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SELECTIVE INTERNAL RADIOTHERAPY

Selective Internal Radiation Therapy (SIRT), also known as radio-embolisation, is a form of radiotherapy used to treat cancer of the liver. In contrast to exposing the body to radiation from outside, SIRT largely protects healthy cells and specifically irradiates the diseased tissue. Treatment is delivered via a catheter inserted into the groin.

Healthy liver tissue obtains its blood primarily via the portal vein (Vena portae) and to a much lesser extent via the hepatic artery (Arteria hepatica). The hepatic artery, however, is the primary source of blood for tumours in the liver. SIRT makes use of this difference in the blood supply: with Selective Internal Radiation Therapy, the team of doctors uses a catheter to put millions of tiny radioactive microspheres in the hepatic artery. The microspheres travel directly to the tumour tissue, where the radiation is delivered very specifically to the malignant cells.

 

 

The microspheres contain Yttrium-90, a radioactive isotope that emits beta radiation. This radiation travels through human tissue for a distance of two to eleven millimetres. With SIRT, a higher and more effective dose of radiation can therefore be targeted directly against the cancer cells than with external radiotherapy.

 

 

Various clinical studies have shown that SIRT can significantly reduce the size of tumours in the liver. Some tumours shrink so much that doctors are able to remove them with surgery at a later date. In some cases, the malignant tissue has even been completely destroyed. Even for patients who are no longer responding to chemotherapy, SIRT can improve their quality of life and increase their life expectancy.

SIRT can be used for patients with

 

 

In addition to further prerequisites that clinicians must check in detail before carrying out SIRT, the patient must most importantly still have a well-functioning liver.

Selective Internal Radiation Therapy is carried out by a team of radiologists and nuclear medicine specialists. Beforehand, liver specialists and oncologists gather information about all of the patient’s existing and previous conditions (medical history). A series of tests are then carried out to determine whether the patient is suitable for SIRT: During the initial procedure, the radiologist blocks off adjacent blood vessels so that the radioactive microspheres travel only to the liver, and not to other organs, when they are injected. A measurement is also taken of how much radioactivity flows from the liver to the lungs.

 

If the initial investigations yield positive results, the SIRT team will administer a customised dose of microspheres one to two weeks later. The catheter used for this is again guided via the groin up to the liver. The procedure generally takes no more than 90 minutes, and the patient can be discharged from hospital one to two days later, after a period of observation.

 

SIRT is now available throughout Germany. Here is where you will find a list of centres in Germany that regularly carry out this treatment.

Selective Internal Radiation Therapy is generally well tolerated, especially compared to external radiotherapy or chemotherapy. Patients may experience abdominal pain, mild fever and nausea following the procedure, however. Further side effects that may last for a few weeks after SIRT include fatigue and exhaustion.

Most statutory and private health insurance companies in Germany will cover the costs of Selective Internal Radiation Therapy.

 

 

 
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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