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Information about the field of Selective internal radiotherapy (SIRT)

What does SIRT mean?

The selective internal radiation therapy (SIRT) is a form of radiation therapy that treats liver cancer that cannot ...

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Information about the field of Selective internal radiotherapy (SIRT)

What does SIRT mean?

The selective internal radiation therapy (SIRT) is a form of radiation therapy that treats liver cancer that cannot be removed surgically anymore. It is used to treat liver carcinoma as well as its metastatic growth. In this form of therapy beta-ray-emitting radionuclides (primarily Yttrium-90) are brought through small balls directly into the carcinogenic liver cells. While doing this the Yttrium-90 radiates nearly one centimetre into the surrounding tissues. In addition to this the small balls, also called microspheres, embolize the arteries that provide nutrients for the cancer cells. So you try to kill the tumor from two sides: On the one hand through radiation and on the other hand through embolization. The SIRT does not promise a full healing of the liver, it should more be taken as a palliative method in combination with a chemotherapy. In some rare cases it was able to shrink the tumor that much that it could be removed in a surgery.

Who is eligible for the SIRT?

Being worthy of consideration for a SIR therapy depends on many factors:

  • You have primary or secondary liver cancer that can’t be treated through a surgery
  • Only the liver is affected, other organs are healthy
  • Except for the tumor you should have a fully functioning liver. Whether this is the case can be found out through several easy blood tests.
  • Your life expectancy should be more than three months

If these points apply to you, you can think of a selective internal radiation therapy. In this case you should conduct a conversation with an oncologist or a practitioner of nuclear medicine. Patients should be aware that pregnant women are a total contra-indication.

Who carries out the SIRT?

Normally the SIRT is carried out by a specialized medical team of doctors. In most cases oncologists, radiologists and practitioners of nuclear medicine belong to this team.

I am eligible for a SIRT! What happens next?

Before starting with the therapy it is inevitable to go through blood tests and examinations that determine the individual concept of the therapy. Normally the patient is hospitalized one to two weeks before beginning the therapy. Several tests are made to provide insight into the dose of the beta-ray-emitting radionuclides for instance. The medical team carries out an angiography (angiograms can show the doctors arteries and veins of an organ). Right at this point the doctor cuts off vessel that entail a risk of carrying radioactive particles to other surrounding organs (lungs and gastrointestinal tract for example). Moreover a test concerning the lungs is made to give an overview about the blood flow between liver and lungs.

If the tests are okay, the microspheres (or SIR-Spheres) can be injected one to two weeks later.

How does the SIRT proceed in particular?

The SIRT is proceeded in a four day stationary stay under local anaesthetic. This means the patient is under full conscious during the SIRT. After applying the local anaesthetic the medical team does a small cut into an artery in the groin. A small catheter leads through this artery directly into the liver tissue. The SIR-Spheres can now be applied here. This intervention can take up to one and a half hour. A possible chemotherapy must be stopped during the whole therapy but can be resumed after the therapy is finished.

What does the SIR-Spheres do in my body?

In order to understand the principle of the microspheres we need to take a look at the physiology of the liver: A healthy liver gets its nutrients up to 90% over liver veins whereas cancer cells get their nutrients up to 90% over liver arteries. Through these arteries the microspheres, whose diameter is half the diameter of a human hair (approximately 30 microns), get to their target: the liver cancer. The microspheres are that small that they can get very close to the tumor and that big that they can embolize the vessels that belong to the tumor.

Within these microspheres is the beta-ray-emitting radionuclide Yttrium-90. Reaching the place of action the Yttrium-90 infiltrates and radiates the surrounding tissues in a distance of up to two centimetres. Yttrium-90 achieves its maximum effects in the first two weeks after treatment. Because the radiation is locally restricted to the liver it is able to apply a high dose of Yttrium-90 while the other organs mostly remain untouched.

What is the benefit of the SIRT?

The SIRT is generally used in combination with a chemotherapy. Studies could show that the combination of SIRT and chemotherapy could shrink the tumor more efficiently than only a chemotherapy. This combination pays its attention to an improved quality of life and an increased life expectancy. Although the SIRT isn’t a guarantor for a full healing of the liver there are some rare cases in which the tumor could be shrunk that much that it could be removed in a surgery later on.

What happens after the SIRT?

After a successful SIRT most patients go through several tests and examinations in the following days that show whether the microspheres were applied correctly or not. Usually the patient is monitored hours after the therapy by the medical team in order to exclude possible side effects and complications.

What do I need to observe after the therapy?

In the first 24 hours as well as a few weeks after the therapy patients must take some precautions. These include:

  • Washing their hands thoroughly after every visit in the bathroom
  • Using own towels
  • Direct contact to other persons should be cut off to two hours a day
  • Contact to kids and pregnant women should be short or should be avoided in the best case
  • Patients shouldn’t go on journeys in the first weeks after the therapy

These precautions are bound to the Federal Office for Radiation Protection. Because patients are treated with radioactive substances during the SIRT they must be considered as potentially radioactive bodies.

How long do I need to be hospitalized?

If the medical team is not to make observations anymore, patients can leave hospital two days after treatment and participate in their daily activities again.

Are there any negative side effects and complications?

In rare cases patients may face stomach ache and nausea. Fever as well as tiredness can also be side effects. In the most cases these side effects can be treated with conventional drugs.

In some very rare cases the microspheres spread to surrounding organs (for instance gastrointestinal tract or gall bladder). These organs then often face inflammations so that further treatment of the affected organs is indicated. 

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