Yttrium-90 microspheres (TheraSphere and SIR-Spheres) for the treatment of unresectable hepatocellular carcinoma.

(1) Microspheres containing radioactive yttrium-90 (90Y) are infused into the hepatic artery. These deliver high doses of ionizing radiation to inoperable hepatocellular carcinoma, the most common type of primary liver cancer. (2) Limited evidence from several case series indicates that palliative therapy with 90Y microspheres may reduce tumour size and increase survival time. (3) In some patients, 90Y treatment may result in enough tumour reduction to permit liver resection or transplantation. (4) While 90Y microsphere therapy is generally well tolerated, major complications and several treatment-related deaths have occurred. Improved patient selection criteria and technical changes to microsphere delivery have reduced the risks of complications and death. (5) Patient selection and the technical aspects of 90Y microsphere treatment are complex and require the coordinated expertise of a multidisciplinary team.