Name of the Procedure:

Common Name: Yttrium-90 Brachytherapy
Technical Term: Brachytherapy source, non-stranded, yttrium-90, per source (HCPCS Code: C2616)

Summary

Yttrium-90 brachytherapy is a type of internal radiation therapy where small amounts of radioactive yttrium-90 are placed directly inside or near a tumor. This localized treatment delivers high doses of radiation to the cancerous area while sparing surrounding healthy tissues.

Purpose

Yttrium-90 brachytherapy is used primarily to treat various types of cancers, including liver cancer, brain tumors, and prostate cancer. The main goal is to destroy cancer cells, shrink tumors, and prevent the spread or recurrence of the disease.

Indications

• Localized solid tumors such as liver cancer (hepatocellular carcinoma)
• Brain tumors (glioblastomas)
• Prostate cancer
• Patients with tumors that are not amenable to surgery or external beam radiation therapy

Preparation

• Patients may need to undergo imaging tests like MRI or CT scans to locate the tumor.
• Fasting may be required for a certain number of hours before the procedure.
• Medication adjustments might be necessary, especially if on blood thinners.
• Consent forms and pre-procedure educational sessions are often conducted.

Procedure Description

1. The patient is positioned appropriately, depending on the tumor location.
2. Under imaging guidance, a catheter or applicator is precisely inserted to the tumor site.
3. Yttrium-90 sources are loaded into the catheter and placed around or inside the tumor.
4. The radiation delivery is monitored and adjusted as needed.
5. After the treatment duration, the catheter is removed.

Tools and Technology:

• Imaging technologies (CT, MRI, Ultrasound)
• Catheters and applicators
• Radiation delivery and monitoring systems

Anesthesia:

• Local anesthesia or light sedation may be used to enhance comfort during the procedure.

Duration

The procedure typically takes between 1-3 hours, depending on the tumor's size and location.

Setting

Yttrium-90 brachytherapy is usually performed in a hospital or a specialized outpatient clinic equipped with advanced radiology and radiation therapy facilities.

Personnel

• Interventional radiologist or radiation oncologist
• Radiology technologists
• Nursing staff
• Anesthesiologist (if sedation is used)

Risks and Complications

Common Risks:

• Localized pain or discomfort at the insertion site
• Mild bleeding or bruising

Rare Risks:

• Infection at the catheter insertion site
• Misplacement of radioactive sources
• Radiation-induced injury to adjacent healthy tissues

Benefits

• Effective local control of tumors with fewer side effects compared to external beam radiation
• Shorter recovery times
• Higher doses of radiation can be delivered directly to the tumor

Recovery

• Post-procedure monitoring for a few hours or overnight, depending on the procedure complexity.
• Pain relief medications as needed.
• Restrictions on physical activities for a few days.
• Follow-up appointments for imaging and assessment of treatment effectiveness.

Alternatives

• External beam radiation therapy: Non-invasive but may affect surrounding tissues more.
• Surgical resection: Removes the tumor physically but is more invasive.
• Systemic chemotherapy: Treats the entire body but has more widespread side effects.

Patient Experience

During the procedure, patients might feel pressure or mild discomfort due to the catheter insertion. Post-procedure, localized pain and a slight discomfort are common, which can be managed with pain medication. Most patients resume normal activities within a few days, although fatigue may persist for a short while. Regular follow-ups ensure proper recovery and monitor treatment outcomes.