Radiation therapy is not often used to treat primary liver cancer. However, two techniques may be offered in specific cases. These are selective internal radiation therapy (SIRT) and stereotactic body radiation therapy (SBRT).
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Also known as radioembolisation, selective internal radiation therapy (SIRT) is a type of internal radiation therapy that precisely targets cancers in the liver, while causing little damage to normal liver tissue. SIRT may be offered for HCC when the tumours can’t be removed with surgery.
SIRT is not available in all hospitals. If you don’t have private health insurance that covers this treatment, you may need to pay for it yourself. Talk to your doctor about SIRT and the costs involved.
Understanding the SIRT process
SIRT deliver high doses of radiation therapy to a liver tumour using tiny radioactive beads known by the brand name SIR-Spheres. The procedure is performed by an interventional radiologist.
1. Before treatment (work-up day)
- You will have a number of tests, including blood tests and a test called an angiogram, as well as a trial run (simulation) of the treatment.
- For the angiogram, you will have a local or general anaesthetic. The interventional radiologist will make a small cut in the groin area and insert a thin plastic tube (catheter) into a blood vessel. The tube will be pushed up into the artery that feeds the liver (hepatic artery). A small amount of dye will be passed through the catheter into the bloodstream. On an x-ray, the dye shows the blood vessels in the liver and helps to map where the radioactive beads need to go.
- For the simulation, some tiny spheres similar in size to the SIR-Spheres will be inserted through the catheter to check how the SIR-Spheres will behave.
- The angiogram and simulation procedure take about 45 minutes and you will be observed for 3–4 hours afterwards. You may also have CT and lung scans, which take about an hour.
- If the results of these tests are good, you will have treatment 1–2 weeks later.
2. During treatment (delivery day)
- On the day of treatment, you will have another angiogram.
- The interventional radiologist will make a cut in the groin area and pass a catheter through to the hepatic artery.
- The SIR-Spheres will be inserted through the catheter into the hepatic artery. These beads can then deliver radiation directly to the tumour.
- The procedure takes about an hour. You will be monitored closely for 3–4 hours before being taken to a general ward, where you will recover overnight.
3. After treatment
- After treatment, you may experience flu-like symptoms, nausea, pain and fever.
- These side effects can be treated with medicines, and you usually can go home within 24 hours.
- The SIR-Spheres will slowly release their radiation into the tumour over the next week or so. This means you may need to take particular precautions, such as avoiding close physical contact with children or pregnant women during this time. The interventional radiologist will explain any precautions to you.
Some specialised centres offer a form of external beam radiation therapy called stereotactic body radiation therapy (SBRT).
For SBRT, you will lie on an examination table and a machine will deliver a few high doses of radiation very precisely to the liver.
SBRT may be offered to some people with small HCC tumours that can’t be removed with surgery. Check costs as this procedure may not be covered by Medicare.