Transarterial radioembolization / selective internal radiation therapy (TARE/SIRT)

What is transarterial radioembolization (TARE) and selective internal radiation therapy (SIRT)?

Transarterial radioembolization (TARE), or selective internal radiotherapy (SIRT) is a type of internal radiation treatment that can treat liver cancer or liver metastases as a result of other cancers like colon cancer. Radioembolization will only be an option for people who can no longer be treated with surgery, ablation (RFA/MWA) and/or synthetic chemotherapy. It is primarily used to offer symptom relief for liver tumors instead of curing the underlying cause. Radioembolization can extend the lifespan and improve the quality of life. Some patients may be able to undergo a liver transplant as a result of the procedure.

What to expect?

The treatment consists of two phases: a pretreatment and actual treatment.

During the first phase, you will have a pre-SIRT done: an exploratory/pretreatment procedure. You will be thoroughly examined before the procedure. All blood vessels that do not lead to the liver will be blocked. Using a local anesthetic, your interventional radiologist will administer a test dose of a radioactive tracer into the hepatic artery through the femoral vein through a thin tube (catheter). We will then make a scan at the nuclear health department to find out whether the protein is only absorbed in the liver. Once we have this scan, we can determine whether you are eligible for treatment and what dose should be used. Your interventional radiologist will tell you more about that. More people can go home at the end of the day of the procedure.

During the second phase, you will receive SIRT treatment. This will take place a week or two after pretreatment and will follow a similar course as the pretreatment. Your interventional radiologist will administer radioactive beads through the hepatic vein towards the tumor. These beads get stuck in the blood vessels surrounding and inside of the tumor where they will give off radiation to destroy the tumor cells, shrinking the tumor. We use the radioactive isotope Yttrium-90 (also known as Y-90) or Holmium-166 (also known as Ho-166) Because the radiation only reaches the tumor itself, we can use a higher radiation dose than we would be able to when using other treatment methods, which will be more effective.

Treatment could cause side effects. After the procedure, you will need to stay at the hospital for one night. after the PET-CT scan, your interventional radiologist will discuss the results of the treatment with you.

What are the risks and complications?

The most common complication is post embolization syndrome. Approximately 20 to 70% of patients will experience this. Symptoms include fatigue, mild fever, nausea, vomiting, and abdominal pain. These symptoms are often most severe over the first two weeks but can last up to a month after treatment. 

Less common complications include bruising, edema, hepatic impairment, and infection. In rare cases, people turn out to be allergic to the contrast agent. The iodine in the contrast agent may, in very rare cases, cause a kidney response.