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TARE (Trans Arterial Radio Embolisation) or Y90 Treatment: Advanced Technique for Liver Cancer Management

TARE (Trans Arterial Radio Embolisation) or Y90 Treatment: Advanced Technique for Liver Cancer Management

By Dr. Shahnawaz B. Kaloo in Interventional Radiology

Jun 27 , 2023 | 3 min read

TARE is recommended for treating intermediate and advanced stages of liver cancer (hepatocellular carcinoma or HCC). TARE involves targeted deposition of the radioactive isotope Yttrium (Y90) deep inside the cancer by angiography. The deposited Y90 radioactive isotope emits gamma radiation, killing the cancer cells in its vicinity.

TARE (Y90 treatment) is a minimally invasive treatment involving targeted delivery of anti-cancer radioisotopes directly into the cancer blood supply to kill cancer. TARE is done via angiography, i.e. a catheter is inserted into a blood vessel (usually through the femoral artery in the groin), and the same catheter is guided towards the liver under the guidance of X-rays in an angiography suite.
Once the catheter reaches the liver, it is further guided into the blood vessel supplying the cancer. Radioactive Y90 particles are injected through the catheter precisely into this blood vessel to deliver them into the cancer. The Y90 particles deposited emit gamma radiation which kills cancer. The entire process is done under local anaesthesia.
TARE treatment is done in 2 steps, about a week apart. Step 1 includes angiography of the liver and studying the blood supply to the cancer. This is followed by injecting technetium-labelled albumin (called MAA) into the cancer and studying its distribution pattern. Step 1 focuses on calculating the dose of Y90 required for successful and safe TARE treatment. The entire process takes a few hours, and once all the calculations are done, the patient is discharged from the hospital.
Before step 2 of the TARE treatment, Y90 medicine is procured from the manufacturer. It is noteworthy that Y90 has a short shelf life (t 1/2 = 2.7 days), and as such, it is generally not stored in the hospital but freshly ordered and freshly used.
Once the Y90 dose arrives in the hospital (1-2 weeks after step 1), step 2 of the TARE treatment can be performed. Angiography of the liver is performed again. A catheter is placed in the liver where the cancer is located, and Y90 radioactive particles are precisely delivered to the corresponding area. The entire process is done under local anaesthesia and takes about an hour. This completes the TARE treatment.
TARE is well tolerated by the patients, and side effects of TARE are usually mild. The common side effects may include acidity, fatigue or weakness etc.
Three months after the TARE treatment, some blood tests and a scan (usually Triple phase Contrast CT scan or MRI scan) are done to assess the results of the treatment. A majority of the patients should have excellent responses to the treatment.
TARE has several advantages; it has very mild side effects, it needs short hospital stay, the results are usually better than other forms of treatment, and it can be done even in advanced stages of cancer, even when cancer has spread in the veins of the liver (portal vein).

Frequently Asked Questions

What precautions are to be observed after TARE?

The puncture site is monitored after the procedure for any bleeding or hematoma formation. Patients must stay in bed for 6 to 8 hours if the puncture site is groin. If the puncture site is the wrist, patients can walk right after the treatment.
Why is step 1 (MAA) needed in TARE treatment?

Step 1 of TARE calculates the dose of Y90 needed for successful treatment. Also, it is done to assess the safety of the TARE treatment in each patient by studying any shunts which can leak the Y90 medicine to other areas of the body, especially the lungs and stomach.
What is the difference between external radiation and Y90 treatment?

TARE treatment delivers the source of the radiation (i.e. Y90 radioactive particles) deep into the cancer bed, and it affects the tissues only in its vicinity. External radiation has to cross the skin and boy wall to reach into deep-located cancer.
Do I need to stay in isolation after TARE treatment because of the radiation emitted by Y90?

No, isolation from family members is not needed after TARE treatment.
How many times is TARE treatment required for liver cancer?

It is mostly performed only once and does not need repeated treatment cycles.

Note: TARE treatment is an individualised treatment. The above description refers to the commonly encountered scenarios and is modified as per the patient's needs.