Y-90

Ripal T. Gandhi, MD, FSIR, FSVM

Suvranu Ganguli, MD, FSIR

Over the last decade, Yttrium-90 radioembolization has advanced as a treatment for primary and secondary liver tumors in many ways, including better patient selection, improvements in technique, mitigation of complications, dose optimization, and implementation of post treatment imaging including voxel-based dosimetry. With the rapid growth of literature dedicated to radioembolization along with substantial progress in systemic therapies, it can be challenging to stay up to date with clinical decisions, techniques, and management algorithms regarding best practice for different disease entities. This issue of DDI is dedicated to the science and evidence as well as the experience of experts regarding radioembolization.

While radioembolization was initially considered a palliative treatment for primary and metastatic malignancies, its role has expanded significantly. For hepatocellular carcinoma, for example, there is now data to support treating early disease, including serving as a neoadjuvant therapy to induce hepatic hypertrophy prior to resection, bridging and downstaging patients to liver transplantation, and even curing certain patients via radiation segmentectomy.

The advent of immuno-oncology has emerged as a significant advancement in cancer care, and research with immune check-point inhibitors is thriving. Our understanding of combining immunotherapies with locoregional therapies like radioembolization is rudimentary at best. The holy grail in immuno-oncology is the potential to induce an abscopal response; combining immunotherapeutics with Y90 has the potential to enhance antitumor immune response, which needs to be proven through well-conducted clinical trials.

Within this issue, we have articles reviewing product specification and patient selection, radioembolization related to specific disease processes such as metastatic colorectal cancer and breast cancer, and a systemic review of radiation-based therapies for hepatocellular carcinoma. We also have articles addressing where radioembolization is heading, with articles on office-based radioembolization, radioembolization outside the liver, and the status of Holmium-166 radioembolization.

Yttrium-90 radioembolization continues to evolve and we realize that this issue is by no means comprehensive. We hope that the articles within provide the reader important updates and encourage further research in this exciting field to ultimately improve the outcomes for our patients.

Publication History

Article published online:
09 June 2021