepatic arterial system. Microspheres loaded with Y-90 are infused into the hepatic arterial branches supplying the tumour, where they lodge in tumour microvasculature and deliver local beta radiation. The surrounding non-tumour liver, fed primarily by portal flow, receives much less of the Y-90[4].
The two types of Y-90 microspheres
Two FDA-approved Y-90 microsphere products are in clinical use[5]:
| Product | Material | Activity per sphere | Typical use |
|---|
| SIR-Spheres (Sirtex) | Resin microspheres | Lower activity per sphere; more spheres delivered per dose | Approved for unresectable metastatic colorectal liver disease; widely used for HCC |
| TheraSphere (Boston Scientific) | Glass microspheres | Higher activity per sphere; fewer spheres per dose | HMDE (humanitarian device exemption) and approval for unresectable HCC; also used for selected liver metastases |
Both products deliver Y-90 to the same intended location with similar clinical objectives. The choice between them is determined by tumour anatomy, vascular characteristics, treatment plan (radiation segmentectomy vs lobar TARE), and centre preference. Both have been studied in major clinical trials and have established outcomes data[6].
Who Y-90 TARE is typically offered to
Y-90 TARE is offered for liver-confined or liver-dominant tumour burden in carefully selected patients[7]:
- Unresectable hepatocellular carcinoma — particularly BCLC stage A patients ineligible for transplant or resection (radiation segmentectomy), BCLC stage B (intermediate) patients with adequate liver function, and selected BCLC stage C patients with portal vein tumour thrombosis.
- Neuroendocrine tumour liver metastases — both pancreatic NET and small-bowel NET liver-dominant disease, particularly where PRRT is being sequenced or as a hepatic disease-control measure.
- Colorectal liver metastases — typically as third-line or salvage therapy after progression on systemic chemotherapy, or as part of multimodal management.
- Intrahepatic cholangiocarcinoma — selected unresectable cases, particularly when locoregional control is the priority.
- Other liver metastases — including from breast cancer, melanoma, and sarcoma, in carefully selected cases with multidisciplinary review.
Critical eligibility considerations include adequate liver function (Child-Pugh A or selected B7), preserved performance status, the absence of substantial extra-hepatic disease, and acceptable lung shunt fraction on pre-treatment workup[8].
Pre-procedure workup — the mapping angiography and Tc-99m MAA scan
Every Y-90 TARE procedure is preceded by a mandatory pre-treatment work-up that takes place approximately 1–2 weeks before the actual Y-90 delivery[9]:
- Tri-phasic contrast CT or MRI — to characterise tumour burden, segmental distribution, and vascular anatomy.
- Mapping angiography — a catheter-based angiogram of the hepatic arterial supply to identify variant anatomy and to embolize aberrant vessels (e.g., to the gastroduodenal artery, right gastric artery) that could shunt microspheres to the gut or other extra-hepatic sites.
- Tc-99m MAA scan — Technetium-99m macroaggregated albumin is infused during the mapping angiogram. MAA particles are similar in size to Y-90 microspheres. SPECT/CT imaging then shows where the particles distribute — including any pulmonary shunt (calculated as a lung shunt fraction). A lung shunt fraction below 10% is generally acceptable; higher values may modify or contraindicate the planned dose.
- Dosimetry planning — using the MAA distribution and tumour volume, the medical physicist and nuclear medicine physician calculate the prescribed Y-90 activity, considering tumour-to-normal-liver ratio and the chosen technique (radiation segmentectomy vs lobar treatment).
- Multidisciplinary review — eligibility is reviewed in tumour-board format including hepatology, interventional radiology, medical oncology, and nuclear medicine.
The procedure day — what to expect
Y-90 TARE delivery is a single-day procedure, typically completed under local anaesthesia with conscious sedation[10]:
- Admission — typically same-day or with overnight stay depending on centre protocol.
- Vascular access — femoral or radial arterial access, similar to a coronary or cerebral angiogram.
- Selective catheterisation — the interventional radiologist navigates the catheter into the hepatic arterial branches supplying the tumour, mirroring the mapping angiogram performed earlier.
- Y-90 microsphere infusion — the prescribed dose is infused slowly under fluoroscopic guidance. Patients typically feel little to no sensation during this part of the procedure.
- Post-treatment imaging — Y-90 PET/CT or bremsstrahlung SPECT/CT is performed within 24 hours to confirm intended distribution and to document any extra-hepatic activity.
- Discharge — most patients are discharged the same day or the following morning with anti-emetic and analgesic prescriptions.
The side-effect profile of Y-90 TARE
The side-effect profile of Y-90 TARE is generally favourable compared to other locoregional liver therapies, though specific risks must be discussed in consent[11]:
| Side effect | Frequency & severity | Notes |
|---|
| Post-embolization syndrome | Common; usually mild; resolves within 1–2 weeks | Low-grade fever, fatigue, abdominal discomfort, mild nausea. Less severe than after TACE due to lower particle burden |
| Fatigue | Common; can last weeks | Often the most reported symptom; gradually resolves |
| Radiation-induced liver disease (REILD) | Uncommon but serious; risk varies by liver reserve and dose | More likely in lower liver reserve or whole-liver treatment |
| Cholecystitis | Uncommon | Risk reduced by careful mapping to avoid the cystic artery |
| Gastrointestinal ulceration | Uncommon if mapping is thorough | Risk minimised by embolizing aberrant vessels to the gut at mapping angiography |
| Radiation pneumonitis | Rare | Risk minimised by pre-procedure lung shunt fraction assessment |
| Biliary stricture | Uncommon | More commonly seen in intrahepatic cholangiocarcinoma populations |
Patient selection — adequate liver reserve, careful mapping to occlude aberrant vessels, acceptable lung shunt fraction, and dosimetric planning — is the most important determinant of the safety profile[12].
The evidence base — major published trials
Y-90 TARE has a substantial evidence base across HCC and liver metastases[13]:
- LEGACY (HCC, single-arm) — radiation segmentectomy with TheraSphere in early-stage HCC reported objective response rates of approximately 88% with sustained tumour control[14].
- DOSISPHERE-01 (HCC) — randomised trial showed personalised dosimetry (tumour-absorbed dose ≥205 Gy) improved objective response compared with standard dosimetry[15].
- SARAH (HCC) — randomised trial comparing Y-90 TARE with sorafenib in advanced HCC; overall survival was similar but quality-of-life and tolerability favoured TARE[16].
- SIRveNIB (HCC) — Asian-population randomised trial of TARE vs sorafenib; similar overall survival with differing tolerability and response patterns[17].
- SIRFLOX / FOXFIRE / FOXFIRE-Global (colorectal liver metastases) — randomised first-line trials adding Y-90 TARE to FOLFOX-based chemotherapy showed improved hepatic-specific PFS but did not show overall survival improvement; current use is generally salvage / third-line[18].
- NET liver metastases — multiple retrospective series and prospective cohorts have documented disease control and symptom palliation with Y-90 TARE in liver-dominant NET disease, including alongside PRRT[19].
Recovery and follow-up after Y-90
Most patients recover from Y-90 TARE within 1–2 weeks for routine activities, though fatigue can persist longer[20]:
- First week — post-embolization syndrome (low-grade fever, fatigue, abdominal discomfort, mild nausea) managed with anti-emetics, hydration, and analgesia.
- Weeks 2–4 — gradual return to baseline activity; fatigue often persists as the most prominent residual symptom.
- Liver function monitoring — biochemistry (liver function, kidney function) at 2, 4, and 8 weeks post-treatment.
- Response imaging — first imaging response assessment with multiphasic CT or MRI is typically performed at 6–12 weeks post-treatment. Y-90 response on imaging takes longer to fully manifest than after TACE.
- Re-treatment planning — depending on response and remaining liver reserve, a second Y-90 treatment to the opposite lobe or to recurrent disease may be considered at the multidisciplinary tumour board.
For comprehensive recovery guidance after TARE, including expected symptom timelines and warning signs, see our companion article on TARE recovery and aftercare.
Y-90 vs TACE and other locoregional options
Y-90 TARE is one of several locoregional therapy options for liver-confined tumour burden. The principal alternatives are[21]:
- TACE (transarterial chemoembolization) — delivers chemotherapy plus embolic particles; well-established for intermediate-stage HCC; typically requires multiple sessions; greater post-embolization syndrome than TARE.
- RFA / MWA (thermal ablation) — radiofrequency or microwave ablation; appropriate for small (typically <3–5 cm) tumours suitable for percutaneous needle placement; not appropriate for multiple lesions or proximity to critical structures.
- SBRT (stereotactic body radiation therapy) — external-beam radiation, appropriate for selected smaller tumours and locations.
- Resection and transplantation — curative-intent options where eligible.
- Systemic therapy — including ARPI/ARSI in HCC, chemotherapy, immunotherapy combinations.
For a more detailed comparison of TARE and TACE specifically, see our companion article on TARE versus TACE for HCC and NET patients.
The bottom line
- Y-90 (yttrium-90) is a beta-emitting radioisotope (half-life ~64 hours; mean tissue range 2.5 mm) used in transarterial radioembolization for liver tumours[1].
- Two Y-90 microsphere products are in clinical use: SIR-Spheres (resin) and TheraSphere (glass), both with established outcomes data across HCC and liver metastases[5].
- Indications include unresectable HCC, NET liver metastases (often alongside PRRT), colorectal liver metastases (salvage), and selected other liver-confined tumour burden[7].
- Every Y-90 procedure is preceded by mandatory pre-treatment workup — multiphasic imaging, mapping angiography, Tc-99m MAA SPECT/CT for lung shunt fraction, dosimetry planning, and multidisciplinary review[9].
- Side-effect profile is generally favourable: post-embolization syndrome (common, mild), fatigue (common, can last weeks); REILD, cholecystitis, GI ulceration, and pneumonitis are uncommon when patient selection and mapping are rigorous[11].
- Evidence base includes LEGACY, DOSISPHERE-01, SARAH, SIRveNIB (HCC), SIRFLOX/FOXFIRE (colorectal liver metastases), and multiple NET cohort studies[13].
- Recovery is typically 1–2 weeks for routine activities; first response imaging is at 6–12 weeks; second-side treatment may be planned at multidisciplinary review.
Important
This article is general information about Y-90 radioembolization. Individual eligibility, candidacy, and treatment planning require formal multidisciplinary review including hepatology, interventional radiology, medical oncology, and nuclear medicine. Patient outcomes vary by indication, liver reserve, dose delivered, and individual factors.
"Y-90 radioembolization is not a single decision — it is a sequence of decisions made by a multidisciplinary team. The mapping angiogram, the Tc-99m MAA scan, the lung shunt calculation, the dosimetry plan, and the multidisciplinary review all happen before the patient ever lies on the procedure table. The quality of those upstream decisions, more than the procedure day itself, is what determines outcome and tolerability."
Dr. Ishita B. Sen, MD · Director & Chief, Nuclear Medicine, FMRI
Multidisciplinary review · Y-90 TARE at FMRI
For Y-90 radioembolization at FMRI Gurugram, our team manages a multidisciplinary workflow including hepatology, interventional radiology, medical oncology, and nuclear medicine. Eligibility review covers imaging, liver reserve, vascular anatomy assessment by mapping angiography, Tc-99m MAA SPECT/CT for lung shunt and tumour distribution, and personalised dosimetry planning.
Multidisciplinary enquiry · WhatsApp +91 8800 988936
For patients & referring clinicians
Frequently asked questions
Q01
What is Yttrium-90 (Y-90) used for?
Yttrium-90 (Y-90) is used in transarterial radioembolization (TARE), also called selective internal radiation therapy (SIRT), to treat liver-confined or liver-dominant tumours. The most-studied indications are unresectable hepatocellular carcinoma (HCC), neuroendocrine tumour (NET) liver metastases, and colorectal liver metastases. Y-90 microspheres are delivered into the hepatic arterial supply to lodge in tumour microvasculature and deliver local beta radiation [1][7].
Q02
How does Y-90 selectively target tumours and not healthy liver?
Healthy liver receives most of its blood supply from the portal vein, whereas liver tumours derive most of their blood supply from the hepatic arterial system. Y-90 microspheres infused via the hepatic artery preferentially lodge in tumour microvasculature, while the surrounding normal liver, fed primarily by portal flow, receives much less of the Y-90 dose. The beta particles have a short tissue range (mean 2.5 mm, max 11 mm), further sparing surrounding tissue [1][4].
Q03
What's the difference between SIR-Spheres and TheraSphere?
Both are FDA-approved Y-90 microsphere products. SIR-Spheres (Sirtex) are resin microspheres with lower activity per sphere — more spheres are delivered per dose. TheraSphere (Boston Scientific) are glass microspheres with higher activity per sphere — fewer spheres per dose. The choice between them depends on tumour anatomy, vascular characteristics, treatment plan (radiation segmentectomy vs lobar treatment), and centre preference. Both have established outcomes data [5][6].
Q04
Why is the Tc-99m MAA scan done before Y-90?
Technetium-99m macroaggregated albumin (Tc-99m MAA) is infused during the pre-treatment mapping angiogram. MAA particles are similar in size to Y-90 microspheres. SPECT/CT imaging then shows where the particles distribute — including any pulmonary shunt (calculated as the lung shunt fraction). This determines whether the planned Y-90 dose is safe and whether any vessels need to be embolized to prevent shunting to the gut. A lung shunt fraction below 10% is generally acceptable; higher values modify or contraindicate the planned dose [9].
Q05
What are the side effects of Y-90 TARE?
The most common side effects are post-embolization syndrome (low-grade fever, fatigue, mild abdominal discomfort, nausea — usually mild and resolves within 1–2 weeks) and fatigue (often the most reported symptom, can last weeks). Less common but more serious risks include radiation-induced liver disease (REILD), cholecystitis, gastrointestinal ulceration, and rarely radiation pneumonitis. Patient selection, careful mapping, and dosimetric planning are the most important determinants of the safety profile [11][12].
Q06
How long does the Y-90 procedure take and is it painful?
The Y-90 delivery procedure is typically a single-day intervention done under local anaesthesia with conscious sedation. The total time including preparation, vascular access, selective catheterisation, microsphere infusion, and recovery is usually 2–4 hours. Patients typically feel little to no sensation during the microsphere infusion itself. Mild discomfort at the arterial access site is common. Most patients are discharged the same day or the following morning [10].
Q07
Am I radioactive after Y-90?
Y-90 is a pure beta-emitter with a short tissue range (max 11 mm). Bremsstrahlung X-rays produced by beta decay can be detected externally on imaging, but the external radiation exposure to family members and the public after Y-90 delivery is minimal and typically does not require special precautions beyond brief common-sense distancing for the first few days. Centres provide written discharge counselling on contact precautions and follow-up [10].
Q08
How long does recovery take?
Most patients recover from Y-90 TARE within 1–2 weeks for routine activities. Post-embolization syndrome typically resolves within the first week. Fatigue can persist for several weeks and is often the most prominent residual symptom. Return to work depends on patient role and job demands; some patients return to desk-based work within a week, while more physical roles may take longer. First response imaging is typically performed at 6–12 weeks post-treatment [20].
Q09
How does Y-90 compare to TACE?
Y-90 TARE and TACE (transarterial chemoembolization) are both hepatic-artery-based locoregional therapies for liver tumours but use different mechanisms. TACE combines chemotherapy with embolic particles; TARE delivers radiation via Y-90 microspheres with less embolic effect. TARE generally has a milder post-embolization syndrome, can be used in some patients with portal vein involvement, and may be delivered in 1–2 sessions rather than multiple TACE sessions. Specific choice depends on tumour characteristics, liver reserve, and multidisciplinary review [21].
Q10
Can Y-90 TARE be repeated?
Yes, repeat Y-90 TARE is feasible depending on remaining liver reserve, response to prior treatment, and disease distribution. Treatment of the contralateral lobe (after lobar TARE) is commonly planned. Repeat treatment of recurrent or new disease in previously-treated segments is decided on a case-by-case basis at multidisciplinary review with consideration of cumulative liver dose [13].
Q11
Does Y-90 cure liver cancer?
In selected early-stage HCC patients treated with high-dose radiation segmentectomy (LEGACY trial setting), Y-90 TARE has demonstrated sustained tumour control rates comparable to ablation or resection in some published series [14]. For most patients treated with TARE for unresectable disease, the goal is durable disease control, symptom relief, downstaging to transplant or resection eligibility, or quality-of-life-focused palliation. Whether a specific patient's outcome can reasonably be called 'cure' depends on stage, response, and follow-up, and should be discussed individually with the multidisciplinary team.
Q12
How do I enquire about Y-90 TARE at FMRI?
For Y-90 radioembolization at FMRI Gurugram, our team manages a multidisciplinary workflow including hepatology, interventional radiology, medical oncology, and nuclear medicine. Eligibility review covers imaging, liver reserve, vascular anatomy assessment by mapping angiography, Tc-99m MAA SPECT/CT for lung shunt and tumour distribution, and personalised dosimetry planning. WhatsApp +91 8800 988936 to begin a confidential review.
Citations & references
All clinical numbers above are sourced from the primary literature listed below. Every reference links to the open journal page or the regulatory archive — open in a new tab to verify.
[1] Salem R, Lewandowski RJ. Yttrium-90 radioembolization for the treatment of hepatocellular carcinoma.
Clin Gastroenterol Hepatol. 2013;11(6):604-611.
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Hepatology. 2021;74(5):2342-2352.
View source ↗[3] Garin E, Tselikas L, Guiu B, et al. Personalised vs standard dosimetry for selective internal radiation therapy (DOSISPHERE-01).
Lancet Gastroenterol Hepatol. 2021;6(1):17-29.
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J Vasc Interv Radiol. 2017;28(1):1-15.
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View source ↗[20] Goin JE, Salem R, Carr BI, et al. Treatment of unresectable hepatocellular carcinoma with intrahepatic yttrium-90 microspheres: factors associated with liver toxicities.
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View source ↗[21] Salem R, Lewandowski RJ, Mulcahy MF, et al. Radioembolization for hepatocellular carcinoma using Yttrium-90 microspheres: a comprehensive report of long-term outcomes.
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About the Author
Dr. Ishita B. Sen
MBBS · MD (Nuclear Medicine) · DNB · Post-doctoral Fellowship, Memorial Sloan Kettering Cancer Center, New York
Director and Chief of Nuclear Medicine at Fortis Memorial Research Institute. Co-founder of Theranostic Physicians Private Limited (TPPL). Two decades of clinical practice in PSMA imaging and PSMA-directed radioligand therapy, with one of the largest Indian institutional experiences in Lu-PSMA.