At a glance
Y-90 radioembolization is a minimally invasive treatment that delivers tiny radioactive beads directly into the blood vessels feeding a liver tumor, killing cancer cells from the inside.
A doctor threads a thin tube called a catheter through an artery in the wrist or groin and guides it into the hepatic artery (the main blood vessel supplying the liver). Millions of microspheres, each about the width of a human hair, are then released. The beads lodge in the small vessels around the tumor and emit yttrium-90 radiation over roughly two weeks, destroying tumor tissue while largely sparing the healthy liver around it.
Medical Condition
Y-90 radioembolization is used when liver tumors cannot be removed by surgery or need to be controlled before surgery becomes an option.
- Hepatocellular carcinoma (HCC), the most common type of primary liver cancer
- Metastatic liver disease, meaning cancer that started elsewhere (commonly the colon, breast, or neuroendocrine system) and spread to the liver
- Cholangiocarcinoma (cancer arising from the bile ducts inside the liver)
- Tumors that have grown too large or are too close to major blood vessels for surgery to be safe
- Patients waiting for a liver transplant, where the goal is to shrink or stabilize tumors within transplant criteria
- Situations where a tumor has not responded well to chemotherapy or ablation (heat-based tumor destruction)
Y-90 radioembolization is not suitable for everyone. A detailed workup is done before a decision is made.
- Patients whose liver has severe cirrhosis (scarring) with very poor remaining liver function
- Cases where imaging shows that a significant amount of radiation would reach the lungs, raising the risk of lung injury
- Tumors where blood flow cannot be directed safely away from the bowel or stomach
- Patients who are pregnant or who have uncorrectable blood-clotting problems
- Certain cases where the tumor has blocked the main portal vein (the other major vessel entering the liver), though some specialized centers do treat selected patients with this condition
Risks & Complications
Y-90 radioembolization is generally well tolerated, but like any procedure that delivers radiation and blocks blood flow inside the body, it carries recognized risks.
- Post-embolization syndrome: fatigue, low-grade fever, nausea, and abdominal discomfort in the days after the procedure, which is the most common side effect
- Radiation-induced liver disease (RILD): inflammation of the healthy liver tissue caused by radiation exposure, ranging from mild to, rarely, severe
- Inadvertent radiation to nearby organs such as the stomach, bowel, or gallbladder if tiny vessels connecting the liver to those organs are not identified and protected beforehand
- Radiation pneumonitis (lung inflammation) if a measurable dose reaches the lungs, which is why a pre-treatment lung-shunting test is always done first
- Biloma (a pocket of bile that collects outside the bile duct) or bile duct injury
- Bruising, bleeding, or a small blood clot at the catheter entry point in the wrist or groin
- Temporary worsening of liver function test results, which usually stabilizes over weeks
- In patients with already reduced liver reserve, a risk of significant liver failure
Preparation & Procedure
Preparation for Y-90 radioembolization happens in two separate sessions, sometimes weeks apart: a planning angiogram first, then the actual treatment.
Before the planning session, most patients are asked to stop blood thinners and certain other medications for a number of days. Your medical team will give specific guidance. You will stop eating and drinking (except small sips of water) for at least six hours before each session. Smoking and alcohol are best avoided in the weeks leading up to treatment, as both can affect liver function and healing.
The tests typically ordered beforehand include blood work to check liver function, kidney function, and clotting; cross-sectional imaging such as CT or MRI to map the tumor and its blood supply; and a nuclear medicine lung-shunting study to confirm that the dose reaching the lungs will be within safe limits.
- Step 1 (Planning session): A radiologist (an imaging and procedure specialist) makes a small puncture in the wrist or groin artery under local anesthesia. A catheter is guided into the hepatic artery using X-ray guidance.
- Step 2 (Planning session): The doctor maps all the arteries feeding the tumor and identifies any vessels that connect to the stomach, bowel, or gallbladder. Those vessels are often coiled off (blocked with tiny metal coils) to protect nearby organs.
- Step 3 (Planning session): A small dose of a temporary tracer is injected to predict how the Y-90 beads will spread and to measure how much dose leaks toward the lungs. Nuclear medicine imaging is done within hours.
- Step 4: The results are reviewed by a multidisciplinary team. If the lung shunting is acceptable and the plan is safe, the treatment date is scheduled, usually one to four weeks later.
- Step 5 (Treatment session): The catheter procedure is repeated. This time, the actual Y-90 microspheres are released into the target artery under real-time X-ray monitoring.
- Step 6: The catheter is removed and the entry point is compressed or sealed. The patient moves to a recovery area for monitoring, typically for several hours.
Aftercare
Most patients go home the same day or after one night in hospital, but the weeks that follow require attention to symptoms, activity limits, and follow-up imaging.
- Radiation precautions: for the first few days after treatment, patients are advised to stay at least one meter away from pregnant women and young children for prolonged periods, and to sleep in a separate bed if possible. The radiation dose from normal social contact is low, but hospitals provide a written guide.
- Fatigue and flu-like symptoms are common in the first one to two weeks. Rest is expected and encouraged.
- Pain or tenderness over the right upper abdomen (where the liver sits) may last several days and is usually managed with oral pain relief prescribed by the treating team.
- The catheter entry site in the wrist or groin should be kept dry and checked for swelling, unusual bruising, or discharge.
- Blood tests are typically repeated at four to six weeks to monitor liver function and check for any treatment-related changes.
- Cross-sectional imaging (CT or MRI) is usually performed at around four to six weeks, then at regular intervals, to assess how the tumor has responded.
- Strenuous exercise and heavy lifting are usually restricted for at least one to two weeks after the procedure.
- Alcohol should be avoided during recovery, as the liver is under additional stress from the radiation.
- The treating team will advise on when and whether further Y-90 sessions, other local treatments, or systemic therapies are appropriate based on the imaging response.
Cost & What Determines It
Y-90 radioembolization is among the more expensive interventional oncology procedures because it combines a specialized medical device, a nuclear medicine planning study, an interventional radiology procedure room, and a multidisciplinary care team, all of which vary significantly in price depending on where treatment is received.
- Type and brand of microspheres: two different Y-90 bead products are in clinical use worldwide, and they are priced differently; the choice depends on tumor characteristics and center preference
- Number of treatment sessions: some patients need only one session, while others require separate sessions for the right and left sides of the liver, effectively doubling the procedure cost
- Extent and complexity of the tumor: larger or more widespread tumors may require more beads and longer procedure time
- Hospital class and country: a university hospital with a dedicated interventional oncology program in a high-cost country charges considerably more than an equivalent center in a country with lower operating costs
- Pre-treatment nuclear medicine lung-shunting study and planning angiogram: these are billed as separate procedures in many hospitals
- Additional imaging (CT or MRI) done at the treating facility before and after the procedure
- Length of hospital stay: day-case versus overnight admission changes the total bill
- Anesthesia or sedation team fees, which may be charged separately from the radiologist's fee
- Supportive medications during and after the procedure, including those for pain, nausea, and infection prevention
Hospital packages, where offered, typically include the procedure room, the microspheres themselves, fluoroscopy (live X-ray) time, nursing care during the stay, and basic post-procedure blood tests. Items commonly billed separately include the pre-treatment planning angiogram, nuclear medicine imaging, follow-up CT or MRI scans, outpatient consultations, and any medications dispensed for home use.
BPJS Kesehatan does not cover treatment received outside Indonesia, and most Indonesian private health insurance policies exclude overseas care as well. Patients who travel abroad for Y-90 radioembolization almost always pay from personal funds or through a private international health insurance plan that explicitly covers cancer treatment abroad. Before travelling, ask the hospital for a written itemized cost estimate that covers both the planning session and the treatment session separately, so there are no unexpected charges on arrival.
Frequently Asked Questions
How many sessions of Y-90 Radioembolization will I need?
Most patients receive one session per affected lobe of the liver, so the total is usually one or two sessions. The liver has two main lobes, and if tumors are present in both, doctors typically treat one side first and wait several weeks before treating the other. Your care team will decide the exact schedule based on how the tumors are distributed and how your liver responds.
What does Y-90 Radioembolization feel like during and after the procedure?
During the procedure you are sedated and should feel little to nothing, as a thin flexible tube called a catheter is guided through a small opening in your wrist or groin into the blood vessels feeding the tumor. Afterward, many patients experience fatigue, mild nausea, or a low-grade fever for one to two weeks, a pattern doctors call post-embolization syndrome. Pain in the upper abdomen is also possible and is usually managed with standard pain relief.
How soon will I know if Y-90 Radioembolization is working?
Doctors typically assess the response four to six weeks after the procedure using imaging scans such as MRI or CT. The microspheres, tiny radioactive beads, keep delivering radiation to the tumor tissue over about two weeks after treatment, so changes take time to appear on scans. Some patients see measurable results at the first follow-up, while others require a longer observation period before a clear picture emerges.
How much does Y-90 Radioembolization cost?
The cost varies considerably because it depends on factors like the number of lobes treated, the specific type and quantity of the radioactive microspheres used, the hospital class, and the length of observation or hospital stay required. The microspheres themselves are a specialized medical device and tend to be a significant part of the total expense. Requesting a written estimate directly from the hospital is the most reliable way to get a figure that reflects your individual situation.
This page is general information, not a substitute for medical advice. Every case is different. Your doctor decides what is right for you.
