TACE vs Y-90

[ChristineRN60]

My husband was Dx Jan 8th with a single 5 cm tumor. He has hep c and cirrhosis. He is going to be listed on two transplant lists in different regions to increase his chance of getting a liver.
One facility wants to do the TACE procedure. The other wants to do the Y-90.  We were told that if you do the Y-90 first then you can do TACE later but not the other way around.
Please help. We need to make a decision.  The facility that has the shortest waiting list is the one that wants to do the TACE.

[Thomas D Schiano, MD]

i am not aware of Y-90 being contraindicated after the performance of TACE.  Y-90 may actually have a more significant effect on liver function than TACE

[ChristineRN60]

Then I'm really confused because we are being told that once we do a TACE procedure that you cannot go back in with the y-90 radiation due to the blocking of the artery during TACE.  Also it looks like to me that the side effects of the TACE are much worse than the radiation.
Sorry for so many questions but we have to make this decision this week and our Drs don't agree.

[Thomas D Schiano, MD]

Y-90 can be done after TACE.  Multiple TACE can be performed without an issue.

[ChristineRN60]

Can the Y-90 be done after you have a TACE?  If not then how do they do multiple TACE procedures?

[Thomas D Schiano, MD]

there are no studies to help us make this decision; often it is at the discretion of the specific transplant program.  Both are effective--typically it takes a while longer post-procedure for Y-90 to see the effect.  Going with the TACE would be fine.