Dr Cormac Farrelly
Consultant Interventional Radiologist, Mater Misericordiae University Hospital
Brenda Byrne BA MSc
Principal Physicist and Radiation Protection Adviser, UCD Assistant Clinical Professor
SIRT is routinely used in the USA, UK and throughout Europe for the treatment of many liver tumours. In Ireland, however, there is no national funding agreement for SIRT, leaving patients with fewer treatment prospects.
Selective internal radiation therapy (SIRT) is a targeted treatment for some liver tumours that delivers millions of tiny radioactive beads, called SIR-Spheres, directly to the site of the cancer.
Liver cancer treatment improves quality of life
Dr Cormac Farrelly, interventional radiologist at Mater Misericordiae University Hospital Dublin, explains:
“The treatment has been around for about 20 years. Patients may have tumours that start in the liver — known as primary liver cancer (Hepatocellular carcinoma) — or they may have tumours that have spread to the liver from a cancer in the bowel — which is known as secondary liver cancer or metastases. Patients with metastatic disease that may benefit from SIRT are not generally surgical candidates, so it’s about aiding quality of life. Results depend on how far the cancer has spread when they get the treatment.
“SIRT can also be used for hepatocellular carcinoma that cannot be surgically removed, where the objective is to shrink the tumour and potentially make it surgically removable.” Brenda Byrne, principal physicist at Mater Misericordiae University Hospital, says benefits include selective injection, so healthy liver is spared, and the ability to tailor the dosing to each patient’s disease.
SIRT can also be used for used for hepatocellular
Brenda Byrne BA MSc
carcinoma that cannot be surgically removed.
Alternative to chemotherapy that directly targets tumours
However, Dr Farrelly adds that patients who found chemotherapy difficult to manage or ineffective may also benefit massively. “Many patients are weakened from extensive chemotherapy, but this treatment is generally administered only once or twice and does not leave the patients needing to isolate, as it is very accurate at only targeting cancerous tumours.”
Unlike traditional radiotherapy delivered from outside the body, SIRT allows delivery of the radiation directly to the tumour, allowing for higher doses and less damage to surrounding healthy cells. This is achieved by using a catheter placed in the femoral artery to feed the radioactive beads directly into the liver blood supply.
Equity of provision of treatment
Despite SIRT being routinely publicly funded in the UK, no funding arrangements are in place in Ireland. Consequently, the hospital providing the treatment is also the sole bearer of the cost of the treatment in the current environment. This is unsustainable in the long-term.
Brenda, who ensures the radiation dose is tailored to each patient to maximise efficacy and safety, says: “There are other hospitals in Ireland that could actually do the treatment. Yet, we are the only ones in Ireland using SIR-Spheres at present. Other hospitals can’t build the resources or expertise because they can’t get funding.” If Ireland invests in this treatment, more people with liver cancers could benefit.