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FREQUENTLY ASKED QUESTIONS AND ANSWERS

 

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Selective Internal Radiation Therapy allows tumours and metastases of the liver to be irradiated directly – with healthy tissue being largely spared. In SIRT, microspheres loaded with the beta emitter yttrium-90 are injected through a thin catheter into the hepatic artery. They then travel directly to the tumour, become lodged there and destroy the tumour from within. Consequently, Selective Internal Radiation Therapy is much more effective and less harmful compared to radiation delivered from outside the body.

The decision regarding whether a patient is suitable for Selective Internal Radiation Therapy is made by the patient’s clinicians. If you meet the following criteria, you may be eligible for SIRT treatment:

 

 

  • You have an inoperable primary liver tumour, such as hepatic cell carcinoma (HCC) or cholangiocarcinoma (CCC).

OR

  • You have inoperable liver metastases from tumours in other organs, such as the breast, bowel, neuroendocrine tumours or choroidal melanoma.

 

  • It is only or mainly your liver that is affected by the cancer.
  • You meet all of the preliminary testing criteria for suitability for Selective Internal Radiation Therapy.

You must have adequate liver and kidney function, as demonstrated by the results of blood tests performed no more than two weeks ago. You must have an adequate amount of healthy liver tissue compared to tumour tissue. The occurrence of metastases outside the liver must be assessed by clinicians on a case-by-case basis. These must be demonstrated or ruled out using modern imaging methods (CT and/or MRI and/or PET/CT). If you have ascites (fluid on the abdomen), your clinician must check whether it is actually possible to carry out SIRT at all.

 

 

A complete checklist of all of the documents that must be submitted can be found here:
PDF Checklist for SIRT consultation

Around a week before SIRT, you will need to be admitted to hospital so that you can be checked to see if there are any liver-lung shunts present in your body. Your doctors will carry out an angiogram for this, during which they will first seal off tiny vessels to the stomach, the pancreas and possibly also the gall bladder via a catheter. They will then inject a fairly weak radioactive substance into the hepatic arteries and perform a nuclear medicine investigation to determine, among other things, how much of this substance collects in the lungs. If the percentage amount is too high, then SIRT cannot be carried out as it could damage the lungs. This only occurs rarely, however. This preparatory investigation also simulates the distribution of the therapeutic substance that will be administered later in the tumours and rule out any collection of microspheres outside the liver.

Selective Internal Radiation Therapy is carried out as part of an inpatient stay lasting usually only three to four days. Following admission, the anaesthetist will advise you on the process of local anaesthetic and the problem of upper abdominal pain. A specialist team, comprising a radiologist, a nuclear medicine expert and an expert in medical physics, will then – usually the following day – carry out the SIRT procedure. Following a local anaesthetic, the team of clinicians will make a small incision in your groin and then guide a fine catheter up through the aorta into the hepatic artery. Through this catheter, the clinicians then administer the dose of radioactive microspheres containing the beta emitter yttrium-90 that has been selected for you. The microspheres settle in the tumour and the blood vessels supplying it and release their radiation there. This enables them to destroy the tumour locally from the inside. The SIRT procedure generally takes around 90 minutes.

Generally speaking, you can leave the hospital again just two days after treatment. Your clinician, however, will decide whether you need to stay in hospital a little longer for monitoring.

Various clinical studies have shown that SIRT can significantly reduce the size of tumours and metastases in the liver. In some cases, the tumours shrink so much that doctors are able to actually remove them with surgery at a later date. Even for patients who are no longer responding to chemotherapy, SIRT can increase life expectancy and improve their quality of life. Your oncologist, along with your team of doctors, will use blood tests and X-ray investigations to determine what effect Selective Internal Radiation Therapy has had for you.

Although SIRT – especially compared to external radiation and many forms of chemotherapy – is tolerated well, pain in the upper abdomen or nausea can occur after the procedure. A slight fever or tiredness can occur for up to several weeks after treatment. These side effects can be effectively treated with medication, however. Your SIRT team will be happy to provide you with more details of potential side effects.

Various hospitals across Germany offer Selective Internal Radiation Therapy. You will find your nearest SIRT centre and contact here.

Yes, Selective Internal Radiation Therapy is generally reimbursed by the statutory and private health insurance companies.

 
NEWS & DATES
More treatment options are necessary for patients with metastatic colorectal cancer – Colorectal cancer prevention is getting more and more attention. However, every third colorectal cancer patient develops metastases in the course of the disease – often in the liver. For these patients, more and better therapy options are needed. Local therapies offer promising opportunities.To the press release
The new ESMO guidelines recommend SIRT for people with metastatic colorectal cancer if the metastases are limited to the liver and are not responding to chemotherapy.
New evidence of the benefits of SIRT in mCRC – The depth-of-response data from the SIRFLOX study shows a significantly larger local depth of response through the combination of SIRT and chemotherapy. To the press release
Metastatic colorectal cancer: the SIRFLOX, FOXFIRE and FOXFIRE Global studies are investigating the benefits of combining SIRT with chemotherapy. The data from the three studies regarding overall survival is expected by the end of 2017. The SARAH and SIRveNIB studies on advanced liver cell cancer are now complete. Both compared Y90 radio-embolisation with sorafenib chemotherapy. The initial results are set to be published at the end of 2016 (SARAH) and 2017 (SIRveNIB).
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