Yttrium-90 Radioembolization Dosimetry: Dose Considerations, Optimization, and Tips

As a form of brachytherapy, yttrium-90 radioembolization (Y90-RE), also known as selective internal radiation therapy (SIRT) or trans-arterial radioembolization (TARE), exerts its locoregional tumoricidal effects by its near-pure emission of beta-particles from the radioactive decay of yttrium-90 ([Table 1]). Since its early therapeutic use for the palliative treatment of patients with advanced unresectable hepatocellular carcinoma (HCC), there has been recognition that the tumor response to Y90-RE will be dependent on the relationship between the delivered activity and dose administered. This appreciation for the importance of dosimetry also stemmed from the recognition that liver toxicity can occur due to delivering "too much dose"—specifically, the recognition of radiation-induced liver disease (RILD).[1]