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Advances in selective internal radiotherapy for primary and secondary liver cancer

Darren Morgan gastrointestinal Helen Winter liver oncology Phil Boardman radiotherapy Ricky Sharma SIRT Tessa Greenhalgh

Liver metastases are the leading cause of death from colorectal cancer (CRC) with a median survival of 19 months when treated with chemotherapy. The increasing incidence of hepatocellular carcinoma and the poor outcomes for intrahepatic cholangiocarcinoma (ICC) also add to the clinical need to develop effective liver-directed treatment strategies.

Surgical approaches have led to prolonged disease control with five-year overall survival rates of over 50%, although only 15-20% of patients presenting with liver metastases are considered resectable. Non-surgical therapies offer the potential for improved disease control. These techniques include microwave and radiofrequency ablation, selective internal radiation therapy (SIRT), trans-arterial chemoembolisation (TACE), bland transarterial embolisation and stereotactic ablative body radiotherapy (SBRT). Recent guidance from NICE compares SIRT and TACE for HCC stating that, in non-randomised series, SIRT has higher response rates and survival outcomes (NICE, MIB 62, 63 2016). In the NHS England Commissioning through Evaluation programme, SIRT is offered to patients with inoperable ICC and patients with advanced CRC who have failed two lines of chemotherapy or are intolerant to chemotherapy.

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