If you or a loved one are exploring treatment options for primary or secondary liver cancer, Selective Internal Radiation Therapy (SIRT) could be a viable solution. SIRT is a cutting-edge, minimally invasive procedure that delivers radiation directly to liver tumours, offering a targeted approach to cancer treatment. The Interventional Radiology Society of Australasia (IRSA) is here to guide you in finding the right interventional radiologist in Australia or New Zealand to perform this procedure.

What is Selective Internal Radiation Therapy (SIRT)?

SIRT, also known as radioembolisation, is a nuclear medicine treatment designed for primary and metastatic liver cancers like hepatocellular carcinoma (HCC).

During the procedure, tiny radioactive microspheres are injected directly into the liver arteries that are supplying the tumours. These microspheres concentrate in the tumours and release radiation over a period of weeks, effectively shrinking or destroying the cancerous cells while minimising damage to surrounding healthy tissue.

SIRT is a vascular interventional radiology procedure often recommended for patients whose liver tumours cannot be surgically removed or treated with other methods.

Why Would My Doctor Refer Me for This Procedure?

Selective Internal Radiation Therapy is a minimally-invasive interventional radiology treatment using implanted radiation that is often recommended when surgery or other ablative treatments are not suitable for addressing liver tumours.
If you have been diagnosed with liver cancer like Hepatocellular carcinoma (HCC) or liver metastases from another cancer (such as colorectal cancer or breast cancer), SIRT might be an option. However, it’s important to note that SIRT is not suitable for all patients, especially those with severe liver failure. Your doctor will assess your liver function and overall health to determine if SIRT is appropriate for you.

Selective Internal Radiation Therapy (SIRT)

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About the SIRT Procedure

Diagnosis

Before the procedure, you’ll undergo a series of tests, including imaging scans (such as CT or MRI) and blood tests, to determine your suitability for SIRT nuclear medicine.

Preparation for SIRT Radiotherapy

You’ll be asked to discuss your medical history and undergo several pre-procedural tests. This may include an angiogram to map the arteries providing blood supply to your liver. Your doctor will advise you on the hospital admission process and any necessary preparations, such as fasting before the procedure.

SIRT Internal Radiotherapy Procedure

The procedure itself is performed in a radiology angiography suite in two parts, each lasting about 2 hours. A small catheter is inserted into the artery through the groin or wrist and guided through the blood vessels to the liver tumour using X-ray imaging. Once in position, the tiny radioactive beads are delivered to the liver tumours through the blood vessels.

The first session is a “test run” to ensure that the treatment will be safe and effective. After a nuclear scan confirms the results, the full treatment is administered 2-3 weeks later. This second session involves the actual infusion of the SIR-Spheres, followed by another nuclear scan to assess the treatment’s effectiveness.

Recovery

You should not have any serious side effects when SIRT radiotherapy is correctly administered. However, you may experience some of the following side effects:

  • Pain in the abdomen that may last for a few hours

    This can be well controlled with pain medication.

  • Nausea

    This can be caused by the angiography contrast medium that is injected into the vessels or because of the SIR-Spheres infusion into the liver: This is a short-term effect (several days) which can be well controlled with anti-nausea medication.

  • Reduced appetite

    Some patients may feel a loss of appetite for several days.

  • Tiredness

    This may be caused by the effect of the radiation on the liver tumours and may last several days.

  • Fever

    The liver tumours essentially decay and breakdown, and the by-products of this may cause a short-term fever (up to a week). This can be well controlled with paracetamol or a similar over the counter analgesic.

  • Radiation in the body

    Your treating doctor will advise you on the effects of radiation and will advise that contact with other people should be minimised for at least the first week after treatment. This means that prolonged, close physical contact should be avoided, such as, sitting/sleeping next to children or pregnant women. Please feel free to discuss this with your radiologist.
pae recovery

Benefits of Selective Internal Radiation Therapy

SIRT radiotherapy offers several key benefits for patients with liver tumours, including:

  • Improved survival rates

    When combined with chemotherapy, SIRT has been shown to improve survival rates compared to chemotherapy alone.

  • Liver tumour size reduction

    SIRT can reduce the size of liver tumours, making them easier to manage or remove surgically.

  • Quality of life improvements

    Many patients report better overall quality of life following SIRT, as it reduces the liver tumour’s burden on the blood supply without the severe side effects of more invasive treatments.

  • Liver transplant eligibility

    In some cases, SIRT may shrink a liver tumour enough to make patients eligible for liver transplants, providing a potential cure.

Risks of Selective Internal Radiation Therapy

SIRT is generally considered safe as it is a minimally invasive procedure and carries fewer risks than traditional open surgery. However, like all medical procedures, there are some risks associated with the procedure. Your interventional radiologist will discuss these risks with you in detail before proceeding:

  • Radiation exposure to nearby organs

    There is a small risk that the radioactive beads could reach other organs, such as the stomach or pancreas, potentially causing ulcers or inflammation.

  • Radiation pneumonitis

    If too much radiation is delivered to the lungs, patients may develop a condition called radiation pneumonitis, which causes a dry cough or lung irritation.

  • Liver damage

    In rare cases, too much radiation to healthy liver tissue can lead to radiation hepatitis. Patients with poor liver function may be at higher risk and may not be suitable for SIRT.

  • Abdominal pain and nausea

    Some patients experience short-term side effects like abdominal pain and nausea after the procedure, but these symptoms are typically manageable with medication.

How Long Does It Take to Respond to the Procedure?

The results of the SIRT treatment may take several weeks or months to become fully apparent. Your doctor will monitor your response to the treatment through a combination of imaging scans and blood tests:

  • CT Scan

    A follow-up CT scan, typically performed 4-12 weeks after the procedure, will show whether the tumours have shrunk in response to the treatment.

  • PET Scan

    In some cases, your doctor may order a PET scan to evaluate how well the treatment is working.

  • Tumour Markers

    Blood tests measuring specific tumour markers can also provide insight into how effectively the cancer is responding to SIRT.

Find a Doctor

Our Doctor Finder offers a comprehensive directory of interventional radiologists practising across Australia and New Zealand. You can search by location and area of expertise to ensure you find a qualified professional who is experienced in performing SIRT to treat cancer.

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FAQs

Selective Internal Radiation Therapy (SIRT) is a minimally invasive treatment for liver tumours. It involves injecting tiny radioactive microspheres directly into the blood vessels that supply liver tumours. These microspheres deliver targeted radiation, which destroys cancer cells while minimising damage to healthy tissue. SIRT is often used for patients with primary or metastatic liver cancer when surgery is not an option. This interventional radiology procedure helps reduce tumour size, control cancer growth, and improve quality of life for liver cancer patients.

Patients with primary liver cancer or metastatic liver tumours that cannot be surgically removed may be eligible for Selective Internal Radiation Therapy (SIRT). Ideal candidates typically have tumours confined to the liver and good liver function. SIRT is often considered when other treatments, like chemotherapy, have not been successful or are not suitable. However, liver cancer patients with poor liver function or extensive liver damage may not qualify. An interventional radiologist will conduct a thorough assessment, including imaging and liver function tests, to determine if SIRT is the right treatment.

SIRT radiotherapy is generally not recommended for pregnant women due to the risks associated with radiation exposure. The radioactive microspheres used in SIRT could potentially harm the developing foetus, so this procedure is typically avoided during pregnancy. If you are pregnant or suspect you might be, it’s crucial to inform your doctor so they can consider alternative treatment options. Consult with an interventional radiologist to explore other safe and effective treatment methods during pregnancy. Here’s how to find an interventional radiology doctor for further guidance.

The procedure is usually well-tolerated, with minimal discomfort during and after the treatment. You may experience mild abdominal pain or nausea, but these side effects can be managed with medication. An interventional radiologist listed in IRSA’s database can provide more details.

Most patients can go home within a day or two after the procedure. While some side effects, like tiredness or nausea, may last for a few days, full recovery typically occurs within a week. Your IRSA-listed doctor will provide detailed aftercare instructions.

The SIRT procedure, like other interventional radiology treatments, is generally safe, but potential risks include radiation reaching nearby organs, lung complications, or liver damage. Your interventional radiologist, located through IRSA, will explain the risks and benefits specific to your condition.

SIRT has been shown to reduce the size of liver tumours and improve survival rates and tumour markers, especially when combined with chemotherapy. Your interventional radiologist can monitor your progress through follow-up scans and blood tests.

Use IRSA’s “Find a Doctor” tool to locate a qualified interventional radiologist in Australia or New Zealand who specialises in SIRT. You can search by geographic location and expertise to find the right professional for your treatment.
Take the first step toward advanced cancer treatment by finding an experienced interventional radiologist through IRSA today!


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