The treatment requires an overnight stay in hospital. Your treating doctor will advise what arrangements need to be made for hospital admission. You may need to check with the hospital what you need to bring with you for admission.
Preparation or “work-up”
The first procedure for SIRT is the preparation phase for the treatment commonly known as the work-up that includes a radiology procedure known as an angiogram. The purpose of the angiogram or mapping is to prepare your liver for SIRT.
In preparation for the angiogram you will have blood tests to evaluate your kidney function and blood clotting. During the mapping procedure your interventional radiologist (a specialist doctor) may block (embolise) some of the liver blood vessels communicating with other blood vessels to minimise the potential for the SIR-Spheres® to travel to areas outside your liver (e.g. the stomach or intestine).
You will also receive a small amount of radioactive spheres (MAA) similar in size to SIR-Spheres® to check the amount of blood that flows from the liver to the lungs. This is also a trial run to see how the SIR-Spheres® will behave when injected into your body.
During the angiogram a small amount of dye (or contrast medium) is injected through a catheter (a thin plastic tube) inserted into an artery. The dye travels down the catheter into the liver and highlights the vessels. Images or pictures are taken throughout the procedure.
The interventional radiologist now has a map of your liver vessels to follow so that the catheter can be advanced closer to the site of the tumours in the liver. Most patients say they feel a little warm when the dye is injected. Throughout the whole procedure you should try to stay as still as possible to avoid moving or dislodging the catheter in place.
This work-up angiogram is done in a conscious state (awake) and a local anaesthetic is given so that the discomfort from the procedure is minimal around the puncture wound.
The work-up procedure for SIRT is normally done on an outpatient basis. You will be observed after the work-up procedure and may then return home. While you are being observed your doctor will review the X-ray images to determine your suitability for SIRT and to see if you are suitable to proceed with the SIR-Spheres® implant.
Implant of SIR-Spheres®
You will need to return to the hospital within 7-10 days of the work-up when a second angiogram is performed to implant the SIR-Spheres® (SIRT). It is identical to the work-up angiogram except that SIR-Spheres® are inserted.
For the procedure, you are admitted to hospital and then taken on a bed to the angiography suite.
Once inside the angiography suite an interventional radiologist (a specialist doctor) will perform the second angiogram. You do need to fast before the angiogram. The purpose of the angiogram this time is to implant the SIR-Spheres®. The catheter used during the angiogram is then guided by the interventional radiologist through the artery and placed close to the tumours in the liver.
While the implantation angiogram is taking place, the nuclear medicine department prepares an individually prescribed dose of radiation for you (SIR-Spheres®). The prescribed dose of SIR-Spheres® is put into a specialised perspex box which is transported from the nuclear medicine department to the angiography suite where your catheter is being inserted.
The perspex box is then brought to the side of the bed and the catheter inserted into your artery is connected to the perspex box. Once connected the system is then ready for the infusion of SIR-Spheres®.
SIR-Spheres® are then infused from the perspex box through the catheter into your liver. During this infusion the radiologist may also insert contrast medium into the catheter to ensure that the catheter has not moved during the procedure. This whole procedure may take about 60 minutes. Once the infusion is complete, the catheter is then removed from the liver and the box used to deliver the SIR-Spheres® microspheres is then taken back to the nuclear medicine department.
Once the catheter has been removed, the interventional radiologist will compress the puncture wound where the catheter was inserted for around 10 minutes. This compression is done to stop excess bleeding at the site of the puncture. You then stay near the angiography suite for about 3 hours for observation to ensure there are no problems following the procedure. After observation you are taken to a general ward for an overnight stay.
In rare circumstances, on the advice of the treating doctor, you may be required to stay more than one night in hospital. Most patients are discharged the day following the procedure.
You may experience pain and nausea during the implantation process. The interventional radiologist and the angiography team will make sure that you receive the necessary medications to make you comfortable.
SIRT is usually done as a single treatment but some patients may be re-treated with SIRT. Re-treatment may occur in rare circumstances and may be indicated where new tumours grow in the liver despite SIRT, or previously treated tumours start to enlarge.