Radioembolisation for liver tumours

Could this treatment help me?

Radioembolisation may be considered for selected cancers starting in the liver or cancers that have spread there. The team reviews how much liver is affected, liver function, blood-vessel anatomy, disease elsewhere and other options.

Ask what the goal is: controlling liver disease, relieving symptoms, or another specific aim within a broader treatment plan. Not everyone with liver tumours is suitable. It does not necessarily replace surgery, medicines that travel throughout the body, or other treatments directed at the tumour.

Preparing and planning treatment

• Ask whether mapping and treatment are separate visits and how far apart they are expected to be.
• Tell the team about kidney disease, pregnancy, breastfeeding, infection or difficulty lying flat. Mention any previous reaction to contrast dye, which helps blood vessels show on scans.
• Obtain a plan for blood-thinning medicines and diabetes treatment. Do not stop either independently.
• Follow fasting instructions. Here fasting may be needed because of sedation (medicine to help you relax or feel drowsy) or the procedure.
• Arrange a responsible adult to take you home if sedation is planned, and ask about supervision afterwards.
• Bring the requested blood results and medicines list, and check how other cancer treatment fits around the procedure.

Your team should discuss both radiation effects and the risks associated with entering an artery, contrast dye and sedation.

The mapping appointment

Before treatment, an interventional radiologist (a doctor who performs treatments guided by medical images) studies the liver's blood supply. A thin tube, called a catheter, is placed through an artery at the wrist or groin. Contrast dye makes the vessels visible on X-rays.

During mapping, a small amount of a radioactive tracer, usually technetium-99m macroaggregated albumin (Tc-99m MAA), is injected through the catheter and followed by a scan. These tiny labelled protein particles act as a test run to show where the treatment beads are likely to travel.

This includes a lung shunt assessment. Some blood can pass through the tumour’s vessels and carry particles towards the lungs. The scan estimates how much could reach the lungs and checks for uptake in other organs. These findings help the team decide whether treatment is suitable and plan the radiation dose to the tumour while protecting healthy liver and lungs. If needed, they may adjust the plan or recommend another treatment.

The planning tracer tests where particles may travel; it does not deliver the radioembolisation treatment. Its purpose is to help make the treatment safer and more appropriately targeted.

On treatment day

The skin is numbed with local anaesthetic, and sedation may help you relax. A catheter is guided into the appropriate liver artery and the tiny radioactive beads are delivered. Staff monitor you throughout. Imaging may be used afterwards to check where treatment has gone.

When the catheter is removed, the artery puncture needs pressure or a closure device. You rest while staff check for bleeding, pain and other concerns. Some people go home the same day; others stay overnight or longer. The timing depends on the procedure and recovery.

Side effects and when to call

Tiredness, reduced appetite, nausea, mild fever or abdominal discomfort can occur. Ask which symptoms are expected, how to take prescribed medicines and when to contact the team. Energy may take time to return, so arrange help with demanding tasks.

More serious complications can include liver injury, stomach or bowel injury if radiation reaches the wrong place, infection, and lung injury. The mapping and dose planning aim to reduce these risks, but cannot remove them completely.

Going home and follow-up

Care of the artery puncture: follow instructions for the dressing, showering, activity, lifting and signs of bleeding or infection. If sedation was given, follow the driving, alcohol, machinery and adult-supervision restrictions in the discharge advice.

Radiation precautions: the beads remain in the liver while their radioactivity gradually fades. Your team will explain the precautions for the type of beads used.

Ask whether any restrictions affect young children, pregnant household members, work or travel and obtain the end dates in writing.

Checking the response

Follow-up includes symptoms, liver blood tests and imaging, often computed tomography (CT) or magnetic resonance imaging (MRI). Imaging changes develop over time and can be complicated by treatment effects. An early scan does not always give a simple answer about success or failure.

Before discharge, know your first review date and whether blood tests are needed sooner. Continue the rest of your cancer care according to the agreed plan.

Questions you may have