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Selective internal radiation therapy (SIRT)

SIRT provides treatment for liver tumours by direct delivery of radioactive microscopic beads (SIR-Spheres) to the tumour site(s). SIR-Spheres® release radiation energy called “Beta” radiation; a common type of radiation also used in other nuclear medicine therapy.

SIRT 1

SIRT provides treatment for liver tumours by direct delivery of radioactive microscopic beads (SIR-Spheres) to the tumour site(s). SIR-Spheres® release radiation energy called “Beta” radiation; a common type of radiation also used in other nuclear medicine therapy.

SIRT can be performed on tumours local to the liver ,or secondary tumours that have spread from other parts of the body to the liver.

These tiny microspheres are lodged directly into the blood supply feeding these tumours, allowing the radiation to be delivered directly to the tumour.

The radiation given off by the beads extends to an area of about 4mm which means that there is little damage to healthy tissue in the liver and no significant level of radiation outside the body.  The radioactivity of the beads decreases over time, with its treatment effect occuring mainly within the first two days. It is almost gone by day 11.
 

SIRT involves two separate procedures. The first procedure is the preparation or work-up stage. The second stage occurs two weeks later, where the delivery of SIR-Spheres® occurs.

Before the procedure

Fasting:  Do not eat or drink 4 hours prior to your procedure time.

Allergies: Please tell Intra staff at the time of booking if you have any food or medication allergies, or previous reactions to X-ray contrast (dye).

Diabetes: If you are diabetic, please tell Intra staff at the time of booking. You may need to discuss your insulin/diabetes medication with your doctor.

Anticoagulants (blood thinners): If you are taking any blood thinners (e.g. Warfarin, Clexane, Pradaxa, Rivaroxban), please make this known to Intra staff at the time of booking. You will need to stop this medication temporarily 2-5 days before the procedure, but this will be advised via your interventional radiologist, Intra nurse, or the admin team.

Other regular medications: Continue taking these.

How is the procedure performed

SIRT stage 1 and 2 are performed by an interventional radiologist. During the procedure you will be sedated but awake.

SIRT 2

The area around your groin will be painted with an antiseptic solution, and a sterile drape will then be placed over your body, to ensure sterility is maintained. Local anaesthetic will be injected around the artery in your groin. This will sting for approximately 30 seconds, but after this, you should not feel any pain. If at any time you feel pain, or discomfort, please inform the doctor immediately, and more pain relief can be given via your IV line, as well as more local anaesthetic.

Using ultrasound guidance, the artery in the groin will be accessed, and a small hollow tube (sheath) will be inserted into the artery. Using contrast dye and fluoroscopy, angiograms in your liver will take place. Wires and catheters will be used to gain access to the tumour(s).

During SIRT stage 1

Once access to the tumour(s) has been gained, a radioactive dye will be injected directly to the area. A device will then be used to close the hole made in your artery, and you will be transferred for a scintigraphy scan, in order to determine any lung shunting prior to stage two. Your radiologist will determine whether it is safe to continue to stage two, and what SIR-Sphere dose will be required.

During SIRT stage 2

Stage 2 is a repeat of the first stage, but also involves the administration of the SIR-Spheres. Again, once the procedure has been completed, a closure device will be used to close the hole in your artery.

After the Procedure

The interventional radiologist will discuss the outcome of the procedure with you.

After Stage 1 has been completed, you will be transferred to your scan via ambulance, escorted by one of the nurses from Intra. Once your scan has been completed, you will be transferred back to Stella Maris ward, Mercy Hospital, where you will stay for the remainder of your recovery time.

After Stage 2 has been completed, you will be transferred to Stella Maris ward, where you will recover overnight. Upon discharge the next morning, you will undergo another scan to ensure the distribution of the spheres are in the correct place.

You will be able to sit up after an hour due to the closure device used in your artery.

You will be able to eat and drink, once the sedation has worn off.

Once you are discharged home:

  • Someone must drive you home or accompany you in a taxi. Please arrange for accompanied transport in advance.
  • Due to the sedation or effects of the general anaesthetic, you may feel lethargic afterwards with reduced concentration. For this reason, for 24 hours after your procedure please:
    • Do not drive.
    • Do not drink alcohol.
    • Do not make any legal decisions or sign legal documents.
  • Do not do activity requiring strength, concentration, or full alertness for the rest of the day.

Before you leave, a nurse will give you discharge instructions to follow at home.

What are the risks?

As with any procedure, there are potential risks involved. Your interventional radiologist will explain the procedure, discuss possible risks and answer any questions you may have. You will then be asked to sign the consent form. This will occur on the day of your procedure.