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Ask The Expert Archive

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SIR-Spheres Archive Questions

Below are Dr. Navesh Sharma’s answers to SIR-Spheres questions
received through the Ask the Expert feature.

This content is provided for informational purposes only, and is not intended
to be a substitute for individual medical advice in diagnosing or treating a
health problem. Please consult with your physician about your specific health
care concerns.

Now displaying records 1 to 15 of 35.

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Q : 1

My wife has colorectal cancer that has metastasized to the liver. The CT scan indicates that about five percent of the liver is not impacted by the cancer. Your website mentions that SIRT is not a cure, but can extend life expectancy. Have there been any studies done indicating how much life expectancy is increased by on average?

SIRT is definitely not a cure in metastatic CRC but has been shown in multiple studies to increase life expectancy by significant amounts. The individual patient's overall condition usually determines appropriateness for treatment. To get an idea of the published literature on SIRT, including trials, please look at and use search terms like radioembolization, SIRT and yttrium 90. For authors look for Guy Van Hazel, Andrew Kennedy and Bruno Sangro. In addition, a large multiinstitutional review was just presented at the largest oncology meeting in the world and is linked here:

Q : 2

Can this procedure be used for an 80-year-old male with a pancreas head tumor? He has been cleared for surgery, but is unsure about taking that route.

This treatment is exclusively for liver disease. If there is pancreatic head tumor (esp. if it is an adenocarcinoma) that has spread to liver, he should probably consider standard therapies including chemotherapy if possible. Liver mets from pancreatic tumors, especially of the neuroendocrine kind, may be amenable to SIRT therapy in an appropriate clinical scenario, age isn't a limitation. His performance status and liver function are more important and the overall determination of treatment suitability requires a thorough analysis of the patient's physical state.

Q : 3

Can SIRT be used for patients who have advanced pancreatic cancer?

Usually not. If there is a slower growing pancreatic tumor that is being limited therapeutically by liver metastases, then there may be an off-label indication for SIRT use for the liver disease only. However, that is usually in very selected cases. Unfortunately, most pancreatic cancer cases do not meet such select criteria and are very advanced.

Q : 4

Can SIRT be administered to cancer liver patient with fatty liver?

SIRT may be an option. There are several individualized patient and disease factors that go into selection for SIRT treatment, but adequate liver function is essential.

Q : 5

What kind of response is being seen with this treatment in carcinoid metastasis to the liver?

Generally, carcinoid tumors are among the more responsive liver metastases when treated with SIRT. However, other factors like prior chemotherapy and local treatments may affect the response somewhat, but overall, neuroendocrine tumors (of which carcinoid is a subset) tend to respond well.

Q : 6

Would SIRT be an option for someone who has already had chemoembolization and who had a stent placed due to bile duct blockage caused by tumor growth?

SIRT can always be done before or after chemoembolization and with a stent in place as long as the patient is clinically doing well and demonstrates adequate liver function in the setting of liver-predominant disease.

Q : 7

Do you deal with late stages of neuroendocrine cancer?

Yes, though individual patient characteristics will determine if they are suitable candidates for treatment or not. Neuroendocrine tumors are among the most responsive tumors to SIR-Spheres therapy.

Q : 8

Can CEA be elevated post SIRT? My mother had normal CEA before SIRT, but three weeks later it was elevated.

CEA levels by themselves can vary due to a variety of factors including laboratory differences. I would start with a repeat test and ask the treating physician, who has all the clinical variables available, as to the significance of the CEA level.

Q : 9

Do you recommend stent placement in CBD for better drainage prior to SIRT?

Not as a rule, it depends on the clinical scenario. If a blocked duct is the only reason the bilirubin is elevated, thereby making a patient ineligible for SIRT, then this may be the best approach. However, this varies based on the patient and the individual case.

Q : 10

If you are already in a clinical trial for cancer and it is not working out, can you be eligible for SIR-Spheres treatment? My wife has liver cancer and is receiving chemo. This keeps her very sick and continually losing weight. She is looking at stopping this treatment.

Previous chemotherapy does not exclude patients from being eligible for SIR spheres. However, her physical condition, the extent of her disease, as well as future prognosis are all considered carefully before we offer patients this treatment.

Q : 11

I am a visiting nurse who is 4 weeks pregnant. I went to the home of a patient who had SIR-Spheres placed approximately 11 days before. I was about 6 -8 feet away from him for 20 minutes. Is there any risk to my fetus?

In reality, there should be practically no risk at that distance and at that time point after the procedure. Y90, the radiatcive compound that is used in these procedures, decays to about half its strength in about 64 hours. In 11 days, it is significantly lower in strength than when originally infused into the patient. Furthermore, at 6-8 feet away, the dosage received will be practically undetectable, so there should be no risk.

Q : 12

Will SIRT work with metastatic breast cancer in the liver?

Yes. In fact we have treated many patients successfully with this approach.

Q : 13

Can SIRT be used for primary stomach cancer?

I'm assuming you mean that there is a primary stomach cancer with metastasis to the liver, in which case, yes. As long as the primary and other disease is under control and the liver metastases are the main source of concern/progression, SIRT can be used.

Q : 14

My husband has had one SIR-spheres treatment for primary liver cancer in September. There is a tumor pressing against his rib on his right side which is very tender. Do the tumors become inflamed and swell before they die? He is due to have another treatment in a couple of months. We have to make a decision to treat this tumor pressing against the rib with regular radiation before it gets bigger.

Yes, treatment of both primary and secondary tumors may result in a phase of transient inflammation which can cause pain and discomfort. However, this is usually something that resolves on its own in a couple of weeks. Since your husband's procedure was performed in September, I would recommend discussing the cause of his pain with your treatment team since further imaging studies may be neccessay to more precisely identify the source of his pain.

Q : 15

Can SIR spheres be used to treat neuroendocrine pancreatic cancer tumors that have spread to the liver?

Yes, most definitely. In fact, neuroendocrine tumors tend to be among the best responders to SIRT, depending on the patient's overall clinical picture.

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