Patient Guide · TARE / Y-90

What is transarterial radioembolization (TARE)?

Yttrium-90 radioembolization — what it is, how the procedure actually works, who is a candidate, the multidisciplinary Optimal Medical Therapy (OMT) workflow, expected side effects, and published outcomes for hepatocellular carcinoma and liver metastases. A sourced patient guide.

Dr. Ishita B. Sen, MDDirector & Chief, Nuclear Medicine · FMRI

Published 13 May 2026

Reviewed by Dr. Dharmender Malik

13 min read

Last reviewed by Dr. Dharmender Malik on 13 May 2026 · this article reflects the published primary literature and current clinical practice at FMRI Gurugram.

Introduction

Transarterial radioembolization (TARE) — also called Y-90 radioembolization or selective internal radiation therapy (SIRT) — is a locoregional therapy for liver tumours that delivers Yttrium-90-loaded microspheres directly into the hepatic artery branches feeding the tumour^[1]. The microspheres lodge in the small tumour vessels and deliver intense beta radiation over approximately 11 days (the Y-90 half-life is 64.1 hours). This article covers what TARE actually is, how the procedure works, who it is appropriate for, what the multidisciplinary workup involves, and what published outcomes look like for hepatocellular carcinoma (HCC) and selected liver metastases.

How TARE works — the biology and physics

AI Overview · short answer

TARE exploits a key feature of liver tumour biology: HCC and most liver metastases derive their blood supply almost entirely from the hepatic artery, while normal liver parenchyma derives most of its blood from the portal vein. By injecting Y-90-loaded microspheres into the hepatic artery, the radiation is selectively concentrated in tumour tissue, sparing most of the normal liver^[2].

The microspheres are approximately 20-30 micrometres in diameter (glass or resin), small enough to travel through the hepatic arterial tree into the tumour microvasculature, large enough to lodge there permanently. Y-90 is a pure beta emitter with a tissue range of approximately 2.5 mm (similar to Lu-177), which provides intense local radiation while sparing surrounding normal tissue^[3].

Two commercial Y-90 microsphere products are in current clinical use:

SIR-Spheres (Sirtex) — resin microspheres, lower specific activity, larger number of particles per dose.
TheraSphere (Boston Scientific) — glass microspheres, higher specific activity, smaller number of particles per dose^[4].

Who is TARE appropriate for

Established indications for TARE include^[5]:

Hepatocellular carcinoma (HCC) — particularly intermediate (BCLC stage B) and selected advanced (BCLC stage C) disease, in patients not eligible for surgery or transplant; also bridging therapy for transplant candidates and downstaging therapy for those just outside transplant criteria.
Metastatic colorectal cancer with liver-dominant disease — typically after first-line systemic chemotherapy progression, in selected patients.
Neuroendocrine tumor liver metastases — selected patients, particularly when PRRT is unavailable or insufficient.
Intrahepatic cholangiocarcinoma — selected patients as part of multidisciplinary care.

Contraindications and cautions include severe liver dysfunction (Child-Pugh C cirrhosis), arteriovenous shunting that would direct microspheres to lungs (assessed by Tc-99m MAA mapping scan), bilirubin > 2 mg/dL in most protocols, and active extra-hepatic disease that is uncontrolled^[6].

Optimal Medical Therapy (OMT) — the multidisciplinary workflow

Audit governance · the OMT framework

TARE is not a stand-alone procedure — it is a component of a multidisciplinary Optimal Medical Therapy (OMT) workflow that involves interventional radiology, hepatology, medical oncology, surgical oncology, transplant hepatology, and nuclear medicine specialists. The pre-procedure mapping scan, dosimetry calculation, and post-procedure surveillance are all part of the OMT framework. Stand-alone TARE without multidisciplinary review is not considered current standard of care.

The typical OMT workflow:

Multidisciplinary tumour board review — confirms TARE candidacy, excludes better alternatives (surgery, transplant, systemic therapy), and defines treatment intent (curative-intent downstaging, palliative disease control, etc.).
Cross-sectional imaging — contrast-enhanced CT or MRI of the abdomen with multi-phase liver protocols, plus chest CT for staging.
Pre-procedure mapping angiography — diagnostic angiogram with technetium-99m MAA injection to map the hepatic arterial anatomy and quantify lung shunt fraction. Patients with lung shunt fraction > 20% are generally excluded; intermediate shunt fractions may require dose reduction^[7].
Dose calculation — personalised dosimetry based on tumour volume, perfused liver volume, and target activity. The DOSISPHERE-01 trial established that personalised dosimetry (targeted to deliver ≥ 205 Gy to tumour) substantially improves outcomes versus standard dosimetry^[8].
TARE procedure — typically 1-3 weeks after the mapping scan, delivered via femoral or radial arterial access.
Post-procedure surveillance — clinical review at 4 weeks, contrast-enhanced cross-sectional imaging at 3 months for first response assessment, then every 3-6 months as clinically indicated.

The procedure day — what happens

TARE is delivered as an inpatient procedure or extended day procedure under conscious sedation. The procedure itself takes 60-120 minutes:

Vascular access — typically right common femoral artery, occasionally radial artery, with a small puncture under local anaesthetic.
Catheterisation — a small catheter is advanced through the aorta into the hepatic artery and then super-selectively into the artery feeding the tumour (or the lobe containing the tumour, depending on the planned approach).
Microsphere injection — the Y-90 microsphere dose is delivered through the catheter into the target arterial branch, typically over 10-20 minutes with intermittent flow checks.
Post-procedure imaging — bremsstrahlung SPECT or Y-90 PET-CT confirms microsphere distribution and informs dose verification^[9].
Recovery — typically 4-6 hours of bed rest after femoral access, then mobilisation. Most patients are discharged the same day or the following morning.

Side effects and recovery

The expected side-effect profile from TARE:

Side effect	Frequency (any grade)	Typical timing & resolution
Post-embolisation syndrome (fatigue, mild nausea, abdominal discomfort, low-grade fever)	~40-70%	1-2 weeks post-procedure; resolves with supportive care
Fatigue (more prolonged)	~40%	Often peaks at 2 weeks; resolves over 4-6 weeks
Right upper quadrant pain	~30-50%	First 24-72 hours; managed with analgesia
Nausea / loss of appetite	~30%	Days 1-7; anti-emetic supportive care
Mild liver function derangement	~20-30%	Self-limiting in most cases
Radioembolisation-induced liver disease (REILD)	~4-8%	Weeks 4-8; can be serious in cirrhotic patients
Gastrointestinal ulceration (from non-target embolisation)	~1-2%	Weeks 1-4; minimised by careful mapping
Cholecystitis (cystic artery embolisation)	~1-2%	Minimised by careful mapping

Most patients resume normal activities within 1-2 weeks. Compared to transarterial chemoembolisation (TACE), TARE typically produces less acute post-embolisation pain but a longer-tailed fatigue profile. For a direct comparison see our TARE vs TACE guide^[10].

Published outcomes — HCC and liver metastases

Published TARE outcomes vary by disease type and treatment intent^[11]^[12]:

Setting	Median OS	Key trial / evidence
HCC (BCLC B/C) with personalised dosimetry	26.6 months	DOSISPHERE-01 (personalised dosimetry arm)
HCC (BCLC B/C) with standard dosimetry	10.7 months	DOSISPHERE-01 (standard dosimetry arm)
HCC bridging to liver transplant	Comparable or improved to TACE bridging	Cohort studies; transplant survival 70-80% at 5 years
Metastatic CRC, liver-dominant, refractory	9-12 months	SIRFLOX, FOXFIRE pooled analysis
NET liver metastases	2-4 year survival, response in 50-90%	Multiple cohort studies; ENETS guidelines

The DOSISPHERE-01 trial is particularly noteworthy because it demonstrated that personalised dosimetry — adjusting the Y-90 activity to deliver at least 205 Gy to the tumour — substantially improved outcomes versus standard dosimetry. This is now the standard approach at experienced centres^[8].

TARE in the broader treatment pathway

TARE fits into the overall hepatocellular carcinoma and liver-dominant metastases treatment pathway as follows^[13]:

Early HCC (BCLC 0/A) — surgical resection, ablation (RFA/MWA), or transplant. TARE may have a role for selected patients ineligible for these.
Intermediate HCC (BCLC B) — TACE or TARE are standard locoregional options. TARE may be preferred for larger tumours, portal vein thrombosis (where TACE is contraindicated), or when curative-intent downstaging is the goal.
Advanced HCC (BCLC C) with portal vein invasion — TARE can be used in selected patients alongside systemic therapy (atezolizumab + bevacizumab, lenvatinib, or sorafenib).
Bridging to liver transplant — TARE is an established bridging strategy alongside TACE; selected centres use TARE preferentially for radiation lobectomy with curative intent^[14].
Metastatic colorectal cancer liver-dominant disease — TARE has a defined salvage role after systemic chemotherapy progression, particularly for patients with liver-dominant disease.

For TARE in the specific context of transplant candidates, see our transplant-bridging guide.

The bottom line

TARE delivers Y-90 microspheres into the hepatic artery branches feeding liver tumours, exploiting the difference in blood supply between tumour (arterial) and normal liver (portal venous).
The DOSISPHERE-01 trial established that personalised dosimetry (≥ 205 Gy tumour dose) substantially improves outcomes — median OS 26.6 vs 10.7 months in BCLC B/C HCC^[8].
TARE is part of a multidisciplinary OMT workflow involving interventional radiology, hepatology, medical oncology, and surgical / transplant teams — not a stand-alone procedure.
The most common side effects are post-embolisation syndrome (fatigue, mild nausea, abdominal discomfort) and prolonged fatigue; most patients recover within 1-2 weeks. Radioembolisation-induced liver disease (REILD) affects ~4-8% and is serious in cirrhotic patients^[15].
Established indications include intermediate/advanced HCC, transplant bridging, metastatic colorectal cancer (liver-dominant, refractory), NET liver metastases, and selected cholangiocarcinoma.

Important

This article is general patient education. Whether TARE is appropriate for any individual patient depends on the specific liver tumour type, distribution, liver function reserve, prior treatments, and treatment goals. TARE candidacy and dosing require multidisciplinary tumour board review and dedicated nuclear medicine workup.

"The most important conversation I have about TARE is not about the procedure itself — it is about where it fits in the broader treatment pathway. TARE is rarely the only answer for a liver tumour; it is a component of a multidisciplinary plan that typically includes systemic therapy, sometimes surgery, sometimes transplant, sometimes ablation. The DOSISPHERE-01 data made one thing very clear: personalised dosimetry matters enormously, and a centre that does TARE without personalised dosimetry is delivering yesterday's standard of care."

Dr. Ishita B. Sen, MD · Director & Chief, Nuclear Medicine, FMRI

TARE candidacy review · multidisciplinary discussion

Whether TARE is appropriate for a liver tumour depends on tumour type, distribution, liver function, prior treatments, and treatment goals. FMRI's multidisciplinary team — interventional radiology, hepatology, medical oncology, and nuclear medicine — can review your specific case as part of an Optimal Medical Therapy workflow.

Discuss TARE for your case · WhatsApp +91 8800 988936

For patients & referring clinicians

Frequently asked questions

Q01 What is TARE?

TARE stands for transarterial radioembolization — also called Y-90 radioembolization or selective internal radiation therapy (SIRT). It is a locoregional liver therapy that delivers Yttrium-90-loaded microspheres directly into the hepatic artery branches feeding a liver tumour. The microspheres lodge in the tumour microvasculature and deliver intense localised beta radiation over approximately 11 days [1].

Q02 How does TARE work?

TARE exploits the fact that liver tumours derive their blood supply almost entirely from the hepatic artery, while normal liver derives most of its blood from the portal vein. By injecting Y-90-loaded microspheres (20-30 micrometres) into the hepatic artery, the radiation is concentrated selectively in tumour tissue while sparing most of the normal liver [2]. The microspheres also produce a mild embolic effect by lodging in tumour vessels.

Q03 Who is a candidate for TARE?

Established TARE candidates include patients with intermediate/advanced hepatocellular carcinoma (BCLC B/C) not eligible for surgery or transplant, transplant candidates needing bridging therapy, downstaging candidates just outside transplant criteria, metastatic colorectal cancer with liver-dominant disease after systemic chemotherapy progression, selected NET liver metastases, and selected intrahepatic cholangiocarcinoma cases [5]. Candidacy requires multidisciplinary tumour board review.

Q04 What is the difference between TARE and TACE?

TACE (transarterial chemoembolisation) delivers chemotherapy (typically doxorubicin) plus an embolic agent. TARE (transarterial radioembolization) delivers Y-90 radiation via embedded microspheres. TARE produces less acute post-embolisation pain but a longer-tailed fatigue profile. TARE can be used in portal vein thrombosis (where TACE is contraindicated). The choice depends on tumour characteristics, liver function, and treatment intent [10].

Q05 What is the OMT framework for TARE?

OMT stands for Optimal Medical Therapy — the multidisciplinary workflow that TARE is part of. TARE is not a stand-alone procedure; it requires interventional radiology, hepatology, medical oncology, surgical/transplant oncology, and nuclear medicine input. The OMT workflow includes multidisciplinary tumour board review, cross-sectional imaging, pre-procedure mapping angiography, personalised dosimetry calculation, the procedure itself, and post-procedure surveillance.

Q06 What is personalised dosimetry and why does it matter?

Personalised dosimetry calculates the Y-90 activity needed to deliver a specific tumour dose (typically ≥ 205 Gy) based on tumour volume, perfused liver volume, and lung shunt fraction. The DOSISPHERE-01 randomised trial showed that personalised dosimetry substantially improved median overall survival versus standard dosimetry (26.6 vs 10.7 months in BCLC B/C HCC) [8]. Personalised dosimetry is now standard at experienced centres.

Q07 Is TARE painful?

Most patients experience minimal pain during the TARE procedure itself, which is performed under conscious sedation. Right upper quadrant pain in the first 24-72 hours is common (~30-50%) and is typically managed with standard analgesia. Compared to TACE, TARE typically produces less acute post-procedure pain. Some patients experience post-embolisation syndrome (mild nausea, abdominal discomfort, low-grade fever, fatigue) over the first 1-2 weeks [10].

Q08 How long does it take to recover from TARE?

Most patients are discharged the same day or the following morning. Acute post-procedure symptoms (pain, mild nausea, low-grade fever) typically resolve within 3-7 days. Fatigue often peaks at 2 weeks and resolves over 4-6 weeks. Most patients resume normal activities within 1-2 weeks. The first response assessment imaging is typically performed at 3 months post-procedure.

Q09 What is REILD?

REILD stands for radioembolisation-induced liver disease — a delayed liver dysfunction occurring 4-8 weeks after TARE in approximately 4-8% of patients. It is characterised by jaundice, ascites, and elevated liver enzymes without disease progression. REILD is more common in cirrhotic patients and those receiving high cumulative liver doses. Careful patient selection and personalised dosimetry reduce REILD risk [15].

Q10 How long does Y-90 stay radioactive?

Y-90 has a physical half-life of 64.1 hours (approximately 2.7 days). After approximately 11 days (5 half-lives), virtually all radiation has decayed. Patients are mildly radioactive immediately after the procedure but the radiation is very locally contained (range ~2.5 mm in tissue), so external radiation exposure to others is minimal. Standard guidance from the IAEA includes avoiding prolonged close contact with children and pregnant women for approximately a week [3][7].

Q11 Can TARE cure liver cancer?

TARE is not generally a curative therapy in isolation, but it can play a role in curative-intent strategies. Radiation lobectomy with TARE — where one hepatic lobe is fully treated to induce hypertrophy of the contralateral lobe — can downstage some patients to potentially curative surgery. TARE bridging to liver transplant can lead to long-term cure when transplant is successful. For most patients with advanced HCC or metastatic disease, TARE is a disease-control therapy [13][14].

Q12 Is TARE available in India?

Yes — TARE is available at a small number of Indian tertiary centres with established interventional radiology and nuclear medicine programmes, including FMRI Gurugram. Delivery requires the full OMT workflow: multidisciplinary tumour board review, pre-procedure mapping angiography with Tc-99m MAA, personalised dosimetry calculation, the procedure itself, and post-procedure surveillance. Costs and availability vary by institution.

Citations & references

All clinical numbers above are sourced from the primary literature listed below. Every reference links to the open journal page or the FDA archive — open in a new tab to verify.

[1] Salem R, Lewandowski RJ. Chemoembolization and radioembolization for hepatocellular carcinoma. Clin Gastroenterol Hepatol. 2013;11(6):604-611. View source ↗

[2] Breedis C, Young G. The blood supply of neoplasms in the liver. Am J Pathol. 1954;30(5):969-977. View source ↗

[3] Kennedy A, Nag S, Salem R, et al. Recommendations for radioembolization of hepatic malignancies using yttrium-90 microsphere brachytherapy: a consensus panel report from the radioembolization brachytherapy oncology consortium. Int J Radiat Oncol Biol Phys. 2007;68(1):13-23. View source ↗

[4] Westcott MA, Coldwell DM, Liu DM, et al. The development, commercialization, and clinical context of yttrium-90 radiolabeled resin and glass microspheres. Adv Radiat Oncol. 2016;1(4):351-364. View source ↗

[5] Reig M, Forner A, Rimola J, et al. BCLC strategy for prognosis prediction and treatment recommendation: The 2022 update. J Hepatol. 2022;76(3):681-693. View source ↗

[6] Mahnken AH, Spreafico C, Maleux G, et al. Standards of practice in transarterial radioembolization. Cardiovasc Intervent Radiol. 2013;36(3):613-622. View source ↗

[7] Salem R, Lewandowski RJ, Sato KT, et al. Technical aspects of radioembolization with ⁹⁰Y microspheres. Tech Vasc Interv Radiol. 2007;10(1):12-29. View source ↗

[8] Garin E, Tselikas L, Guiu B, et al. Personalised versus standard dosimetry approach of selective internal radiation therapy in patients with locally advanced hepatocellular carcinoma (DOSISPHERE-01). Lancet Gastroenterol Hepatol. 2021;6(1):17-29. View source ↗

[9] Lhommel R, Goffette P, Van den Eynde M, et al. Yttrium-90 TOF PET scan demonstrates high-resolution biodistribution after liver SIRT. Eur J Nucl Med Mol Imaging. 2009;36(10):1696. View source ↗

[10] Salem R, Gordon AC, Mouli S, et al. Y90 Radioembolization Significantly Prolongs Time to Progression Compared With Chemoembolization in Patients With Hepatocellular Carcinoma. Gastroenterology. 2016;151(6):1155-1163. View source ↗

[11] Salem R, Johnson GE, Kim E, et al. Yttrium-90 Radioembolization for the Treatment of Solitary, Unresectable HCC: The LEGACY Study. Hepatology. 2021;74(5):2342-2352. View source ↗

[12] Mosconi C, Solaini L, Vara G, et al. Transarterial Chemoembolization and Radioembolization for Unresectable Intrahepatic Cholangiocarcinoma. Cardiovasc Intervent Radiol. 2020;43(11):1644-1655. View source ↗

[13] Llovet JM, Castet F, Heikenwalder M, et al. Immunotherapies for hepatocellular carcinoma. Nat Rev Clin Oncol. 2022;19(3):151-172. View source ↗

[14] Salem R, Padia SA, Lam M, et al. Clinical and dosimetric considerations for Y90: recommendations from an international multidisciplinary working group. Eur J Nucl Med Mol Imaging. 2019;46(8):1695-1704. View source ↗

[15] Sangro B, Bilbao JI, Boan J, et al. Radioembolization using ⁹⁰Y-resin microspheres for patients with advanced hepatocellular carcinoma. Int J Radiat Oncol Biol Phys. 2006;66(3):792-800. View source ↗

[16] Riaz A, Awais R, Salem R. Side effects of yttrium-90 radioembolization. Front Oncol. 2014;4:198. View source ↗

[17] Sangro B, Carpanese L, Cianni R, et al. Survival after yttrium-90 resin microsphere radioembolization of hepatocellular carcinoma across Barcelona Clinic Liver Cancer stages. Hepatology. 2011;54(3):868-878. View source ↗

[18] Wasan HS, Gibbs P, Sharma NK, et al. First-line selective internal radiotherapy plus chemotherapy versus chemotherapy alone in patients with liver metastases from colorectal cancer (FOXFIRE, SIRFLOX, FOXFIRE-Global). Lancet Oncol. 2017;18(9):1159-1171. View source ↗

[19] Memon K, Lewandowski RJ, Mulcahy MF, et al. Radioembolization for neuroendocrine liver metastases: safety, imaging, and long-term outcomes. Int J Radiat Oncol Biol Phys. 2012;83(3):887-894. View source ↗

[20] Padia SA, Lewandowski RJ, Johnson GE, et al. Radioembolization of Hepatic Malignancies: Background, Quality Improvement Guidelines, and Future Directions. J Vasc Interv Radiol. 2017;28(11):1457-1473. View source ↗

[21] Lewandowski RJ, Donahue L, Chokechanachaisakul A, et al. ⁹⁰Y radiation lobectomy: outcomes following surgical resection in patients with hepatic tumors. J Surg Oncol. 2016;114(1):99-105. View source ↗

[22] Vouche M, Lewandowski RJ, Atassi R, et al. Radiation lobectomy: time-dependent analysis of future liver remnant volume in unresectable liver cancer as a bridge to resection. J Hepatol. 2013;59(5):1029-1036. View source ↗

[23] Garin E, Lenoir L, Edeline J, et al. Boosted selective internal radiation therapy with ⁹⁰Y-loaded glass microspheres (B-SIRT) for hepatocellular carcinoma patients. Eur J Nucl Med Mol Imaging. 2013;40(7):1057-1068. View source ↗

[24] Cremonesi M, Chiesa C, Strigari L, et al. Radioembolization of hepatic lesions from a radiobiology and dosimetric perspective. Front Oncol. 2014;4:210. View source ↗

[25] Kim DY, Park BJ, Kim YH, et al. Radioembolization with Yttrium-90 Resin Microspheres in Hepatocellular Carcinoma: A Multicenter Prospective Study. Am J Clin Oncol. 2015;38(5):495-501. View source ↗

[26] Vilgrain V, Pereira H, Assenat E, et al. Efficacy and safety of selective internal radiotherapy with yttrium-90 resin microspheres compared with sorafenib in locally advanced and inoperable hepatocellular carcinoma (SARAH). Lancet Oncol. 2017;18(12):1624-1636. View source ↗

[27] Chow PKH, Gandhi M, Tan SB, et al. SIRveNIB: Selective Internal Radiation Therapy Versus Sorafenib in Asia-Pacific Patients With Hepatocellular Carcinoma. J Clin Oncol. 2018;36(19):1913-1921. View source ↗

[28] Salem R, Mazzaferro V, Sangro B. Yttrium 90 radioembolization for the treatment of hepatocellular carcinoma: biological lessons, current challenges, and clinical perspectives. Hepatology. 2013;58(6):2188-2197. View source ↗

[29] European Association for the Study of the Liver. EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma. J Hepatol. 2018;69(1):182-236. View source ↗

[30] Marrero JA, Kulik LM, Sirlin CB, et al. Diagnosis, Staging, and Management of Hepatocellular Carcinoma: 2018 Practice Guidance by the AASLD. Hepatology. 2018;68(2):723-750. View source ↗

[31] Bilbao JI, Reiser MF, eds. Liver Radioembolization with ⁹⁰Y Microspheres. Springer Medical Radiology series. 2014. View source ↗

[32] Boas FE, Bodei L, Sofocleous CT. Radioembolization of Colorectal Liver Metastases: Indications, Technique, and Outcomes. J Nucl Med. 2017;58(Suppl 2):104S-111S. View source ↗

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.

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