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Interventional oncology · London

Y-90 radioembolisation (SIRT) - private in London.

A day-case, catheter-delivered dose of yttrium-90 microspheres for liver tumours - HCC, colorectal liver metastases, cholangiocarcinoma and neuroendocrine metastases - done by an interventional oncologist in a unit with a weekly Y-90 service and full hepatobiliary MDT backing.

A stethoscope on a clinical desk

Indicative pricing

What private Y-90 SIRT costs in London.

Indicative ranges across UK interventional oncology units.

In short

£22,000-£38,000 all-inclusive, home the same day.

Procedure Indicative range
Second-opinion review of imaging and MDT summary £350-£650
Workup angiogram and MAA lung-shunt scan £4,500-£7,500
Y-90 SIRT, single lobe (TheraSphere or SIR-Spheres) £22,000-£30,000
Y-90 SIRT, bilobar sequential (both lobes) £34,000-£38,000
Radiation segmentectomy (small HCC, high-dose) £24,000-£32,000
Follow-up MRI or CT liver at 3 months £650-£1,100

Y-90 pricing is all-inclusive: workup angiogram and MAA scan, the microsphere product (TheraSphere or SIR-Spheres), the treatment procedure, personalised dosimetry, post-treatment PET-CT and the first follow-up MRI at 3 months. Bilobar disease is treated in two sequential sessions.

The problem

The right interventional oncologist, the right microsphere, the right unit.

Y-90 works when the tumour selection, the dosimetry and the MDT plan are right. A one-size-fits-all lobar SIRT in a low-volume unit is not the same procedure, and we make sure you get the difference.

  • Is SIRT even the right treatment?

    For a small solitary HCC, resection or ablation is often better. For bilobar disease with a high tumour burden, systemic therapy first can be safer. We say so.

  • Which microsphere, at what dose?

    TheraSphere for HCC and radiation segmentectomy, SIR-Spheres for many colorectal cases. Personalised dosimetry, not flat activity, drives the outcome.

  • Booked into a genuine SIRT service?

    A named interventional oncologist, a weekly Y-90 list, on-site nuclear medicine and a hepatobiliary MDT - not a monthly favour done between other lists.

When it helps

When Y-90 SIRT is the right step - and when it is not.

The tumours we see most, plus the physiological gates (lung shunt, bilirubin, extrahepatic spread) that mean SIRT is deferred in favour of TACE, ablation, systemic therapy or best supportive care.

  • Hepatocellular carcinoma (HCC), BCLC B or C

    Intermediate or advanced HCC unsuitable for resection, transplant or ablation. SIRT is a mainstream option, with equivalence to sorafenib in the SARAH and SIRveNIB trials.

  • Colorectal liver metastases, chemo-refractory

    Liver-dominant colorectal metastases progressing on FOLFOX/FOLFIRI or unsuitable for further systemic escalation, per the EPOCH trial.

  • Intrahepatic cholangiocarcinoma

    Unresectable intrahepatic cholangiocarcinoma, either as first-line liver-directed therapy or after gemcitabine/cisplatin progression.

  • Neuroendocrine liver metastases

    Progressive liver-dominant NET metastases where PRRT is unavailable, unsuitable, or an adjunct to somatostatin analogues is needed.

  • Radiation segmentectomy for small HCC

    A very high tumoricidal dose (>190 Gy) delivered to a single segment for solitary HCC under 5 cm, with 5-year survival approaching resection in selected series.

  • Radiation lobectomy and downstaging

    Lobar SIRT can induce contralateral hypertrophy over 3-6 months, downstaging borderline patients to resection or transplant.

  • Selected other liver-dominant primaries

    Uveal melanoma, breast and sarcoma liver metastases in an MDT context where liver disease drives symptoms or survival.

  • Not right if lung shunt or bilirubin too high

    A lung shunt fraction over 20%, bilirubin over 34 micromol/L without a reversible cause, or extensive extrahepatic disease usually excludes SIRT.

Procedure options

SIRT is a family of techniques - and TACE sits beside it.

What each option on the table actually involves - which microsphere, which dose, which delivery. And how SIRT compares to TACE on time to progression, tolerability and cost.

  • TheraSphere (glass Y-90 microspheres)

    Boston Scientific glass microspheres, 20-30 microns, high specific activity, low sphere burden. The standard for HCC and radiation segmentectomy in most UK centres.

  • SIR-Spheres (resin Y-90 microspheres)

    Sirtex resin microspheres, 20-60 microns, lower specific activity, higher sphere burden. Well-established in colorectal liver metastases per SIRFLOX, FOXFIRE and EPOCH.

  • Workup angiogram and coil embolisation

    Prophylactic coiling of the gastroduodenal, right gastric or other extrahepatic branches at risk, so Y-90 does not reflux to the stomach, duodenum or pancreas.

  • MAA scan and lung shunt fraction

    Technetium-99m macroaggregated albumin mimics the Y-90 distribution. A gamma camera measures lung shunt (must be under 20%) and confirms no gut uptake before dosing.

  • Personalised dosimetry

    Modern MIRD or partition-model dosimetry calculates a personalised activity in gigabecquerels, based on tumour volume, perfused liver volume, lung shunt and tumour-to-normal-liver ratio.

  • TACE (transarterial chemoembolisation)

    The sister technique: doxorubicin or drug-eluting beads plus ischaemic embolisation. Cheaper per session, more sessions typically needed, more post-embolisation syndrome. Better for small, well-defined HCC in some centres.

  • Second-opinion review

    A specialist review of your CT, MRI, MDT summary and prior treatments, sometimes the answer is TACE, ablation, or continuing systemic therapy rather than SIRT.

SIRT vs TACE, at a glance

TACE (transarterial chemoembolisation) is cheaper per session but usually needs multiple sessions, works by combining chemotherapy with arterial ischaemia, and often produces a more marked post-embolisation syndrome. SIRT is a single-session, well-tolerated radiation therapy with a longer time to progression on HCC data, and non-inferior overall survival to sorafenib in the SARAH and SIRveNIB trials. The EPOCH trial supports SIRT in chemo-refractory colorectal liver metastases. Radiation segmentectomy at high tumoricidal dose can deliver 5-year survival approaching resection for solitary small HCC.

Outcomes, safety and recovery

What Y-90 achieves, and what to plan for afterwards.

Median overall survival is 12-16 months for BCLC B/C HCC and 8-12 months for chemo-refractory colorectal liver metastases. Radiation segmentectomy for small solitary HCC delivers 5-year overall survival of 60-70% in specialist series. Recovery is measured in days, not weeks.

  • Fatigue and RUQ discomfort for 1-2 weeks

    Post-radioembolisation syndrome is milder than TACE. Fatigue, mild right-upper-quadrant ache and low-grade fever settle over 1-2 weeks with paracetamol and rest.

  • Radiation-induced liver disease (REILD)

    REILD occurs in around 1-4% and is more likely in patients with cirrhosis, high whole-liver dose or prior chemotherapy. Careful dosimetry and lobar treatment minimise the risk.

  • Non-target embolisation to stomach or duodenum

    Rare with modern workup and prophylactic coiling. Presents as gastroduodenal ulceration a few weeks later, treated with high-dose PPI and endoscopic care.

  • Radiation pneumonitis if lung shunt missed

    Uncommon with proper MAA assessment. The lung shunt fraction must be under 20% and lung dose kept under 30 Gy per treatment, 50 Gy cumulative.

  • Access-site care after the femoral or radial puncture

    A few hours of bed rest for a femoral puncture, less for a radial approach. Simple wound care, watching for haematoma, and no heavy lifting for a week.

  • Simple radiation precautions

    Y-90 is a pure beta emitter so external radiation risk is very low. Standard advice: separate bedrooms and toilet hygiene for a few days, and no close contact with pregnant women or young children for a week.

  • Bilirubin and LFT monitoring

    Bilirubin, ALT, ALP and albumin at 2 and 6 weeks. A modest transient rise is expected. A sustained rise triggers hepatology review before any second lobe is treated.

  • Response assessment by mRECIST

    MRI or CT at 3 months, then quarterly, using modified RECIST for HCC (loss of arterial enhancement) rather than tumour shrinkage alone.

  • Red flags after discharge

    Severe abdominal pain, vomiting, high fever, jaundice or black stools, call the unit or attend A&E the same day.

Reading your SIRT report

Your Y-90 report in four parts. Read the last one first.

Whichever microsphere was used, the report the interventional oncologist sends you keeps to the same shape.

A London interventional oncologist reviewing a Y-90 SIRT report

A quiet reminder

Interventional oncology language is precise and can read coldly - ask your care team to explain anything that is unclear.

Ask your care team to explain anything that is unclear.

  1. 01 Workup

    Arterial anatomy, coils and lung shunt

    Which vessels were mapped, which extrahepatic branches were coiled, and the MAA-derived lung shunt fraction that set your dose ceiling.

  2. 02 Dosimetry

    Activity delivered and target dose

    Total activity in gigabecquerels, tumour-absorbed dose in Gy, normal perfused liver dose, and the dosimetry model used (MIRD, partition or voxel-based).

  3. 03 Findings

    Distribution on post-treatment imaging

    The Y-90 PET-CT or bremsstrahlung SPECT distribution: where the dose actually landed, whether it matched the target, and any non-target activity.

  4. 04 Impression

    Response plan and second-lobe timing

    Read this first: when the follow-up MRI is booked, whether a second lobe is planned, and what your hepatology and oncology follow-up looks like.

Recognised by major UK insurers

BupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealix

Cover for Y-90 SIRT varies by insurer and by indication - usually funded when medically indicated and MDT-recommended.

Frequently asked

Everything we get asked about Y-90 SIRT.

Quick answers on day-case treatment, repeatability, insurance cover, lung shunt, MDT decisions and recovery.

  • Is Y-90 SIRT an outpatient procedure?

    For most patients, yes. The workup angiogram and the Y-90 treatment itself are both day-case procedures, with an optional overnight stay if the arterial access is complex or you live far from the centre. There is no general anaesthetic, just local anaesthetic and light sedation.

  • Can SIRT be repeated if the tumour progresses?

    Yes. A second SIRT to the other lobe is a standard bilobar strategy, typically 6-8 weeks after the first. Retreatment of the same lobe is possible in selected patients if dosimetry, liver function and MDT review support it, though the cumulative liver dose is watched carefully to avoid REILD.

  • Will my insurance cover Y-90 radioembolisation?

    Most major UK insurers (Bupa, AXA, Vitality, Cigna, Aviva, WPA) fund SIRT for approved indications such as HCC and colorectal liver metastases, on prior authorisation and an MDT recommendation. Cover for less common indications is decided case by case.

  • Why does the lung shunt fraction matter so much?

    Y-90 microspheres lodge in the tumour capillary bed, but a proportion can pass through arteriovenous shunts inside the tumour and reach the lungs. A lung shunt over 20% risks radiation pneumonitis, so the MAA scan is a mandatory safety gate before dosing. A high shunt may exclude SIRT or trigger a reduced dose.

  • Do I need an MDT decision before SIRT?

    Yes. Every SIRT candidate goes through a hepatobiliary or upper-GI MDT with hepatology, oncology, surgery, nuclear medicine and interventional radiology. It confirms the diagnosis, rules out better options (resection, transplant, ablation, systemic therapy) and documents the treatment intent (curative segmentectomy, disease control, downstaging).

  • What is recovery like after Y-90?

    Most patients feel tired with a mild right-upper-quadrant ache for 1-2 weeks. Paracetamol and rest are usually enough. Work, driving and normal activity are typically resumed within 7-10 days. LFTs are checked at 2 and 6 weeks, and the first response MRI or CT is at 3 months.

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