ModifiedColorado Rocky Mountain Health PlansPolicy 2026T0445CC

Transarterial Radioembolization (TARE)/Selective Internal Radiation Therapy (SIRT) for the Treatment of Malignant Cancers of the Liver

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Coverage of Y-90 TARE/SIRT for selected primary and metastatic liver cancers, including covered indications, clinical requirements, documentation expectations, and noncovered indications.

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ModifiedColorado Rocky Mountain Health PlansPolicy 2026T0445CC

Transarterial Radioembolization (TARE)/Selective Internal Radiation Therapy (SIRT) for the Treatment of Malignant Cancers of the Liver

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Sign up for Colorado Rocky Mountain Health Plans Policy 2026T0445CC alerts

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Coverage of Y-90 TARE/SIRT for selected primary and metastatic liver cancers, including covered indications, clinical requirements, documentation expectations, and noncovered indications.

Policy Summary

PayerColorado Rocky Mountain Health Plans

PolicyTransarterial Radioembolization (TARE)/Selective Internal Radiation Therapy (SIRT) for the Treatment of Malignant Cancers of the Liver

Policy CodePolicy 2026T0445CC

Change TypeModified

Effective DateNovember 1, 2026

Next Review DateNot specified

Key ActionFor adults, document a covered Y-90 TARE/SIRT indication and an ECOG Performance Status of 0, 1, or 2.

SourceLink

POLICY UPDATE CHANGES

The list of proven and medically necessary indications for Y-90 TARE/SIRT was revised.

Policy content and supporting evidence were updated.

6Covered indication categories

0-2Adult ECOG range

19 yearsAge threshold

Y-90Required treatment material

<2 mg/dLLobar or bilobar bilirubin guidance

50%-70%Relative contraindication: liver tumor burden

Covered and Noncovered Indications

Covered adult indications

Covered for individuals age 19 or older when all of the following are met.

Adult covered TARE/SIRT

Covered indication
- Primary hepatocellular carcinoma: Liver-dominant primary hepatocellular carcinoma in an individual who is not a surgical candidate.
- Hepatocellular carcinoma bridge to transplant: Primary hepatocellular carcinoma treated as a bridge to liver transplant.
- Neuroendocrine tumor metastases: Liver metastases from neuroendocrine tumors in an individual who is not a surgical candidate when systemic therapy has failed to control symptoms.
- Colorectal carcinoma metastases: Liver metastases from colorectal carcinoma with chemotherapy-resistant or refractory disease and predominant hepatic metastases.
- Intrahepatic cholangiocarcinoma metastases: Liver metastases from intrahepatic cholangiocarcinoma in an individual who is not a surgical candidate.
- Uveal melanoma metastases: Metastasis from uveal melanoma confined to the liver.

Individuals younger than 19 years

Covered without further review for individuals younger than 19 years of age.

Pediatric coverage: The individual is younger than 19 years of age and is receiving TARE/SIRT using yttrium-90 microspheres.Age < 19 years

Coverage is available without further review; benefit-plan terms still apply.

Unproven and not medically necessary indications

Not medically necessary and unproven for all other indications.

Other indications: The requested yttrium-90 TARE/SIRT indication is not one of the policy's listed covered indications.

TARE/SIRT is considered unproven and not medically necessary because of insufficient evidence of efficacy.

Colorectal liver metastases

NCCN describes Y-90 selective internal radiation as an option for highly selected patients.

Highly selected colorectal cancer patients: The patient has colorectal liver metastases that are chemotherapy-resistant or refractory, with predominant hepatic disease.

NCCN category 2A arterial-directed therapy recommendation.

Colorectal cancer: resectability and remnant liver volume

NCCN identifies a potential radiation lobectomy role when metastatic disease is not optimally resectable.

Potential radiation lobectomy scenarios: Y-90 radioembolization may be considered instead of portal vein embolization when hepatic metastatic disease is not optimally resectable because of insufficient remnant liver volume, or when borderline resectable disease may benefit from tumor downsizing and remnant hypertrophy.

Neuroendocrine liver metastases

Guidelines describe TARE/SIRT as a consideration for selected neuroendocrine liver metastases.

Neuroendocrine tumor liver-directed therapy scenarios: TARE may be considered for lobar or segmental disease distribution, or in patients with prior Whipple surgery or biliary tract instrumentation; NICE recommends SIRT as a treatment option for neuroendocrine tumors metastatic to the liver.

Multidisciplinary selection and treatment in specialized centers are recommended. Late chronic hepatotoxicity is a concern, particularly with bilobar treatment.

Primary hepatocellular carcinoma

AASLD identifies several accepted or potentially useful roles for TARE in hepatocellular carcinoma.

HCC treatment roles: TARE with Y-90 may be used for solitary unresectable HCC; as neoadjuvant liver-directed or bridging therapy to transplant; for subcapsular, subdiaphragmatic, or pericardiac tumors that are challenging for ablation; for microsatellites; for radiation segmentectomy; or as an alternative intra-arterial therapy for intermediate-stage HCC.

No single liver-directed therapy is preferred for bridging to transplant.

Selective or segmental treatment

AASLD guidance supports selective treatment when transarterial therapy is performed.

Treatment approach: When transarterial therapy is performed, treatment should be delivered in a selective or segmental fashion rather than by lobar treatment whenever possible.

This approach is intended to reduce the risk of hepatic dysfunction.

General patient selection

Potentially appropriate when ALL of the following are met.

General SIRT suitability: The patient has an unresectable or inoperable primary or secondary liver malignancy; performance status sufficient to benefit from therapy; liver-dominant tumor burden, which need not be exclusive to the liver; life expectancy of at least 3 months; and laboratory data indicating that the procedure can be performed safely.Life expectancy ≥ 3 months

Multidisciplinary expertise is essential.

Hepatocellular carcinoma

Clinical contexts supported in HCC guidance.

HCC treatment contexts: TARE with Y-90 may be used for solitary unresectable HCC; as neoadjuvant locoregional therapy or bridging therapy to control tumor growth and reduce transplant waitlist dropout; for subcapsular, subdiaphragmatic, pericardiac, or microsatellite disease that may be challenging for ablation; for radiation segmentectomy providing local control or bridging to transplant; or as an accepted alternative intra-arterial therapy for intermediate-stage HCC.

AASLD states that no single locoregional therapy is preferred over another for bridging to transplant; selective or segmental treatment is preferred whenever possible.

Primary and metastatic liver malignancies

ACR-described appropriateness contexts.

Tumor-specific contexts: TARE with Y-90 may be appropriate for a cirrhotic solitary tumor less than 3 cm; peripheral hepatic lobar ICC less than 3 cm without biliary ductal dilatation, macroscopic vascular invasion, regional lymphadenopathy, or distant metastases; hilar cholangiocarcinoma greater than 3 cm with poorly defined margins, vascular invasion, and periportal lymphadenopathy; solitary colorectal liver metastasis; multifocal bilobar colorectal carcinoma that is liver-dominant or isolated; multifocal metastatic neuroendocrine tumor; a cirrhotic solitary tumor 3 to 5 cm; cirrhotic multifocal bilobar disease with at least one tumor greater than 5 cm; or cirrhotic solitary or multifocal disease with vascular invasion.

These are ACR appropriateness contexts, including categories described as usually appropriate.

Intrahepatic cholangiocarcinoma

Potentially appropriate for selected ICC patients.

ICC locoregional therapy contexts: TARE may be considered for peripheral hepatic lobar cholangiocarcinoma less than 3 cm without biliary ductal dilatation, macroscopic vascular invasion, regional lymphadenopathy, or distant metastases; for patients not eligible for curative surgery; for downstaging toward curative resection or another treatment; or for selected patients with limited extrahepatic disease in combination with systemic therapy.Limited extrahepatic disease: hilar lymph node ≤ 3 cm or five or fewer lung nodules, each ≤ 1 cm

Y-90 may be used alone or followed by systemic chemotherapy. Personalized dosimetry or radiation segmentectomy targeting >205 Gy may improve outcome. Bilirubin >3 mg/dL is a relative contraindication.

Absolute contraindications

Do not proceed when ANY absolute contraindication is present.

Absolute contraindications: Inability to catheterize the hepatic artery; fulminant liver failure; clinically unacceptable nontarget deposition that cannot be corrected by embolization or delivery adjustment; an unfavorable pulmonary shunt fraction exceeding product-specific acceptable limits; acute hepatic infection; or uncorrectable coagulopathy.

Any listed finding precludes treatment.

Relative contraindications

Relative contraindications require individualized risk-benefit assessment.

Relative contraindications: Tumor replacing more than 50% to 70% of liver parenchyma; total bilirubin greater than 2 mg/dL without an obstructive cause; prior radiation involving a significant volume of the liver or upper abdomen; concurrent systemic therapies that may potentiate or alter radioembolization effects; pregnancy except potentially extraordinary circumstances with multidisciplinary consultation; or bilirubin greater than 3 mg/dL unless segmental treatment can be performed.Bilirubin >2 mg/dL generally; bilirubin >3 mg/dL in NCCN guidance

Preserved synthetic hepatic function or selective/segmental treatment may permit treatment in selected cases, particularly HCC.

Uveal Melanoma

TARE with Y-90 microspheres is usually appropriate for uveal melanoma hepatic metastases, particularly when disease is confined to the liver and regional therapy is being considered.

Uveal melanoma: The patient has hepatic metastases from uveal melanoma, particularly disease confined to the liver, and is being considered for regional therapy.

NCCN states that regional therapies such as radioembolization should be considered when disease is confined to the liver.

Bridge to Transplant or HCC Downstaging

TARE with Y-90 microspheres may be used as a locoregional therapy for eligible patients with HCC who are being bridged to transplant or downstaged before transplant.

Bridge to transplant or downstaging: The patient has hepatocellular carcinoma and is being considered for locoregional therapy to slow tumor progression, reduce transplant-list dropout, bridge to liver transplant, or downstage disease to transplant eligibility.

NCCN particularly notes use when transplant waiting times are long.

Breast Cancer Liver Metastases

TARE with Y-90 microspheres may be considered in selected patients with breast cancer liver metastases, especially after progression on systemic therapy.

Selected breast cancer liver metastases: The patient has breast cancer with liver metastases and is being considered for liver-directed therapy after adequate systemic therapy has demonstrated disease control or after progression on prior systemic treatment.

Local therapy should be limited to very selected cases with good performance status, limited liver involvement, and no extrahepatic lesions. Evidence is limited and heterogeneous.

Pancreatic Cancer Liver Metastases

Evidence is available for transarterial therapy, including TARE, in liver-dominant metastatic pancreatic acinar cell carcinoma.

Pancreatic acinar cell carcinoma: The patient has biopsy-confirmed pure or mixed pancreatic acinar cell carcinoma with liver-dominant metastatic disease and is being considered for transarterial liver-directed therapy.

The cited study included ECOG Performance Status 0 to 2 and bilirubin <2.0 mg/dL; these were study inclusion criteria, not expressly stated payer requirements.

All indications other than the specifically listed covered indications are excluded from coverage as unproven and not medically necessary because of insufficient evidence of efficacy.

TARE/SIRT should not be performed when the hepatic artery cannot be catheterized; the patient has fulminant liver failure, acute hepatic infection, or uncorrectable coagulopathy; or mapping studies show clinically unacceptable nontarget deposition that cannot be corrected through embolization or delivery adjustment. An unfavorable pulmonary shunt fraction exceeding the Y-90 product-specific acceptable limit is also an absolute contraindication.

For liver metastases from primary sites outside the specifically covered indications, evidence supporting TARE/SIRT with Y-90 microspheres is limited. Clinical utility and safety remain uncertain, and the available studies are heterogeneous, small, and largely noncomparative; larger multicenter randomized studies are needed to establish appropriate clinical use.

For breast cancer liver metastases, local therapy should be considered only in very selected cases with good performance status, limited liver involvement, and no extrahepatic lesions, after adequate systemic therapy has demonstrated disease control.

TARE/SIRT using Y-90 microspheres is not medically necessary for indications other than the specifically listed covered categories: liver-dominant primary hepatocellular carcinoma in nonsurgical candidates, hepatocellular carcinoma as a bridge to transplant, selected symptomatic neuroendocrine liver metastases, chemotherapy-resistant or refractory colorectal liver metastases with predominant hepatic disease, intrahepatic cholangiocarcinoma liver metastases in nonsurgical candidates, or uveal melanoma metastasis confined to the liver.

Codes and Clinical Thresholds

CPT CodesCPT

37243	Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for tumors, organ ischemia, or infarction.
75894	Transcatheter therapy, embolization, any method, radiological supervision and interpretation.
79445	Radiopharmaceutical therapy, by intra-arterial particulate administration.

HCPCS CodeHCPCS

S2095

Transcatheter occlusion or embolization for tumor destruction, percutaneous, any method, using yttrium-90 microspheres.

Adult age threshold

Adult threshold19 years or older

Younger than 19Covered without further review

Adult clinical requirementECOG Performance Status of 0, 1, or 2 and a covered indication

ECOG Performance Status

Required rangeECOG Performance Status 0, 1, or 2

ECOG 0Fully active, without restriction

ECOG 1–2

Documentation and Review Requirements

Documentation Required

Document Covered Indication and ECOG Status

Document the covered indication and confirm the individual is an adult with an ECOG Performance Status of 0, 1, or 2. TARE/SIRT with yttrium-90 microspheres is covered for the specified primary or metastatic liver cancers when the applicable indication criteria are met.

Covered indications include liver-dominant primary hepatocellular carcinoma in individuals who are not surgical candidates; HCC as a bridge to liver transplant; unresectable neuroendocrine tumor liver metastases with uncontrolled symptoms after systemic therapy; chemotherapy-resistant or refractory colorectal liver metastases with predominant hepatic disease; unresectable intrahepatic cholangiocarcinoma; and uveal melanoma confined to the liver.

Documentation Required

Submit Medical Records for Review

Submit the medical records needed to assess whether the member meets the clinical criteria for coverage. Records may be required for review but do not guarantee coverage; coverage remains subject to the member-specific benefit plan and applicable law.

Refer to the Medical Records Documentation Used for Reviews guideline when assembling supporting documentation.

Therapy Overview

Transarterial radioembolization (TARE), also called selective internal radiation therapy (SIRT), is a catheter-directed liver treatment. Radioactive yttrium-90 (Y-90) microspheres are selectively injected into the hepatic artery to deliver localized radiation to hepatic tumors. The policy supports this approach for selected primary liver cancers and liver-dominant metastatic cancers, particularly when surgery is not appropriate or systemic treatment has failed or cannot control the disease. Patient selection considers liver function, tumor burden, performance status, extrahepatic disease, pulmonary shunt fraction, and prior liver-directed or radiation treatment.

Policy Terms

Eastern Cooperative Oncology Group (ECOG) Scale of Performance Status

PurposeStandard criterion for measuring how disease affects functioning

Functional domainsAbility to care for oneself, perform daily activities, and remain physically active

Scale rangeECOG 0 means fully active; ECOG 5 means dead

Limited Extrahepatic Disease

Lung metastasesFewer than five nodules measuring no more than 1 cm, or a single nodule measuring no more than 1.7 cm

Lymph-node involvementA single area measuring less than 2 cm in diameter

Overall definition

Policy Summary

PayerColorado Rocky Mountain Health Plans

PolicyTransarterial Radioembolization (TARE)/Selective Internal Radiation Therapy (SIRT) for the Treatment of Malignant Cancers of the Liver

Policy CodePolicy 2026T0445CC

Change TypeModified

Effective DateNovember 1, 2026

Next Review DateNot specified

Key ActionFor adults, document a covered Y-90 TARE/SIRT indication and an ECOG Performance Status of 0, 1, or 2.

SourceLink

On This Page

ECOG 1: ambulatory with restriction in strenuous activity; ECOG 2: ambulatory and capable of self-care but unable to work

Bilirubin for lobar or bilobar treatment

Lobar or bilobar treatmentBilirubin should be less than 2 mg/dL

Preferred levelIdeally below 1.3 mg/dL

Selective treatment exceptionHigher bilirubin levels may be acceptable when selective radiation segmentectomy is performed

Albumin

Albumin thresholdGreater than 3 g/dL

Clinical significanceAlbumin levels above 3 g/dL are associated with improved survival after TARE

Risk considerationDecreasing albumin levels forecast impending liver dysfunction

Creatinine clearance

Relative contraindicationCreatinine clearance less than 30 mL/min

Clinical descriptionAcute or severe chronic renal failure

Guideline contextListed as a relative contraindication for colorectal liver metastases treatment

Minimum life expectancy

Minimum expected survivalAt least 3 months

Absolute contraindication contextLife expectancy of less than 3 months is an absolute contraindication in the colorectal cancer guidance

Candidate selectionSIRT may be indicated for unresectable or inoperable liver malignancy when expected survival is at least 3 months

Excessive hepatic tumor burden

Relative contraindicationMore than 50% to 70% of liver parenchyma replaced by tumor

AAPM contextGreater than 70% to 75% liver involvement is a relative contraindication

Possible considerationWith more extensive tumor burden, treatment may be considered if synthetic hepatic function is preserved

Total bilirubin

Relative contraindicationTotal bilirubin greater than 2 mg/dL without an obstructive cause

Clinical meaningNonobstructive elevation indicates severe liver function impairment

HCC exceptionPatients with HCC and elevated bilirubin may be treated if segmental or subsegmental infusion can be performed

NCCN bilirubin threshold

NCCN thresholdBilirubin greater than 3 mg/dL

Clinical statusA relative contraindication to arterially directed therapy

ExceptionTreatment may be performed when segmental treatment is feasible

Limited extrahepatic disease for ICC

Hilar lymph node limit3 cm or less

Lung nodule limitFive or fewer lung nodules, each 1 cm or less

Treatment contextSelected patients with these limits may be considered for arterially directed therapy with systemic therapy

Potential ICC tumor dose

Potential tumor doseGreater than 205 Gy to the tumor

Planning approachPersonalized dosimetry or radiation segmentectomy

Potential benefitMay improve outcome in intrahepatic cholangiocarcinoma

Documentation Required

Document Clinical Selection and Treatment History

Provide clinical selection and treatment-history documentation supporting the appropriateness of Y-90 TARE/SIRT. The record should demonstrate liver disease characteristics, relevant laboratory and prognostic findings, and the treatments already attempted.

Include contrast-enhanced liver-protocol CT or MRI documenting lesion burden and relevant imaging findings such as ascites.
Include blood count, coagulation, liver, and renal studies; bilirubin and albumin; and relevant prognostic markers such as carcinoembryonic antigen when applicable.
Document prior treatment history, including systemic therapy response or failure, previous surgeries, TACE, and local ablation procedures.

Documentation Required

Document Eligibility and Treatment Safety

Document eligibility and safety before treatment, including disease extent, operability, performance status, expected survival, distribution of disease, and laboratory evidence that treatment can be performed safely. Multidisciplinary evaluation is essential for appropriate patient selection and treatment planning.

Document unresectable or inoperable primary or secondary liver malignancy, performance status sufficient to benefit, and life expectancy of at least 3 months.
Document that disease is liver-dominant and characterize extrahepatic disease; limited extrahepatic disease may be considered in selected ICC cases.
For ICC, document lack of candidacy for curative surgery or the rationale for downstaging, the multidisciplinary treatment plan, and consideration of personalized dosimetry or radiation segmentectomy.

Documentation Required

Assess Hepatic Impairment and Treatment Risks

Assess risk factors that may increase hepatic toxicity or reduce the likelihood of benefit before authorizing treatment. Record the clinical rationale when treatment is considered despite a relative contraindication.

Assess tumor burden, including greater than 50% to 70% liver replacement, infiltrative disease, ascites, and liver volume in patients with cirrhosis.
Document bilirubin and hepatic synthetic function, including albumin and Child-Pugh status. Bilirubin greater than 2 mg/dL is generally a relative contraindication; bilirubin greater than 3 mg/dL is relatively contraindicated unless segmental treatment can be performed.
Assess prior liver or upper-abdominal radiation, renal function, lung shunt fraction, performance status, pregnancy status, and concurrent systemic therapies that may potentiate toxicity.

Documentation Required

Plan ICC Treatment in a Multidisciplinary Setting

For intrahepatic cholangiocarcinoma, document surgical candidacy, the extent of extrahepatic disease, and the intended role of TARE/SIRT in the overall treatment plan. Treatment selection should be made by an experienced multidisciplinary team and may be used alone, with systemic therapy, or for downstaging when clinically appropriate.

Document that the patient is not a candidate for curative surgery or that downstaging is intended.
Characterize limited extrahepatic disease when present, including hilar lymph nodes and pulmonary nodules, and explain how it affects treatment selection.
Document personalized dosimetry or radiation segmentectomy considerations and treatment at a specialist center when applicable.

Denial Risk

Indications Outside Covered Categories

TARE/SIRT with Y-90 microspheres is unproven and not medically necessary for indications outside the covered categories because evidence of efficacy is insufficient.

Do not assume coverage for an indication solely because the malignancy involves the liver.

Denial Risk

Adult Clinical Criteria Must Be Met

Coverage requires the applicable adult clinical criteria, including an ECOG Performance Status of 0, 1, or 2 and a covered liver cancer indication. Requests that do not meet these criteria are not medically necessary under this policy.

Individuals younger than 19 years of age are covered without further review under the policy statement.
For adults, document the covered indication and ECOG status in the medical record.

Billing Rule

Benefit-Plan Limitation

Benefit coverage is determined by the member-specific benefit plan document and applicable law, including laws that may require coverage for a specific service. Clinical criteria or submitted medical records do not guarantee coverage.

Verify the member's benefits and any applicable plan limitations before treatment.

Denial Risk

Absolute Contraindications

Do not perform TARE/SIRT when an absolute contraindication is present. Resolve or exclude these conditions before proceeding with treatment.

Inability to catheterize the hepatic artery.
Fulminant liver failure or acute hepatic infection.
Clinically unacceptable nontarget deposition on mapping angiography, cone-beam CT, or hepatic arterial perfusion scintigraphy that cannot be corrected.
Unacceptable liver-to-lung shunt fraction for the applicable Y-90 product.
Uncorrectable coagulopathy.

Denial Risk

Significant Hepatic Impairment or Treatment Risk

Significant hepatic impairment and other treatment risks require individualized assessment and may make TARE/SIRT inappropriate. Document preserved synthetic function, the risk-benefit rationale, and any treatment modifications when proceeding despite a relative contraindication.

Relative risks include decompensated liver function or Child-Pugh score greater than 7, excessive tumor burden, poor performance status, pregnancy, high lung shunt fraction, severe renal failure, and prior external-beam radiation.
Total bilirubin greater than 2 mg/dL generally indicates increased risk; bilirubin greater than 3 mg/dL is relatively contraindicated unless segmental treatment is feasible. Segmental or subsegmental treatment may be considered in selected HCC cases with elevated bilirubin.
Exercise caution with prior liver or upper-abdominal radiation and with systemic therapies that may potentiate or alter radioembolization effects.

Documentation Required

Confirm Clinical Suitability

Clinical suitability requires unresectable or inoperable disease, performance status sufficient to benefit, life expectancy of at least 3 months, and liver-dominant disease. Confirm that laboratory findings and disease distribution support safe treatment before submission or authorization.

The tumor burden should be liver dominant, although disease need not be confined exclusively to the liver.
Use multidisciplinary expertise and document that laboratory data support safe performance of the procedure.

Denial Risk

FDA Approval Alone Does Not Establish Coverage

FDA approval of a Y-90 microsphere product alone does not establish coverage under this policy. Coverage still depends on the policy's covered indication, clinical criteria, medical-necessity requirements, and the member-specific benefit plan.

TheraSphere and SIR-Spheres have distinct FDA indications and remain subject to applicable Nuclear Regulatory Commission requirements.

Metastases limited to the lung and/or a single limited area of lymph-node involvement

Refractory

DefinitionCancer that does not respond to treatment

Primary resistanceThe cancer was resistant at the beginning of treatment

Acquired resistanceThe cancer became resistant during treatment; also called resistant cancer

Transarterial Radioembolization (TARE)

Treatment typeAn intra-arterial cancer therapy

Therapeutic materialRadioactive microspheres impregnated with yttrium-90

Delivery routeMicrospheres are directly injected into the hepatic artery; also called radioembolization or selective internal radiation therapy

TARE/SIRT

TARETransarterial radioembolization

SIRTSelective internal radiation therapy

Shared meaningLiver-directed treatment using Y-90 microspheres delivered through the hepatic arterial circulation

Liver-dominant tumor burden

Predominant disease siteThe liver is the predominant site of tumor involvement

Extrahepatic diseaseDisease does not necessarily have to be confined exclusively to the liver

Treatment contextSIRT may be considered for liver-dominant primary or secondary liver malignancies

Nontarget deposition

DefinitionDelivery of radioactive microspheres to tissues outside the intended hepatic tumor target

DetectionMay be demonstrated during mapping angiography, contrast-enhanced cone-beam CT, or hepatic perfusion imaging

Treatment implicationClinically unacceptable deposition that cannot be corrected by embolization or delivery adjustment is an absolute contraindication

Segmental or subsegmental infusion

DefinitionSelective delivery of radioembolization to a liver segment or subsegment

Treatment territoryUsed instead of treating a larger lobar or whole-liver territory

Clinical purposeMay permit treatment of selected tumors despite some hepatic risk factors, including elevated bilirubin