Shannon Kauffman, MD Speaks About Y-90 Video Transcript

Y-90 or Yttruim 90 is a radioactive particle that is either implanted in tiny little beads or on the surface of tiny little beads and we can deliver that to tumors in the liver via the arteries that supply the liver. So those tumors are, have more blood supply to them than the rest of the liver and these little tiny beads get selectively taken up by the chambers and, thus sparing the majority of the normal liver, going to the tumors and irradiating those tumors so that they either shrink or die completely.  And that is for patients who have either primary liver cancer, cancer that started in the liver such as basso cellular carcinoma, or cholangiocarcinoma, or tumors that have spread to the liver from somewhere else like colon cancer. That is one of the most common things that we see. And those tumors are different in the liver in that they take up, they use mostly arterial supply as opposed to the normal liver which has a portal venous supply. And those tumors can then he selectively treated through a small incision in the groin where we feed a catheter up through the arteries -- out into the arteries that supply the liver and deliver those beads.

Yttrium 90 is a very complex procedure. Radio embolization is very complex and we have to be very meticulous.  It's done on a two or three outpatient procedure days. The first day is called the planning arteriogram where we put a small catheter up from the artery overlying the groin. We fish a catheter up into the arteries that supply the liver. We have to basically create a roadmap to decide which tumors are being supplied by what arteries and where the tumors are at. The arterial supply to the upper G.I. tract is very extensive and there are certain blood vessels that we don't want the beads to get into. They will irradiate whatever tissue they get into. So we want to make sure we’re very careful with those and not get beads outside the liver. So there is certain blood vessels that we have to coil. We put little tiny metal coils in to block those off. Arteries that go to the stomach, or to the pancreas, or the duodenum. Once we get that taken care of, we put a test dose of radiation in that helps us calculate the amount of radiation that you'll need to be able to effectively treat those tumors. Then we gather all that data, we calculate a dose specific for that patient and for that section of the liver. And usually in about 7 to 10 days we'll bring the patient back for a repeat arteriogram. We check to make sure all the blood vessels are still blocked off and no new blood vessels have opened up, and as long as that's the case we can put the catheters exactly where we want it and deliver all those beads.

If patients have tumors on both sides of the liver or different arteries that we need to treat, we'll generally wait about a month between treatments. So in about a month we'll bring them back, check liver function studies, make sure everything is going well. We'll go right back up through the same arterial system, put the catheter into a different location and treat again.

Usually, then we'll wait about three months before we do any imaging to see what our effects are on the tumors. Because it's radiation, the radiation lasts about two weeks before it's gone, but it takes time for those tumor cells to die and before we see any change in what's going on with the tumors. It's a very well-tolerated procedure.  It's all outpatient -- home same day. We've not had to keep any patients overnight for this procedure. Very minimal pain with the planner arteriogram itself – we’ve had a little bit of pain in the groin as we take the tube back out, we put a little clip on the artery. Bedrest for anywhere from 2 to 6 hours after the procedure, and then home the same day. No heavy lifting for about three days after the procedure. After the treatment, about 50% of the patients will have some fatigue that lasts anywhere from 3 to 5 to 7 days. They may have some right upper quadrant pain so we send patients home with some pain medicine. Some take it, some don't. They may have a little bit of nausea as well, but otherwise it's a very, very well tolerated treatment. We've had patients go right back to work the next day.

Before this procedure we use conscious sedation. Conscious sedation is made up of two medicines so it kind of put you out in the twilight, similar to other procedures, but there's no general anesthesia requirement. Here at Miami Valley, we were the first to bring this to town and we’ve certainly got the most experience in doing this. We've been doing this for a number of years now and we've seen a large number of patients and that experience, I think, is vitally important in this because it is a very meticulous process to be able to go through the arterial supply and the anatomy that you see is different in almost every patient and to be able to recognize those variants, it's certainly a procedure that requires a lot of experience to do.