Worldwide data has shown that SIRT is a highly effective treatment for multiple tumour types in the liver. Patients being considered for SIRT should be referred to an oncologist within the SIRT team. The patient will usually have an oncology consultation before their case is presented to the multidisciplinary SIRT/hepatobiliary team.

The multidisciplinary team (MDT) is made up of a range of clinicians, including oncologists, radiologists, hepatobiliary surgeons and other members of the SIRT team. It meets weekly to discuss each patient’s treatment plan and ensure that each patient is receiving the optimum care at every stage.

Every case is reviewed on its individual merits and a decision is made as to whether the patient:

• Should be offered SIRT within the context of their specific cancer problem.
• Is fit for the procedure.
• Is suitable for SIRT from a technical point of view.

If they feel it is more appropriate, the team may recommend a treatment programme which does not involve SIRT, such as liver surgery, radiofrequency ablation, cryotherapy, microwave therapy, intrahepatic chemotherapy, peripheral chemotherapy, immunotherapy, targeted radiotherapy or a combination of treatments.

At this point a treatment plan is prepared to offer to the patient, and dates are provisionally agreed.

Sometimes, especially if the patient has not been seen by one of the oncologists prior to the meeting, the team may feel that they cannot give a comprehensive recommendation.

Chemotherapy With SIRT

Often, though not always, a course of chemotherapy is recommended as part of the treatment programme. Patients usually have chemotherapy around the time when the SIR-spheres are inserted, and often have a course of chemotherapy afterwards. Chemotherapy works with SIRT and makes it more effective. It also protects against any tumour cells which may be spreading around the body at this time.