KHSC expands liver cancer treatment with cutting-edge Y90 therapy

Kingston Health Sciences Centre (KHSC) is now home to one of the most advanced treatments for liver cancer in Canada. Named after the radioactive isotope it uses, Yttrium-90, (Y-90) it’s a minimally invasive procedure that precisely delivers a knockout blow to tumors from within.   

Y-90 therapy uses advanced image guidance to navigate a catheter through the patient’s arteries to place microscopic radioactive glass beads, smaller than the diameter of human hair, directly inside tumors. The beads then emit radiation, killing the cancer cells from the inside while preserving nearby healthy tissue.  

Y-90 matters because it has the ability to cure, convert and control cancers. Firstly, it can be used to cure certain types of liver cancer. It can also ‘convert’ by shrinking tumors down to a size where surgery becomes a curative option. If curative intent is not an option, it can control cancer, giving patients precious time.

– Dr. Emidio Tarulli

Compared to surgery or conventional external radiation therapy, Y-90 has fewer side-effects and faster recovery. It’s performed over two outpatient appointments, so patients can go home at the end of the day. 

“We were frequently identifying patients who could benefit from this therapy but were unable to travel out of the region due to their condition,” says Tarulli. “This is the Interventional Radiology and Nuclear Medicine teams at KHSC stepping up to deliver an international standard of liver cancer care in Kingston.” 

The Y-90 program fills an important gap in liver cancer treatments, giving patients in the southeastern Ontario region access to this kind of personalized care, making KHSC one of the earliest of adopters in Canada. 

Precision treatment requires teamwork  

Y-90 treatment requires absolute precision. The radioactive beads, or “microspheres,” are each around 15-25 micrometres in diameter. Between 1.2 -8 million beads fit inside a treatment vial and, while that sounds like a lot, it’s usually smaller than the measurement of a teaspoon. It’s the size of the beads that allows for a level of precision that keeps nearby organs safe and preserves more healthy liver tissue compared to surgery or conventional radiation. 

On the first visit, a mapping angiogram is performed in an Interventional Radiology (IVR) suite, which is then followed by a nuclear medicine scan which allows the team to create a personalized treatment plan for each patient.   

During the second visit, the treatment is delivered in IVR followed by another nuclear medicine scan to confirm the dose reached the tumor.  

The Y-90 team consists of over 40 staff across multiple departments, and the entire process takes weeks of planning for something that has a delivery window of only a few hours. Everyone from the scheduling clerks and patient navigators to the medical radiation technologists plays a part in making sure the process goes smoothly.  

“The logistical challenge is a big part of the accomplishment here,” says Tarulli. “The multiple timed appointments to deliver the customized dose to each patient at the right time requires a massive, coordinated effort between our IVR, Computed Tomography (CT) and Nuclear Medicine departments. We’ve been able to treat more patients than anticipated since starting the program because our teams are so well integrated.”