TARE-Y90 is an innovative new therapy in children that destroys tumors. It allows targeted high-dose radiation therapy to be delivered directly into liver tumors through an intra-arterial catheter (a long, thin tube inserted into the arteries). Because this treatment targets the radiation directly to the tumor, it avoids damage to the normal liver tissue around the tumor. TARE-Y90 has the potential to offer some kids with liver tumors a cure. It may help others feel better without having to get more chemotherapy that could cause short- and long-term side effects.

At Nemours, our team specializes in children's liver tumor care. That includes giving second opinions and treating high-risk patients. We often serve as consulting physicians for children with challenging and complex conditions. We're here to offer families expert help — and hope.

Learn More About Liver Tumors

We treat these cancers at the Nemours Liver Tumor Program:

• hepatoblastoma (HB) — the most common type of pediatric liver cancer
• hepatocellular carcinoma (HCC) — a liver tumor that often happens in children with other liver disease
• rhabdoid tumor of the liver — a rare, aggressive tumor most often found in babies
• undifferentiated embryonal sarcoma of the liver (UESL) — a rare liver tumor that most often affects children 6-10 years old

We also treat liver tumors that are not cancerous (they’re “benign”).

Treatment of cancerous liver tumors depends on staging. Staging considers the size and location of the tumor (or tumors), how easily it can be removed by surgery, and whether it has spread to nearby or distant organs. We also look at a child’s age and overall heath to help us develop a treatment plan that follows this three-step approach:
 

1. Shrink the tumor.

Doctors may be able to reduce the size of the tumor with chemotherapy and an interventional radiology procedure called "radioembolization." Chemotherapy (“chemo”) is the term for medications used to kill cancer cells and stop their growth. Interventional radiology (IR) is the use of medical imaging techniques (such as an ultrasound, CAT scan or fluoroscopy) to guide doctors as they diagnose and treat problems. IR (also called "image-guided therapy") techniques are minimally invasive, which means we use tiny incisions (cuts). And that often means shorter recovery times, very small or no scars, and less pain.

Transarterial radioembolization with yttrium-90 (TARE-Y90) delivers a high dose of radiation therapy directly into the tumor(s). Nemours is one of the only pediatric health systems providing this treatment for children. TARE-Y90 can be used as the main therapy for some kids with liver tumors that don’t respond well to chemo. Or, it can be used in kids with tumors that have relapsed (come back) or haven’t shrunk enough for surgery. In some cases, kids who get TARE-Y90 therapy may still need to have a large part of their liver removed (this is called a “liver resection”), but they won’t need a liver transplant. Other times, TARE-Y90 may serve as a "bridge." That means it helps keep kids as healthy as possible before a liver resection or transplant by reducing tumor growth.

Our other advanced IR procedures include:

• transarterial chemoembolization (TACE), which delivers chemotherapy medication directly to the tumor through a catheter inserted into the arteries
• bland embolization, which uses small particles to shut off the blood supply of the tumor
• tumor ablation, which kills tumors using small needles to heat or cool them
   

2. Remove the tumor and affected part of the liver.

Liver tumors in children need to be taken out through surgery to be cured. The liver is a unique organ in the body. Even if surgeons remove a large portion of the liver, the remaining part can regenerate (regrow). The liver is the only organ that can grow back like this.

3. Transplant, if necessary.

A liver transplant is a surgical procedure that removes the entire liver and replaces it with another liver (from either a living related donor or a deceased organ donor). A child may need a liver transplant if the tumor can’t be removed due to its size or location without leaving enough of the liver behind to function. Over the past 30 years, children with liver cancer have had excellent cure rates thanks to liver transplants. In fact, most kids who have liver transplants go on to live active, healthy lives.

If your child has a liver tumor, our comprehensive team of pediatric experts from many specialties will create the most effective treatment plan personalized for your child’s specific needs. We have the expertise to get treatment or surgery right the first time to avoid tumors from coming back. And our experience in children's liver cancer helps us make decisions about your child's care as soon as possible.

Here are some of the other reasons families choose us for their pediatric liver cancer care:

• large team of experts, including a clinical coordinator (a nurse who provides support, education and care coordination) and specialists in oncology (cancer care), hepatology (liver care), general surgery, liver transplantation, interventional radiology, anesthesiology, pain management, nutrition, social work and more
• telemedicine (live online doctor's visits) available throughout our care network. This means your child can meet by video with our experts, no matter where they're located.
• one of the largest pediatric hematology/oncology programs in the country (when combining our patient numbers from all of our locations)
• one of only two pediatric National Cancer Institute Community Oncology Research Programs (NCORP) in the nation dedicated exclusively to children. Because our care and research go hand-in-hand, your child gets exceptional care combined with the newest evidenced-based treatments and techniques.
• one of the largest pediatric interventional radiology programs in the United States (with teams in the Delaware Valley and Florida)
• one of the nation’s top programs performing advanced liver procedures in children
• leader in surgical results and overall quality of surgical care. Nemours is involved in a nationwide effort to improve surgical care for kids.
• physicians and surgeons recognized as "Best Doctors in America®" and "Top Doctors" by local magazines in our regions, year after year

Regional Pediatric Liver Tumor Program Highlights

Services, programs and care teams differ at each location. Call for details.

Sometimes the best support and peace of mind comes from families who’ve been there. Meet some of the inspiring kids we’ve been honored to treat.

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