OBJECTIVE: To discuss the basic concepts involved in the development of yttrium 90 (Y-90) microsphere selective internal radiation treatment and review the clinical data pertaining to its application in hepatic colorectal cancer metastases. DATA SOURCES: Published studies and scientific paper presentations. STUDY SELECTION: Randomized clinical studies and retrospective reviews. CONCLUSIONS: Selective internal radiation treatment is a promising new modality in the treatment of patients with hepatic colorectal cancer metastases as part of a multimodality approach. A chemo-selective internal radiation treatment neoadjuvant approach has a potential to improve therapeutic outcomes. Clinical studies in neoadjuvant and salvage settings are needed for more concrete outcome data and design of optimal multimodality treatment strategies.