TARE

TARE — transarterial radioembolisation, also called Y-90 radioembolisation — treats liver tumours from the inside of the blood supply. Tiny glass or resin beads carrying the radioactive isotope yttrium-90 are injected into the hepatic artery branches that feed the tumour, lodge there, and irradiate it from within. It is performed by an interventional radiologist through a catheter, not by a surgeon through an incision.

What it is used for

Hepatocellular carcinoma, the commonest primary liver cancer. Cancer that has spread to the liver from elsewhere. Cholangiocarcinoma, cancer of the bile ducts. It is aimed particularly at tumours that cannot be removed surgically, and at patients who are not fit for an operation — which is the situation it exists to answer.

Why it takes two visits

The first is a mapping procedure, and it is not optional. A hepatic angiogram maps the arterial anatomy of your liver, which varies more between people than most anatomy does. Then a dose of technetium-99m macroaggregated albumin — particles of a similar size to the treatment beads, but harmless — is injected and scanned, to see where they actually go. The purpose is to measure how much would shunt through to the lungs, and to identify any vessel that would carry beads to the stomach or bowel. Only after that is the treatment dose calculated and the second procedure booked. Skipping this step is how radiation reaches the wrong organ.

The treatment itself

The catheter is repositioned in the hepatic artery and the yttrium-90 microspheres are delivered. It takes roughly three to four hours depending on where the tumour sits and how extensive it is. Afterwards there is an inpatient stay of about four to five days, and part of the reason is radiation protection — you are briefly a source, and the precautions are for the people around you rather than for you.

Afterwards

Fatigue, nausea, vomiting and abdominal pain are common in the days that follow and usually settle. Less commonly there is bleeding at the catheter site, radiation reaching healthy liver or adjacent organs, deterioration in liver function, or a fall in white cells or platelets. Follow-up imaging is done to see how the tumour has responded, and TARE is frequently one part of a plan rather than the whole of it — chemotherapy, ablation, resection or transplant may sit alongside it. Ask who is coordinating that plan, because a procedure done in isolation from an oncology team is a procedure without a next step.