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Information about the field of Selective internal radiotherapy (SIRT)
Information about the field of Selective internal radiotherapy (SIRT)
What does SIRT mean?
Selective Internal Radiation Therapy (SIRT) is a form of radiotherapy that treats liver cancer that can not be surgically removed. 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, the small balls, also called microspheres, embolize the arteries that provide nutrients for the cancerous cells. So you try to kill the tumor from two sides: on the one hand by radiation and on the other hand by embolization. The SIRT does not promise complete healing of the liver, it should be taken rather as a palliative method in combination with chemotherapy. In some rare cases, the tumor could be shrunk so much that it could be removed in one operation.
Who is eligible for SIRT?
Consideration of SIR therapy depends on many factors:
- You have primary or secondary liver cancer that can’t be treated by surgery
- Only the liver is affected, other organs are healthy
- In addition to the tumor, you should have a fully functional liver. Whether this is the case can be determined by several simple blood tests.
- Your life expectancy should be more than three months
If these points apply to you, you may be considering a selective internal radiation therapy. In this case, you should have 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 SIRT?
Normally the SIRT is performed by a specialized medical team of doctors. In most cases, oncologists, radiologists, and practitioners of nuclear medicine are part of this team.
I am eligible for SIRT! What happens next?
Before starting therapy, it is inevitable to go through blood tests and examinations to determine the individual therapy concept. Usually, the patient is hospitalized one to two weeks before the start of therapy. Several tests are made to provide an insight into the dose of beta-ray-emitting radionuclides. The medical team performs angiography (angiograms can show doctors arteries and veins of an organ). At this point in time, the doctor will cut off vessel that is likely to carry radioactive particles into other surrounding organs (such as lungs and gastrointestinal tract). In addition, a pulmonary test is accomplished to give an overview of 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 SIRT proceed in particular?
The SIRT is proceeded in a four day stationary stay under local anaesthetic. This means the patient is fully conscious during the SIRT. After applying the local anaesthetic, the medical team makes a small incision in 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 hours. A possible chemotherapy must be stopped during the entire therapy, but can be resumed after completion of the therapy.
What are the SIR Spheres doing 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% via liver veins, whereas cancer cells get their nutrients up to 90% via liver arteries. Through these arteries, the microspheres, whose diameter is half the diameter of a human hair (approximately 30 microns), reach their target: liver cancer. The microspheres are so small that they can get very close to the tumor and so large that they can embolize the vessels belonging 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 effect 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 SIRT?
The SIRT is generally used in combination with a chemotherapy. Studies have shown that the combination of SIRT and chemotherapy can shrink the tumor more efficiently than just chemotherapy. This combination emphasizes an improved quality of life and increased life expectancy. Although the SIRT is not a guarantee 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 SIRT?
After a successful SIRT, most patients will udergo several tests and examinations in the following days to show whether the microspheres have been applied correctly or not. Usually, the patient is monitored by the medical team hours after therapy in order to rule out potential side effects and complications.
What do I need to consider after therapy?
During the first 24 hours as well as a few weeks after the therapy patients must take some precautions. These include:
- Wash hands thoroughly after each visit to the bathroom
- Use own towels
- Direct contact with other people should be reduced to two hours a day
- Contact with kids and pregnant women should be short or avoided at best
- Patients should not travel in the first weeks after therapy
These precautionary guidelines are bound to the Federal Office for Radiation Protection. Since patients are treated with radioactive substances during SIRT, they must be considered as potentially radioactive bodies.
How long do I need to be hospitalized?
As long as the medical team does not need to make any further observations, patients can usually leave the hospital two days after treatment and continue their daily activities.
Are there any negative side effects and complications?
In rare cases patients may face stomach ache and nausea. Fever as well as fatique can also be side effects. In 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 are then often exposed to inflammations, so that further treatment of the affected organs may be indicated.
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