Yttrium-90 Selective Internal Radiation Therapy, SIRT, Theranostics, Theranostics Singapore, Cancer Treatment, Liver Cancer, Dr Andrew Tan

What Is Yttrium-90 Selective Internal Radiation Therapy (SIRT)

Yttrium-90 Selective Internal Radiation Therapy (SIRT) is known as radioembolisation, and its purpose is to eliminate tumours located in the liver. It works as small radioactive beads that migrate to the tumour through one’s arteries. These beads emit short-range radiation, which targets the tumour but minimises damage to the surrounding tissues.

What Is Liver Cancer?

Liver (Hepatic) cancer occurs when there is an abnormal and uncontrolled growth of liver cells. Although there are many different types, the most common is hepatocellular carcinoma.

Various risk factors can lead to this type of cancer. Among them, we have episodes of hepatitis, liver cirrhosis, excessive alcohol consumption, obesity, and diabetes, among others.

Typically, there is pain in the right abdominal region and yellowing of the skin (pathological jaundice). Although it is usually asymptomatic at the beginning, it tends to generate symptoms after the disease has advanced significantly.

What Is A Mapping Arteriogram Procedure / Liver Lung Shunt Study & Why Do I Need It?

Mapping Arteriogram Procedure / Liver Lung shunt study must be performed a week before starting the SIRT treatment. Mapping will allow the identification of the blood vessels (arteries) that are directed to the tumour, as well as blocking the  passage to other organs such as the intestines. This is necessary to prevent the radiation from affecting healthy organs.

The procedure requires a series of preparations and steps before, during, and after. Everything related to mapping arteriography will be explained in detail by your treating physician.

What to Expect Before Treatment With Yttrium-90 Selective Internal Radiation Therapy (SIRT)?

Aside from the angiography, there will be a series of blood tests to assess the baseline liver, kidney and bone marrow function. 

The patient is required to fast for 6 hours before the angiogram, and there will be a clinical examination prior to the procedure. 

The angiogram will be performed with a liver lung shunt study. This involves injecting a diagnostic radiotracer into the hepatic artery catheters, which will allow the doctors to fully understand the distribution of particles into the tumour and normal tissue. The doctors will then be able to determine if the patient is a suitable candidate for Y90 SIRT and, if so, to calculate a proper dose of the radioactive microspheres.

  • Speak to Our Doctor About Other Prescribed Medications

A series of medications will most likely need to be discontinued on the day of treatment to ensure successful therapy and even mapping, so make a list of your medications and consult with our doctor.

Among them, we have anticoagulants – such as aspirin, AINES, vitamin E, oral hypoglycemic agents, and insulin – and diuretics, among others. In the case of diabetes treatment, your dose may be adjusted.

  • Reactions to Contrast 

These types of procedures generally make use of contrast media, allowing the doctor to see the arteries that communicate with the tumour. If you have previously had allergic reactions to contrast media, you should notify your medical care team to avoid complications. This will allow our doctor to look for an alternative to be used as a contrast medium.

What to Expect During Treatment With Yttrium-90 Selective Internal Radiation Therapy (SIRT)?

The actual Y90 SIRT procedure is almost entirely like the pre-treatment angiographic mapping and liver lung shunt. The only difference is the radioactive particles used. While in the assessment phase, a diagnostic tracer is used, in the treatment phase, the Y90 microspheres are injected.

How Long Does Treatment With Yttrium-90 Selective Internal Radiation Therapy (SIRT) Take?

The angiographic procedure and implantation of the microspheres depend on the complexity of the patient. Usually, the procedure will take about 90 minutes.

What to Expect After Treatment With Yttrium-90 Selective Internal Radiation Therapy (SIRT)?

After treatment, the patient will be transferred to a recovery area where they will remain for approximately 1 to 4 hours. During this period, the catheter is removed from the bladder. 

Yttrium-90 Selective Internal Radiation Therapy (SIRT) treatment has several reported side effects. These include: 

  • A fever of more than 38 ° C
  • Abdominal pain
  • Nausea and vomiting

Our specialist will indicate if antipyretic, analgesic and antiemetic medications are necessary.

How Long Before I Can Be Discharged After Treatment With Yttrium-90 Selective Internal Radiation Therapy (SIRT)? 

You are typically required to rest in bed for a minimum of 6 hours post-treatment. If everything goes well with no complications, you should be able to be discharged the next morning.

You Should Arrange For Someone to Take You Home Following Treatment With Yttrium-90 Selective Internal Radiation Therapy (SIRT)

As it is a radiation treatment that causes fatigue in patients, our doctor will recommend that someone take care of bringing you home safely. You should arrange for an accompanying adult after your treatment. 

What Questions Should I Ask My Doctor?

It is normal to experience fear or doubts when diagnosed with liver cancer, so we have prepared a shortlist of questions that you can ask your doctor. 

  • How do I know if I am a candidate for Selective Internal Radiation Therapy (SIRT)?
  • Is it mandatory to perform mapping arteriography before starting SRIT?
  • Should I stop my medication if I am diabetic?
  • What if I am allergic to contrast and am not aware?
  • If I have a device on my skin, what should I do?
  • Can I have sex?
  • What to do with my clothes in case they get stained with body fluids?
  • Is it mandatory to have a companion when I go home?
  • If I follow another treatment such as chemotherapy, should I stop it?

In case of not feeling well, you should notify your companion of your discomfort. Your companion should inform your treating physician. Side effects after therapy are generally few and short-lived.

It is essential that if your companion notices something out of the ordinary after the treatment, they should immediately notify your doctor so that they can carry out the corresponding corrections.