Yttrium-90
A radioactive metal that fires high-energy particles a short distance into surrounding tissue. Millions of microscopic beads carrying it are injected into the artery feeding a liver tumour, where they lodge and irradiate the tumour from inside.
Overview
Yttrium-90 is a near-pure beta emitter (a small pair-production fraction allows PET imaging of its distribution) that decays to stable zirconium-90 with a physical half-life of 64.1 hours (2.67 days). Its beta particles have a mean energy near 0.93-0.94 MeV, a mean tissue range of about 2.5 mm and a maximum of roughly 11 mm, and 94% of the total dose is delivered within about 11 days.
It is the workhorse isotope of liver radioembolisation (TARE/SIRT): glass microspheres (TheraSphere) with 90Y built into the glass matrix, and resin microspheres (SIR-Spheres) with 90Y bound to the surface, are delivered via a hepatic-artery catheter and become permanently embedded in and around the tumour. It is also used, chelated to peptides and antibodies, for radioligand and radioimmunotherapy (e.g. ibritumomab tiuxetan).
90Y for microsphere manufacture is produced either by decay of its 28.8-year fission-product parent strontium-90 (chemically separated as it decays) or by direct reactor neutron activation of stable yttrium-89. Because the parent Sr-90/generator route and direct reactor activation are both well established at multiple sites, supply for the approved microsphere products is generally adequate.
- β− average 0.93-0.94 MeV, maximum 2.28 MeV
- DOTA
Theranostic partners
- Technetium-99m · The single most widely used medical radioisotope: a metastable metal with a six-hour lifetime, milked on demand from a bedside generator (a 'moly cow') and attached to a cold kit to image bone, heart, kidneys or lymph nodes.
Tiny plastic beads carrying a radioactive, slightly magnetic metal are injected into the artery feeding a liver tumour. Because the metal shows up on both nuclear scans and MRI, doctors can check exactly where the beads went.
Zevalin is an antibody carrying a radioactive isotope that seeks out CD20 on lymphoma cells. It treats follicular lymphoma that has relapsed and is given as a one-off consolidation after chemotherapy.
A cancer-targeting antibody carrying a radioactive form of iodine was used, as a single course, to treat a type of blood cancer called non-Hodgkin lymphoma. The manufacturer stopped selling it in 2014 because too few patients were using it.
Tiny clumps of albumin, a normal blood protein, tagged with a radioactive marker and injected into a vein. They wedge briefly in the smallest blood vessels of the lung wherever blood is flowing, so the scan maps the lung's blood supply; the clumps then break up and clear.
Microscopic glass beads containing a radioactive metal are injected into the artery that supplies a liver tumour. The beads stay in place permanently and give off radiation that fades away within about two weeks.
Tiny radioactive beads are injected through a small tube into the artery that feeds the liver. They lodge in the tumour and give it radiation from the inside, mostly sparing the rest of the liver.
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