Last reviewed by Dr. Dharmender Malik on 13 May 2026 · this article reflects the published evidence and current clinical practice at FMRI Gurugram.
Introduction
Yttrium-90 radioembolization — also known as transarterial radioembolization (TARE) or selective internal radiation therapy (SIRT) — is a targeted radiation therapy delivered into the liver via the hepatic artery. It uses tiny glass or resin microspheres loaded with the beta-emitting radioisotope Yttrium-90 to deliver a high local radiation dose directly to liver tumours while largely sparing normal liver tissue. The therapy has matured over more than two decades into a standard option for several liver cancer scenarios, with a strong evidence base and a well-defined patient selection framework.
This guide is a comprehensive clinical walk-through of Y-90 radioembolization — what it is, how it works, who qualifies, what the planning and treatment days involve, what the recovery period looks like, and where the outcomes data stands. It is written for patients and families considering the therapy, and for referring physicians who want a current overview.
The science: how Y-90 works in liver tumours
The liver has a unique blood supply: most of its blood comes from the portal vein (carrying blood from the gut), while the hepatic artery contributes a smaller fraction. Liver tumours, in contrast, draw most of their blood supply from the hepatic artery. This biological quirk is what makes intra-arterial therapy possible — an interventional radiologist can selectively deliver a therapeutic agent into the artery feeding a tumour, and the tumour will receive far more of it than the normal liver does.
Y-90 microspheres are very small (20 to 60 micrometres in diameter) — small enough to lodge in the small tumour vessels but large enough not to pass through into the systemic circulation. Once lodged, they deliver beta radiation over a tissue range of approximately 2 to 11 millimetres, treating the tumour cells in the immediate vicinity. The half-life of Y-90 is 64.1 hours, so most of the therapeutic effect is delivered over the first one to two weeks after the procedure.
Which liver cancers are treated with Y-90
Y-90 radioembolization is used in three main settings: hepatocellular carcinoma (HCC) that is unresectable or not suitable for transplant in the immediate term; intrahepatic cholangiocarcinoma (bile duct cancer arising in the liver); and liver metastases from a variety of primary cancers, particularly colorectal cancer, neuroendocrine tumours, and some breast and ocular melanoma metastases.
Within HCC, Y-90 has found specific roles. Radiation segmentectomy delivers a very high dose to a single liver segment containing a tumour and can produce complete pathological response, sometimes acting as a curative-intent therapy. Radiation lobectomy uses Y-90 to a whole hepatic lobe with the dual goal of treating tumour and inducing contralateral lobe hypertrophy as a bridge to surgery. Y-90 is also a recognised option for HCC with portal vein tumour thrombus, where TACE is often contraindicated.
The pre-treatment Tc-99m MAA planning scan
Before any Y-90 procedure, a planning step is essential. The interventional radiologist performs a diagnostic angiogram of the hepatic arteries and then injects a small amount of Tc-99m macroaggregated albumin (MAA) — particles of a similar size to the eventual Y-90 microspheres but labelled with a diagnostic isotope. The patient is then scanned with SPECT-CT to map where the Tc-99m MAA distributes.
This planning scan does three critical things. First, it confirms that the microspheres reach the intended tumour areas and not unintended targets. Second, it quantifies any pulmonary shunting — the small fraction of microspheres that may pass through the liver into the lungs — and allows the Y-90 dose to be adjusted or the procedure cancelled if the shunt is too high. Third, it identifies any non-target hepatic arteries that could deliver microspheres to the stomach or duodenum; if present, these are coil-embolised before Y-90 delivery to prevent radiation gastritis or duodenitis. The Tc-99m MAA scan is the foundation of modern dosimetry-guided Y-90 therapy.
Dosimetry: how the dose is calculated
Modern Y-90 therapy is dosimetry-guided — the dose is calculated based on the specific tumour volume, the perfused liver volume that will receive radiation, the lung-shunt fraction from the planning scan, and the underlying liver function. Older approaches used simpler body-weight-based dose calculations; the contemporary approach uses partition-model or voxel-based dosimetry that aims to deliver a tumour dose of typically 150 to 200 Gray or more while keeping the normal liver dose below thresholds for radiation-induced liver disease.
The DOSISPHERE-01 randomised trial demonstrated that personalised dosimetry-guided Y-90 (aiming for tumour dose ≥ 205 Gy) produced substantially better response rates than standard dosimetry in patients with locally advanced HCC. This is the foundation of contemporary practice.
The procedure and the recovery
The Y-90 procedure itself is performed by the interventional radiologist using fluoroscopic guidance, with arterial access typically from the right femoral or right radial artery. The catheter is advanced into the appropriate hepatic artery branch and the Y-90 microspheres are infused over typically 30 to 60 minutes. The whole procedure usually takes two to three hours including preparation and observation.
Most patients stay in hospital for one night for observation. Common post-procedure experiences include fatigue (often lasting two to four weeks), mild-to-moderate post-embolisation syndrome (fever, right-upper-quadrant pain, nausea — milder than after TACE), and transient increase in liver enzymes. Most patients are back to their usual activities within two to three weeks, though full recovery from fatigue can take longer. Follow-up imaging (typically a multiphase CT or MRI) is scheduled at one to three months to assess response.
Outcomes and where Y-90 fits
For HCC, modern dosimetry-guided Y-90 achieves response rates of approximately 60 to 80 percent depending on tumour size, location, and dose. For HCC with portal vein tumour thrombus, where TACE is generally contraindicated, Y-90 has demonstrated meaningful disease control and survival benefit. For colorectal liver metastases that have failed systemic chemotherapy, Y-90 in the EPOCH and SIRFLOX trials showed prolonged hepatic progression-free survival but mixed evidence for overall survival benefit — its role is now anchored in salvage rather than first-line metastatic disease. For neuroendocrine tumour liver metastases, Y-90 produces meaningful tumour reduction and symptom control in many patients, alongside or sequenced with PRRT.
At FMRI Gurugram, Y-90 radioembolization is delivered through a multidisciplinary Liver Tumour Board that reviews each candidate's case before proceeding. The team includes hepatology, interventional radiology, nuclear medicine, surgical oncology, transplant surgery, and medical oncology. The aim is the right therapy for the right tumour pattern at the right time — sometimes Y-90, sometimes TACE, sometimes systemic therapy, and sometimes a combination.
For patients & referring clinicians
Frequently asked questions
Q01
What is Yttrium-90 radioembolization?
Yttrium-90 radioembolization (also called TARE or SIRT) is a targeted radiation therapy for liver cancer. Tiny microspheres loaded with the beta-emitting radioisotope Yttrium-90 are delivered into the liver via the hepatic artery by an interventional radiologist. The microspheres lodge in the small tumour vessels and deliver radiation locally over about two weeks. The procedure is typically a one-time intervention per liver segment treated.
Q02
Which liver cancers can be treated with Y-90?
Y-90 is used for hepatocellular carcinoma (HCC), particularly when the tumour is unresectable or when patients are being considered for transplant; intrahepatic cholangiocarcinoma (bile duct cancer); and liver metastases from a variety of primaries, especially colorectal cancer and neuroendocrine tumours. Specific Y-90 strategies — radiation segmentectomy, radiation lobectomy, and treatment of HCC with portal vein tumour thrombus — have particular roles.
Q03
What is the pre-treatment planning scan?
Before Y-90 delivery, a Tc-99m macroaggregated albumin (MAA) SPECT-CT scan is performed. This planning scan confirms that the microspheres will reach the intended tumour areas, quantifies any pulmonary shunting, and identifies any non-target arteries that need pre-embolisation. The scan is essential — it is what allows Y-90 to be delivered safely. If the planning scan shows excessive lung shunting or unmanageable non-target distribution, the procedure may be modified or cancelled.
Q04
How is the dose calculated?
Modern Y-90 therapy uses personalised dosimetry — the dose is calculated based on the specific tumour volume, the perfused liver volume, the lung-shunt fraction from the planning scan, and the underlying liver function. The aim is typically a tumour dose of 150 to 200 Gy or more, while keeping the normal liver dose below thresholds for radiation-induced liver disease. The DOSISPHERE-01 trial established that personalised dosimetry produces substantially better outcomes than older standardised approaches.
Q05
What does the recovery look like?
Most patients stay in hospital for one night after Y-90 delivery. Common post-procedure experiences are fatigue (often lasting two to four weeks), mild-to-moderate post-embolisation syndrome (fever, right-upper-quadrant pain, nausea), and transient elevation of liver enzymes. Most patients return to their usual activities within two to three weeks, though fatigue can persist longer. Follow-up imaging at one to three months assesses tumour response.
Q06
What are the main side effects?
Common side effects are fatigue, post-embolisation syndrome (fever, pain, nausea), and transient liver enzyme elevation. Less common but important side effects relate to radiation reaching non-target tissues: radiation pneumonitis (from lung shunting — screened for in the planning scan), radiation gastritis or duodenitis (from non-target hepatic artery branches — addressed by pre-procedure coil embolisation), and radiation-induced liver disease (rare in modern dosimetry-guided practice). Thorough planning is what keeps these complications uncommon.
Q07
What is the cost in India?
At FMRI Gurugram, Y-90 radioembolization is typically in the indicative range of INR 9 to 14 lakh per procedure, including the planning angiogram and MAA scan, the dosimetric planning, the Y-90 microspheres, the procedural delivery, and the inpatient observation. Final pricing is confirmed after the planning workup is complete and the dose is determined. The procedure compares favourably to similar procedures in the United States, where total costs are typically in the range of USD 60,000 to 100,000.
Citations & references
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): a randomised, multicentre, open-label phase 2 trial.
Lancet Gastroenterol Hepatol. 2021;6(1):17-29.
ReferenceSalem 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.
Reference
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.