Selective Internal Radiation Therapy (SIRT)

You are unique, and your treatment should be too.

Selective internal radiation therapy (SIRT), also known as radioembolization, is a targeted therapy for treating liver tumors. SIRT uses the fact that the source of blood supply to a liver tumor is different from that to healthy liver tissue. As much as 99% of the blood supply to a liver tumor comes from the liver artery (also known as hepatic artery); whereas 80% of blood supply to the healthy liver tissue comes from the portal vein. During the SIRT procedure, millions of tiny radioactive beads, or microspheres, are administered directly into (branches of) the hepatic artery. Due to the preferential blood flow towards the liver tumor(s) and the specific size of the microspheres, they accumulate in and around the liver tumor(s). Tumor cells are killed by the locally delivered radiation dose. With SIRT, a relative high radiation dose is delivered to the tumor(s) whereas the healthy liver tissue receives a much lower dose.

Quirem Quirem

QuiremSpheres® are tiny biodegradable polymer beads, called microspheres, that contain radioactive holmium-166. These microspheres are used during SIRT treatment. Because Holmium-166 emits gamma-radiation, it is visible on MRI and SPECT scans. This makes it possible to monitor the QuiremSpheres® and how they are distributed in the tumor. These post-treatment images provide insight on treatment efficiency by determining whether all tumors have been efficiently targeted. This is then used to formulate a follow-up strategy.

QuiremSpheres® received European regulatory approval (CE-mark) in 2015 for treating liver tumors that cannot be surgically removed. These tumors can either originate from liver (also known as primary liver cancer) or spread to the liver from other parts of the body (also known as secondary liver cancer or metastases).

The effectiveness and safety of SIRT depends on numerous patient related factors, such as anatomy, tumor blood supply, tumor type and tumor staging. It is therefore essential that the expected SIRT treatment outcome is evaluated for each patient individually. QuiremScout® is used to simulate the SIRT treatment, using a safe dose of microspheres identical to those used for the therapy. QuiremScout® is a micro dose of QuiremSpheres ®and is used to safely evaluate the distribution of intra-arterially injected microspheres prior to performing SIRT. The insights gained with QuiremScout® can be used by the treating physician to make an informed decision about the expected safety and efficacy of the SIRT procedure.

The administration of QuiremSpheres® can only be performed by trained and certified healthcare professionals (HCPs). In most centers, performing the procedure is a collaborative effort between the nuclear medicine physician and interventional radiologists. QuiremSpheres® treatment is typically an outpatient procedure, meaning you do not need to be hospitalized. Before the treatment, you may be given pain medication and a sedative to help you relax. You are able to communicate with your treating physician and the team throughout the procedure In short, the procedure goes as follows:
  • Your treating physician injects QuiremSpheres® into the liver artery through a small flexible tube, also known as a catheter. Access to the liver artery is usually obtained by creating a small puncture into the artery from either around the femur (near the groin) or the wrist. The catheter is then guided through the artery into the liver under x-ray imaging. A numbing medication will be applied at the site beforehand.
  • The tiny QuiremSpheres®are administered through this catheter and flow directly into the liver tumor via its own blood vessels and become permanently lodged in the small blood vessels surrounding the tumor.
  • The entire administration procedure takes between 60-90 minutes

After the procedure, the catheter is removed. You are taken to a recovery area in the nuclear medicine department of the hospital where you will typically stay for 4-6 hrs.
SIRT one of many treatments for liver cancer. SIRT is suitable for patients with liver tumors where the liver is either the only site of disease or the liver is the major site of disease as SIRT has no effect on tumors outside the liver. Your doctor considers several factors to decide whether you are suitable for SIRT. One of the most important factors is whether your liver is healthy enough to receive the treatment. This assessment can usually be achieved by a simple blood test. Other factors can be your medical history, relevant therapies you have received in the past and the blood flow in your liver (to minimize side effects). You can ask your doctor about the tests that are performed prior to your SIRT treatment.
The typical level of side effects after SIRT are mild to moderate. Common side effects are fatigue, nausea, vomiting, abdominal pain, and fever. These side effects are transient. After the SIRT procedure, your doctor will monitor your health status and liver function.

To find a clinic near you which offers SIRT treatment using QuiremSpheres® or if you want more information in general on Quirem Medical products, please contact us via info@quirem.com.

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