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Selective internal radiotherapy

Since early 2008, the Institute of Clinical Radiology and Nuclear Medicine at Mannheim University Hospital has been offering a new therapy for the treatment of liver cancers: selective internal radiotherapy (SIRT).

This innovative therapy is currently only used by a limited number of hospitals in Germany. It is mainly aimed at patients suffering from a primary liver tumour, but also helps patients suffering from other types of cancer who have developed liver metastases. SIRT is a minimally invasive method in which small radioactive spheres – so-called microspheres – are delivered directly to the site of the liver tumours through the hepatic artery. The microspheres are injected through the patient’s groin, in the same way as a heart catheter examination. The microspheres irradiate the tumours and lead to the shrinkage or even complete destruction of the tumour from the inside out. Since the treatment also minimises the harmful effects on the surrounding healthy tissues, which usually recover very quickly, SIRT is in general well tolerated by patients.
SIRT - a catheter is inserted into the femoral artery and the microscpheres threaded into the cancer tissues (Figure: Sirtex Medical Europe GmbH)
Selective internal radiotherapy is used in cases where it is impossible to destroy liver tumours using traditional therapies. However, as this treatment method is not suitable for all liver cancer patients, only patients that are likely to derive the greatest benefit from this method are selected for treatment. At the Mannheim University Hospital, the decision as to whether SIRT is indicated or not is made by an interdisciplinary team of experts working in the fields of oncology, radiation and surgery.

SIRT process

Prior to applying selective internal radiotherapy, the treating physicians have to assess whether the patient is suited to this therapy or not. Patients for whom SIRT is suitable suffer from a liver cancer that cannot be either surgically removed or destroyed through chemotherapy. In addition, their liver still has to be functioning satisfactorily, the liver artery must be penetrable, and the patients should not have previously undergone radiotherapy.

SIRT is prepared in several stages, involving modern methods such as magnetic resonance imaging or positron emission tomographs. The actual intervention is carried out at the Institute of Clinical Radiology and Nuclear Medicine by an experienced team of radiologists, nuclear physicians and radiation safety experts. It takes no more than thirty minutes. After a local anaesthetic, a thin plastic tube (catheter) is inserted through a small cut into the femoral artery of the upper thigh and fed into the hepatic artery. Prior to threading the radioactive microspheres into the cancer tissues, all arteries leading to other organs are closed to ensure that the cancerous tissue in the liver is destroyed whilst sparing the healthy tissue in the surrounding organs.

After treatment, the SIRT patients must remain in bed for four to six hours. An overnight stay in hospital is recommended for medical observation. At the University Hospital in Mannheim, the patients spend a night in the Hospital for Radiotherapy and Radiooncology. No severe complications have so far been observed. Some patients may complain about pain in the upper abdomen a few hours after the administration of the microspheres; occasional nausea, vomiting and fever has also been reported, but these symptoms can be easily treated with medication.

Cancers of the liver

Liver tumour with vessels during the treatment with microspheres (Photo: Mannheim University Hospital)
SIRT is mainly used in patients with what are known secondary malignant liver tumours. These are metastases of a primary tumour, for example bowel, breast or skin cancer. SIRT is recommended when the traditional treatment of metastases is ineffective or in cases when the side effects of such therapies are so strong that they would do more harm than good.

Primary liver cancer is rarely discovered early (30 per cent) and often does not respond to current treatments, thus the prognosis is often poor. That is why therapies like SIRT are gaining in importance; they are at least able to shrink the cancer and hence increase the patients’ life expectancy as well as improving their quality of life. Worldwide, approximately 7,000 patients have so far been treated with SIRT. It is possible to prolong survival by several months.

Source: University Hospital Mannheim - 4 April 2008
Website address: https://www.gesundheitsindustrie-bw.de/en/article/news/selective-internal-radiotherapy