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Technical and procedural innovations in Y-90 radioembolization including existing and investigational next-generation technologies.

Yttrium-90 (Y-90) transarterial radioembolization (TARE), also known as selective internal radiation therapy (SIRT), has been used for the treatment of primary and secondary liver cancer for decades. This therapy has greatly advanced since the seminal publications on the clinical, technical, and procedural aspects of Y-90 therapy.1-3 Numerous subsequent studies have confirmed the safety and efficacy of Y-90 therapy, resulting in significant growth in its use. Multidisciplinary recognition of the value of Y-90 therapy is highlighted by its inclusion in the National Comprehensive Cancer Network guidelines as a category 2A recommended therapy for colon and rectal cancer liver metastases.4 This, as well as a key institution’s multidisciplinary team’s decision to choose Y-90 as first-line therapy for hepatocellular carcinoma (HCC),5 should lead to continued growth and adoption. This article describes technical and procedural innovations in Y-90 radioembolization and introduces promising next-generation investigational technologies for this well-established and effective therapy.