Selective internal radiation treatment (S.I.R.T.) of colonic liver metastases: the role of the radiologist and nuclear physician

Full text: Many tumours respond to treatment combinations including chemotherapy and radiation therapy with colonic liver metastases being no exception. Radiologists and nuclear physicians play an essential role in the selection and management of patients in S.I.R.T. We report our experience in 36 patients. Prior to S.I.R.T. all patients underwent Chest CT, Angio CT and macroaggregates of albumin (M.A.A.) lung scan to determine if patients were suitable for S.I.R.T. 35 patients were deemed suitable for Yttrium injection via the transfemoral route. In 1 patient M.A.A. scan indicated >25% lung uptake contraindicating treatment due to the risk of radiation pneumonitis. Micro-catheters were necessary in the delivery of the therapeutic isotope in 16 patients (2 microcatheters in 1 patient). 5 patients required embolisation of the gastroduodenal or left gastric arteries to prevent pancreatic and / or duodenal irradiation. Due to the suspected risk of reflux at the time of angiographic administration of Yttrium only 70% of the planned dose was injected in 1 patient and 10% in another. Yttrium injection resulted in severe pain in 3 patients, of whom 1 developed gastroduodenal junction ulceration due to unidentified reflux of isotope at injection. No patients developed radiation pneumonitis. Therapeutic administration of Yttrium to the liver was achieved in 35 of the 36 patients. Complications may occur if anomalous vessels are not recognised during the diagnostic workup. Copyright (2002) Blackwell Science Pty Ltd