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Selective internal radiation therapy

Dr Yuranga Weerakkody et al.

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.

Contraindications

Absolute contraindications to microsphere-based ⁹⁰Y treatment include ⁴

exaggerated hepatopulmonary shunting,
reflux into the arteries that supply the gastroduodenal region.

Relative precautions

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

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