The use of sirtex in inoperable liver tumours. A surgeon's view

Abstract

Over the past few years, selective internal radiation therapy (SIRT) has been used clinically for the treatment of non-resectable hepatic metastases in the absence of extrahepatic metastases and in combination with hepatic arterial chemotherapy. The procedure involves using Yttrium-90 microspheres (25-35 u in diameter (fig. 32b. 1), that are injected using a syringe into the hepatic artery via an access route: either a trans-femoral catheter or a permanently implanted hepatic artery port with catheter (fig. 32b.2). Once injected, the spheres travel through the blood stream and target the tumour within the liver, delivering high doses of beta radiation of 0.93 MeV energy, with a maximum 11 mm and mean 2.5 mm penetration distance [1, 2]. Treatment takes around 20-30 minutes and is delivered under mild sedation. In a randomised controlled trial of selective internal radiation therapy in combination with chemotherapy, patients receiving SIRT had improved response rates as measured by tumour area, volume and CEA in comparison to those patients receiving chemotherapy alone. However, evidence on survival indicated no statistically significant difference in the outcomes of patients receiving SIRT, compared with those treated with chemotherapy alone. More or less, this treatment modality has been increasingly adopted in recent years with a great enthusiasm for management of patients with liver cancer as an established treatment option without a clear evidence of survival benefit and its cost implications [3]. © 2006 Springer-Verlag/ Wien.