Radioembolization / Selective Internal Radiation Therapy (SIRT)

Radioembolization or Selective Internal Radiation Therapy (SIRT) treatment is a targeted radiation therapy that delivers a dose of internal radiation up to 40 times higher than conventional external beam therapy while sparing healthy tissue. This maximizes the treatment’s effectiveness and reduces the risk of injury to the liver. The treatment is usually performed outpatient procedure at Miami Cancer Institute in conjunction with Miami Cardiac & Vascular Institute

If you or a loved one has been diagnosed with liver cancer whether it be primary liver cancer (hepatocellular carcinoma) or metastatic (such as spread from colorectal cancer, breast cancer, neuroendocrine/carcinoid tumor, or others), it is important to learn the facts and evaluate treatment options. 

Primary liver cancer is globally the sixth most frequent cancer and the second leading cause of death from cancer.  Of the 150,000 Americans diagnosed with colorectal cancer each year, more than 60 percent develop liver tumors. A diagnosis of primary liver cancer or metastatic liver cancer can be overwhelming, but there is hope.

Radioembolization or Selective Internal Radiation Therapy (SIRT) treatment is a targeted radiation therapy that delivers a dose of internal radiation up to 40 times higher than conventional external beam therapy while sparing healthy tissue. This maximizes the treatment’s effectiveness and reduces the risk of injury to the liver. The treatment is typically administered as an outpatient procedure at a local treating hospital.

Y 90 Microspheres

Who is a candidate for the treatment?
This treatment is indicated for patients with primary liver cancer or metastatic liver cancer.  As with any treatment, your medical team can help you decide if this treatment is best suited for your condition. 

How is Radioembolization / SIRT Therapy administered?
During the Radioembolization / SIRT procedure, an interventional radiologist makes a small puncture, usually into the femoral artery near the groin. A small flexible tube, known as a catheter is then guided through the artery into the liver and millions of microscopic spheres (about a third of the width of a human hair), are delivered directly into the tumor. The entire procedure takes about 90 minutes. Patients will be sleepy during the procedure but able to communicate with the doctor and the team. Most patients return home four to six hours following treatment. 

Y 90 Microspheres In Body

How do Y-90 microspheres work?
The radioembolization procedure delivers radiation, which is often used to treat cancer, directly into the liver tumors by using the tumor’s own blood supply. Normal liver tissue takes about 90 percent of its blood supply from the veins, while liver tumors receive about 90 percent of their blood supply from arteries. This allows the microspheres to target the liver tumors with a tumor-killing dose of radiation via the hepatic artery, while sparing surrounding healthy liver tissue. This typically isn’t possible with conventional external beam radiation. 

What are the goals of treatment using Y-90 microspheres?
Clinical trials have shown SIRT increases the time-to-disease progression and overall survival without adversely affecting the patient’s quality of life.2-8,10,11 In clinical studies, Y-90 microspheres have been combined with modern chemotherapy or administered as a monotherapy during a chemotherapy holiday and have been proven to: 2-9

  • Decrease the tumor burden in the liver 2-7
  • Increase time-to-disease progression 2,3
  • Increase survival time 11
  • Potentially downsize tumors to liver resection or ablation 2,4,8,9 
  • Provide palliation of symptoms

What side effects and complications can I expect?
When properly administered, most side effects are typically mild and subside within several days. Post treatment side effects can include abdominal pain and/or nausea which normally subside after a short time and/or with routine medication. Patients may also develop a mild fever that may last up to a week and fatigue which may last for several weeks. As a precaution, additional medications may be recommended with the aim of preventing or minimizing these side effects.

In rare instances there is a possibility that a small number of microspheres may inadvertently reach other organs in the body, such as the gall bladder, stomach, intestine or pancreas. If Y-90 microspheres reach these organs, they may cause inflammation of the gall bladder (cholecystitis), stomach (gastritis) or intestine (duodenitis). These complications are rare, but if one of these occurs, they will require additional treatment. Your treatment team will have received special training to minimize these risks and to prevent them from happening.

REFERENCES

1 SH, Murray T, Bolden S, et al. Cancer Statistics, 1999. CA Cancer J Clin 1999; 49: 8–31, 31.

2 Gray B, van Hazel G, Hope M et al Annals of Oncology 2001; 12: 1711–1720

3  van Hazel G, Blackwell A, Anderson J et al. Journal of Surgical Oncology 2004; 88: 78–85.

4Sharma R, van Hazel G, Morgan B et al. Journal of Clinical Oncology 2007; 25: 1099–1106.

5 van Hazel GA, Pavlakis N, Goldstein D et al. Journal of Clinical Oncology 2009; 27: 4089–4095.

6 Kennedy A, Coldwell D, Nutting C et al. International Journal of Radiation Oncology, Biology and Physics. 2006; 65: 412–425.

7Jakobs TF, Hoffmann RT, Dehm K et al. Journal of Vascular and Interventional Radiology 2008; 19: 1187–1195.

8 Hoffmann RT, Jakobs TF, Kubisch C, et al., Eur J Radiol, 2009; Mar 6; Epub.

9 Whitney R, Tatum C, Hahl M, et al J Surg Res., 2009 Jun 12; Epub.

10 Cosimelli M, Golfieri R, Cagol PP, et al British Journal of Cancer 2010; 103, 324–331

11 Seidensticker R, Denecke T, Kraus P, et al, Cardiovascular Interventional Radiology, 2011 July 29; Epub.


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