Radiation therapy: SIRT and SBRT for secondary liver cancer

Also known as radiotherapy, radiation therapy uses targeted radiation to treat cancer. The radiation is usually in the form of x-ray beams. Conventional external beam radiation therapy is not often used for secondary cancer in the liver, but two specialised forms of radiation therapy may be offered in some cases.

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SIRT

The most common type of radiation therapy used for secondary cancer in the liver is selective internal radiation therapy (SIRT).

SIRT may be offered for bowel cancer and other cancers that have spread to the liver when the tumours can’t be removed with surgery. It’s often used if there are many small tumours throughout the liver.

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.

How does the SIRT process work?

Also called radioembolisation, SIRT is a treatment that precisely targets cancers in the liver with high doses of radiation while causing little damage to normal liver tissue. It uses tiny radioactive beads known by the brand name SIR-Spheres.

SIRT can be given as a single treatment to the whole liver or separate treatments to the right and left lobes.

The procedure is done 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.
  • The radiation from the microspheres damages the cancer cells and their blood supply. This means the cancers can’t get the nutrients they need and they shrink.
  • You may need to take some safety precautions, such as avoiding close physical contact with children or pregnant women for at least a week. The interventional radiologist will explain any precautions to you.

SBRT

Some cancer centres offer a form of external radiation therapy called stereotactic body radiation therapy (SBRT). You will lie on a treatment table and a machine will deliver tightly focused beams of high-dose radiation precisely onto the tumour from many different angles.

SBRT may be offered to some people with small secondary tumours in the liver. Side effects after treatment may include fatigue, nausea and abdominal discomfort. SBRT is sometimes called stereotactic ablative body radiation therapy (SABR).

This information was last reviewed in July 2020. View who reviewed this content.

Dr David Yeo, Hepatobiliary/Transplant Surgeon, Royal Prince Alfred, Chris O’Brien Lifehouse Cancer Centre and St George Hospitals, NSW; Dr Lorraine Chantrill, Head of Department Medical Oncology, Illawarra Shoalhaven Local Health District, NSW; Michael Coulson, Consumer; Dr Sam Davis, Interventional Radiologist, Staff Specialist, Royal Brisbane and Women‘s Hospital, QLD; Prof Chris Karapetis, Network Clinical Director (Cancer Services), Southern Adelaide Local Health Network, Head, Department of Medical Oncology, Flinders Medical Centre and Flinders University, SA; Dr Howard Liu, Radiation Oncologist, Princess Alexandra Hospital, QLD; Caitriona Nienaber, 13 11 20 Consultant, Cancer Council WA; Lina Sharma, Consumer; Dr Graham Starkey, Hepato-Biliary and General Surgeon, Austin Hospital, VIC; Catherine Trevaskis, Gastrointestinal Cancer Specialist Nurse, Canberra Hospital and Health Services, ACT; Dr Michael Wallace, Western Australia Liver Transplant Service, Sir Charles Gairdner Hospital, WA.

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