Treatment and side effects

Before the therapy, you will have a CT scan that the doctors will use to plan the treatment. You will also meet with the interventional radiologist who will administer the therapy.

 

You will be asked not to eat for four hours prior to each stage of the treatment. You may drink water until two hours before the procedure. You will be able to eat and drink normally after the treatment.

 

Before you have the Y-90 therapy you will be given a local anaesthetic in the groin or wrist, and you will be awake for the whole procedure. The doctor will then embolise (block off) any blood vessels. This enhances treatment effects and prevents microspheres from reaching other organs, minimising side effects. X-ray equipment will be used to guide the catheter and to take several pictures of the blood supply to your liver and other organs. 

 

Next, a radioactive tracer mimicking the treatment is injected. You’ll then undergo a SPECT/CT scan in the Nuclear Medicine department. This is a 3D scan which shows where the radioactive tracer has travelled inside your body. This scan helps to decide the next stage of your therapy.

 

You will be ab le to go home at the end of the day, or early the next morning.

 

 

 

The second stage of therapy consists of the microspheres treatment, performed one to two weeks after your initial tests. This procedure is very similar to stage one.

 

You will have another angiogram to check that no new blood vessels need embolising (blocking off). The doctor will also position the catheter for the injection of the microspheres into your liver. The microspheres have to be injected very slowly, and sometimes into different vessels separately. This procedure takes time, but it is normally shorter than the previous angiogram. Afterwards, you will be transferred to the ward where you may need to stay overnight. The following day, you will have another gamma camera scan to confirm the placement of the microspheres. This scan will again last about an hour. The Nuclear Medicine team will give you a ‘yellow card’ that will contain radiation protection advice for you to follow.

 

You will be discharged from the ward and will be able to go home. You will be given the contact details of the clinical nurse specialist who will organise your follow-up appointments and CT scan.

Common side effects

As with all cancer treatments, there are some potential complications of the SIRT procedure. These complications are all very rare, but you need to be aware of them. They are detailed below:

 

• Radiation damage to the liver. Despite the microspheres concentrating in the tumours, there will always be some effect of the radiation to healthy liver. If this occurs, it is usually short-lived. However, in rare cases it can be enough to cause significant liver damage or failure. This is more likely if you already have other liver disease, such as cirrhosis.  

 

• Radiation damage to other organs. The first stage of the treatment is designed to ensure the microspheres are delivered only to the tumour. However, there is a small chance that some of the microspheres may end up in blood vessels supplying other organs. These organs could include the lungs, stomach or pancreas. The radiation can damage these organs, causing inflammation (pneumonitis, gastritis, and pancreatitis). These may require further medical treatment.

 

• Damage to blood vessels. Some chemotherapy can make blood vessels very fragile and sensitive to damage during angiography. This may sometimes make it impossible to complete the SIRT treatment.

 

Some patients experience abdominal pain and feel sick after the second stage of the treatment. You may also develop a fever and feel tired for a few weeks after the treatment. As a precaution, you may be given some medication to take home with you. These may include painkillers, anti-inflammatory and anti-sickness drugs. The treatment can irritate your stomach, because it is close to the liver. For this reason, you will also be given some medication called proton-pump inhibitors (PPIs). These are taken for the four weeks following the treatment. PPIs reduce acid in your stomach, which can help relieve the stomach irritation. Some patients may also experience diarrhoea alongside the stomach irritation. Other extremely rare side effects may include stomach ulcers; blood clots; nerve damage causing pain, numbness or weakness in your hands, arms or feet; and fluid retention.

 

When to seek help?

Please inform the nursing staff if you require any medical help.

Because this is a radioactive treatment, there are some simple precautions that you must follow after the second stage of the treatment. These include thoroughly washing your hands after using the toilet and cleaning up any spills of body fluids promptly and disposing of them down the toilet. A medical physicist will explain the precautions at the end of your treatment. You will be given a yellow restriction card with the details to take home with you.

 

After you are discharged, you will have regular blood tests and scans to monitor the success of the therapy. Your doctor will see you in a follow-up clinic two weeks after the treatment, where you will have blood tests to monitor your liver function. You will have a CT scan of your liver eight weeks after the treatment. This is to monitor your response to the therapy. The doctor will discuss this with you in a clinic appointment one week after your CT scan.