Selection Internal Radiation Therapy (SIRT)

SIRT is a newly emerging treatment for many types of liver cancer. It was developed during the late 1980s and early 1990s at the Royal Perth Hospital in Australia and during the latter 1990s began to be used at The Chinese University in Hong Kong for non-resectable primary liver cancer and The Wakefield Clinic in Wellington for secondary liver cancer. Although a small experience has been developed in a number of North American centres most of the World experience todate has been obtained in Perth, Wellington and Hong Kong. The treatment was approved by the FDA in the USA in early 2002 and the United States experience is now growing rapidly.

It entails injecting 90 Yttrium microspheres into the hepatic artery which deliver a high dose of ionising radiation (radiotherapy) to the liver secondaries while giving a relatively smaller dose to the normal parts of the liver. We follow a single treatment of 90 Yttrium microspheres with monthly hepatic arterial chemotherapy.

SIRT is appropriate for those with disease too extensive for resection or cryotherapy but which still appears confined to the liver. Excellent responses are seen in over 90% of patients treated. Average survival time for patients with colorectal liver secondaries is now between 18 and 24 months where without treatment average survival would probably have been only 6-12 months. The treatment requires an operation for the placement of an hepatic artery Portacath (see below). The risk of dying having the surgery is less than one percent. The potential risks of the SIRT relate to the development of radiation hepatitis, radiation pneumonitis or development of peptic ulceration, all of which could be serious and potentially life threatening. However with appropriate planning and care the risks of these complications is very small. Hepatic artery chemotherapy is seldom associated with side effects. Quality of life during the treatment is maintained at fairly normal levels. As with cryotherapy this treatment can not be expected to achieve a cure.

More information about SIRT can be viewed at www.sirtex.com.

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