Selective Internal Radiation Therapy (using SIR-SpheresŪ )
What is Selective Internal Radiation Therapy (SIRT)?
SIRT is one of the treatment choices for people who have tumors in the liver. It is a procedure in which radioactive spheres (very tiny seeds) are placed into an artery in the liver. These spheres travel through smaller arteries into the tumor. Once the spheres are in the tumor, they give off radiation. The radiation causes damage to cancer cells with little damage to healthy liver tissue.
Is SIRT right for you?
Your Oncologist, the Interventional Radiology and Radiation Oncology staff will review your health history and your recent CT scans and blood work. They will assess your general health and if you can tolerate SIRT. There are three screening tests that are done to see if you can have SIRT:
- A triphasic CT scan is a special type of CT scan. A series of x-ray pictures are taken to look closely at the blood vessels in your liver and to measure the exact size of the liver tumor(s). This will help decide the correct dose of radiation for the tumor(s) in your liver.
- An angiogram is a series of x-ray pictures taken after x-ray dye has been injected into an artery. A small catheter is placed in an artery in your groin. It is then moved into the artery that provides blood to the liver. The dye is instilled into the catheter and x-ray pictures are taken. The angiogram will provide the Interventional Radiologist with a ‘road map’ of the arteries in your liver. You will need to lie flat for the next 4-6 hours to prevent bleeding at the puncture site in your groin.
- After the angiogram, a perfusion scan will be done to help decide whether it is safe to perform SIRT on you. The x-ray pictures taken during this scan will show the amount of blood that flows around your liver and into your lungs. For this test, you will be placed in a scanner for about 1/2 hour. After this test is over, you will be taken to the recovery area until you are ready to go home.
If these tests show that it is safe for you to have SIRT, you will be set up for the first treatment within the next few weeks. Most of the time, one side of the liver is treated first and the other side is treated about a month later. Sometimes the whole liver is treated at once. It depends on how much liver disease you have and the blood supply to the liver.
Getting Ready for SIRT
Before the procedure:
- Do not drink or eat anything after midnight the night before.
- You may take scheduled medicines with a sip of water.
- If you are on blood-thinners (such as Coumadin®, aspirin, or Plavix®) you will be told when to stop them.
When you arrive for your procedure:
- Blood samples will be taken.
- An intravenous line (IV) will be put into your arm and you will be given IV fluids.
- A tube (catheter) will be placed in your bladder to drain urine.
- A nurse will perform a brief physical exam.
During the Procedure
You will be taken to the Interventional Radiology Suite on a cart. You will be given medicine in your IV to prevent pain and help you relax. Your upper leg and groin area will be washed with soap. The doctor will inject numbing medicine into the groin. A small tube will be placed into the large blood vessel in your groin. The tube is threaded into the artery that provides blood to the liver. X-ray dye is instilled into the tube to make sure that it is in the correct place. Once the tube position has been confirmed, the doctor will slowly inject the radioactive spheres. The tube will be removed and pressure will be put on the groin site to prevent bleeding. You will be taken to your room to recover.
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Back in Your Room
You will need to lie flat for 4-6 hours. This will help stop bleeding from the groin puncture site. At first, you will only have clear liquids to drink. This will help you avoid nausea and bloating. If you can drink the clear liquids without any problems, you will be allowed to eat what you’d like.
After the SIRT, you may have symptoms of fever, abdominal pain, nausea, vomiting and fatigue. You will be given medicine to help control pain and nausea. The symptoms of fever and fatigue can last up to 14 days. In most cases, you will be able to leave the hospital the same day. If you live more than 30 minutes from the hospital you will be asked to stay at a local hotel for 1-2 nights. A brief scan will be done the next day. If you are feeling well at that time, you will be allowed to go home.
You will be scheduled for a clinic visit with the Oncologist about 2 weeks later. If you need to have a second SIRT, it will be scheduled about 4 weeks after the first treatment.
Listed below are some simple instructions that you must follow after you go home from the hospital. If you have any questions about these please ask your doctor or nurse. At the end of the handout there are phone numbers that you should call if you have any problems after you leave the hospital.
Home Care
Please go over the instructions below to avoid problems after your procedure.
Diet:
- Drink plenty of fluids - Drink at least eight 8 oz glasses of water, juice, or soda over the next 24 hours.
- You may eat what you’d like when you leave the hospital.
- Do not drink any alcoholic beverages for 4 weeks after your SIRT treatment.
Medicine:
- Restart your scheduled medicine as prescribed.
- Take ranitidine 150mg at bedtime for 4 weeks after the procedure.
Site Care:
- You may remove the groin dressing after 24 hours.
- Do not take a hot bath or shower for at least 24 hours.
Activity: No strenuous physical activity of any kind.
- Do not bend the leg that was used for the procedure more than needed for 24 hours.
- Do not lift greater than 10 pounds for 48 hours.
- Avoid strenuous activity such as sports, heavy cleaning, and stair climbing for 48 hours.
- No driving for 24 hours, or while taking pain medicine.
When to Call the Doctor
Call if
- You notice redness, swelling, or drainage at the groin site. Some bruising at the puncture site is normal and will go away in a couple days.
- You feel increased pain, numbness, coolness, or see blue discoloration of the leg where the puncture site is located.
- You have abdominal pain that gets worse over time.
- You notice bleeding at the puncture site. Put pressure on the site to stop the bleeding and then call the phone number below.
- You have nausea and vomiting that are not controlled by medicines or lasts for more than 24 hours.
- Fever is common for the first several days. This can be relieved by taking acetaminophen (Tylenol®) 325 mg, 1-2 tablets every 4 hours; or, ibuprofen (Advil®) 200mg, 1-2 tablets, every 4 hours. Call if fever is more than 101°F for two readings taken 4 hours apart.
The spheres used for this procedure are radioactive and take time to become inactive. This means that for 3 days (72 hours) after the procedure, other people that you are around may be exposed to radiation from your body. Please follow these simple guidelines:
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Phone Numbers
Interventional Radiology Department: Mon-Fri. 8:00 am-4:00 pm.
(608) 263-8355
After hours, weekends and holidays, this number will give you the hospital paging operator. Ask for Interventional Radiology Resident on call. Give your name and phone number with the area code. The doctor will call you back.
If you live outside the area, please call 1-800-323-8942
The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.
Last Updated: 11/05/2012
Copyright © 11/05/2012 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#5908
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