SIRT via the wrist reduces procedure times for liver cancer patients at The Christie

The Christie NHS Foundation Trust in Manchester is pioneering a procedure to treat liver cancer through the wrist. Developed by interventional radiologists during the COVID-19 pandemic to avoid overnight hospital stays, the procedure is based on a technique used by cardiologists to restore blood flow for heart patients. Called SIRT (selective internal radiation therapy), the procedure involves injecting radioactive particles into the liver arteries through a catheter under local anaesthetic. The radiologist is guided to the patient’s liver arteries via ultrasound and x-rays.

The current standard treatment involves the SIRT particles and catheter entering the body via the femoral artery in the groin. When the procedure enters via the radial artery in the wrist, the patient is required to lie flat for the duration of the two-hour procedure but is then free to leave, in contrast with the groin where the patient is required to lie still for a further six hours.

In addition, performing the procedure via the wrist has demonstrated a much greater safety profile compared with the groin. The RAD observational study, led by consultant interventional radiologist Dr Pavan Najran from the interventional radiology team at The Christie, measures the radial artery during the procedure in a range of patients to determine whether the wrist can be used for a range of interventional procedures. The study also enables radiologists to better understand delivery of liver radiotherapy through the wrist and develop better guidance to be used globally. The study is sponsored by The Christie NHS Foundation Trust and supported by a scientific grant from Terumo.

Dr Najran, who developed the technique with national and international colleagues, explained: “Using the radial artery to administer radiotherapy is such an innovation that specific devices to perform the procedure have not been developed fully. We have had to adapt the equipment available to us. We want to make this available for all patients with liver cancer requiring SIRT.

“This approach is beneficial for patients as it has a much lower risk, and it also means we can treat more patients, particularly those who would be unable to lie flat for a considerable amount of time. It also reduces a two-day visit, involving an overnight stay, to just one day.

“This is a game-changing technique, and we are now looking to see if we can support the development of radial procedures, opening other specialities to use it more widely including treating patients who have had a stroke.”

Heather Norgrove from Coventry, who was a hospital manager for 40 years, has experienced both radiotherapy through the groin and the wrist to treat her liver cancer. She said: “When I was asked if I would like to take part in the trial and have the radiotherapy through my wrist, I was happy to try it. It’s a little more painful but you know it only lasts a couple of hours so, on balance, it’s worth it for the relative freedom it brings. You can walk around the ward and eat between procedures. My hand went numb and I had pins and needles but that quickly passed.”

Lead picture: Study team members Emma Ross and Lauren MacGregor (seated), with Greg Royle, Dr Pavan Najran, Bryony Cotterell and Harry Bond.

See the full report on the front page of the October 2023 issue of RAD Magazine.