Selective internal radiation therapy
Selective internal radiation therapy (SIRT) is a relatively new and developing modality for treating non-resectable liver tumours. It generally considered efficacious in patients with hepatocellular cancer and colorectal liver metastases. It generally involves a single delivery of 90yttrium micro-spheres into the hepatic artery. Preferential uptake is achieved into liver tumours, because of their predominant hepatic arterial blood supply. Average tumour doses of radiation in excess of 200 Gy are achieved.
Absolute contraindications to microsphere-based 90Y treatment include 4
- exaggerated hepatopulmonary shunting,
- reflux into the arteries that supply the gastroduodenal region.
- prior, concurrent, or subsequent treatment with capecitabine may increase the risk of toxic effects in the liver
- presence of ascites or an elevated bilirubin level usually indicates decreased functional hepatocellular reserve; after treatment, arterial ischemia, combined with the effects of radiation on non-tumoral tissue, usually results in further deterioration of hepatic function.
- portal venous thrombosis (while it is listed in the package insert as a contraindication to use of the resin microsphere device, treatment with the glass microsphere device has been successful in patients with this condition 4
- 1. Stubbs RS, Wickremesekera SK. Selective internal radiation therapy (SIRT): a new modality for treating patients with colorectal liver metastases. HPB (Oxford). 2004;6 (3): 133-9. doi:10.1080/13651820410025084 - Free text at pubmed - Pubmed citation
- 2. Stubbs RS, Cannan RJ, Mitchell AW. Selective internal radiation therapy with 90yttrium microspheres for extensive colorectal liver metastases. J. Gastrointest. Surg. 5 (3): 294-302. J. Gastrointest. Surg. (link) - Pubmed citation
- 3. Stubbs RS, Cannan RJ, Mitchell AW. Selective internal radiation therapy (SIRT) with 90Yttrium microspheres for extensive colorectal liver metastases. Hepatogastroenterology. 48 (38): 333-7. - Pubmed citation
- 4. Murthy R, Nunez R, Szklaruk J et-al. Yttrium-90 microsphere therapy for hepatic malignancy: devices, indications, technical considerations, and potential complications. Radiographics. 2005;25 Suppl 1 : S41-55. doi:10.1148/rg.25si055515 - Pubmed citation
Synonyms & Alternative Spellings
|Synonyms or Alternative Spelling||Include in Listings?|
|Selective internal radiation therapy (SIRT)||✗|
|Yttrium-90 microsphere therapy||✗|