SIR-Spheres Archive Questions

Below are Dr. Regine’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 16.

1

2

---

Q : 1 01/07/2010	Do you know if SIR therapy is being used in all western countries? I live in Sweden and I have been in contact with cancer centers and have not gotten a clear answer. I know of use in Australia and the U.S. Not sure of other countries.
Q : 2 01/02/2010	I am about to begin SIRT treatment. What side effects will I experience after the first round, and will the effects be more or less severe after the 2nd treatment? It depends somewhat on your tumor type and more so on the amount of tumor and location within your liver. Your treating physician should be able to explain or answer more appropriately. Best of Luck.
Q : 3 10/21/2009	My son, age 54, had the SIR-Spheres procedure done a couple of weeks ago. The first week was not too bad, but he then developed DVT, then a low grade fever, nausea and extreme fatigue. Are these symptoms due to the cancer, the radiation, or the procedure's effect on the liver? It could be anyone or some combination of all three. This would need to be answered in the context of his overall cancer status (based on follow-up imaging) and his general condition.
Q : 4 10/06/2009	I am a 60-year-old male with three surgeries in 2005, 2007, and 2009 for primary hepatic carcinoid tumors. These surgeries are exacting a toll on my person and I am wondering about the viability of SIRT -- a therapy I have just learned about. SIRT can be very effective for carcinoid of the liver and we have experience using it in carcinoid. Please call me at my office if I can be of further assistance.
Q : 5 08/29/2009	My mother, 49-years-old, has liver cancer. The CT scan showed that 80 percent of her liver is consumed by the tumor. Is it suitable for her to have SIRT? Given the extent of the tumor's involvement with her liver, it is not likely. Chemoembolization may be a better alternative for treatment.
Q : 6 08/19/2009	Can Trilogy be used for pancreas tumor that has metastasized to the liver? My wife is 41 years old and very healthy otherwise. Not typically. The only scenarios in pancreatic cancer we have considered are if a patient has had at least 18-24 months since the original pancreas cancer diagnosis without liver spread. Please call my office if it's easier to explain/understand on the phone.
Q : 7 07/07/2009	I recently learned my father-in-law has pancreatic cancer that has spread to his liver. If the pancreatic cancer can be resected, would it be beneficial for him to have SIRT radiation therapy? Unfortunately, SIRT would not be considered a first line therapy option for a patient who has pancreatic cancer that has spread to the liver as it is for those with colorectal cancer.
Q : 8 04/27/2009	My mother has multiple liver metastases from adrenal cortical carcinoma. Could SIRT be an appropriate treatment for someone with her diagnosis? Do you know what the current FDA restrictions are for this treatment? Is it possible to receive permission even if it has not been approved specifically for ACC metastases? Currently SIRT is FDA-approved for recurrent colorectal cancer. Certain insurers will sometimes allow "off-label" use.
Q : 9 03/06/2009	A family member had the beads for secondary liver cancer. The tumors at first disappeared; now 6 mos. later are back. She had a terrible ulcer and a stomach blockage; is being tube fed. Is this a common side-effect? It's been five months. The ulcer could be seen on a CT scan. She has been given a possible 2 years to live. Can she get a second look by you? The risk of developing a gastric ulcer is typically a fuction of location of tumor in the left lobe (proximal to stomach) and therefore potentially receiving radiation dose if a patient has a very peripheral medial lesion in the left lobe adjacent to the stomach. It is also a function of technique - if Y90 microspheres flow retrograde from the catheter position (backward and away from the liver rather than forward), they can flow into the gastroduodenal artery and distribute to the stomach potentially causing a stomach ulcer - this is the reason we typically embolize the GDA in patients and treat each lobe of the liver separately - our gastric ulcer incidence is much lower than the national average as a result. I am happy to see your family member in consult, but if the ulcer has already developed, at this point it is time and good medical management that will ultimately result in healing and recovery.
Q : 10 03/05/2009	I was diagnosed with colon cancer in 10/07 which metastasized to my liver in 1/08. I had my liver resected in 2/08 but there was a return of liver metastasis in 11/08. I was supposed to have the right lobe of my liver removed, but they discovered that there was metastasis on the left side too. Could I be a candidate for SIR-Spheres? A FDA announcement for SIR-Spheres in 2002 stated that a patient must wait two months before having sir-Spheres if they are currently receiving capecitabine. It also said that a patient can never receive capectabine after having the sir-spheres implanted. Is this still the case with use of capecitabine? Yes, generally speaking these are still the guidelines for use of capecrabine. SIRT is FDA approved for recurrent colorectal cancer and may be a viable treatment option for you because it sounds like you are currently suffering from this disease.
Q : 11 12/06/2008	Greenebaum Cancer Center performing regional therapies-- RFA, SIRTS, HAI or resection -- on stage 4 colon cancer patients with liver mets and minimal lymph node involvement (one node that has never shown up on a PET? Is interventional used in addition to systemic chemo which is becoming less effective due to low blood counts? Would low counts be determining factor to go towards interventional such as SIRTS, RFA, HAI to restage for resection? Peritonial fluid tests negative, CEA @20. Are interventional options available to such patients at Greenebaum? Yes we perform RFA, cryo, SBRT, SIRT, HAI, TACE, isolated hepatic perfusion and other regional and focal liver therapies. We most frequently do these as a part of a global plan that includes intravenous chemotherapy. As to low counts, it would depend on how low and what was low. You would need an adequate red blood cell and platelet count (without a coagulopathy history) to undergo certain invasive techniques without undue risk. Certain chemotherapy regimens are more hematologically toxic than others, and so an appropriate regimen would need to be chosen in light of the cytopenias identified. If you would like to be evaluated here for the above therapies, you can contact us at 410-328-8017.
Q : 12 10/24/2008	My father is a 52-year-old man who was diagnosed as HCC in 2006 with HBV(+) having a 5.5cm Solitary nodules and Rt lobe resection was done after having a course of TACE. 13 months after surgery, he was found to have multiple recurrent nodules on CT scan, ranging from 1cm-3cm; was treated with RFA to 4 nodules (2-4cm) and a course of TACE. Again at 24th month, CT scan show new multifocal nodules ranging from 1-3cm and was treated with SIRT. His liver function has been normal and there is no spread beyond the liver so far. Now he is about 3 months after SIRT. How long does the effect of SIRT last? Can SIRT be repeated again in the event of new multiple recurrent nodules? Is the Liver transplant an option in his case? The durability of response to Y-90 microspheres for multifocal HCC has been variable, but as I understand it your father is currently 3 months out with disease stability in known lesions and no new lesions. With respect to your second question, generally repeat SIR-spheres is not performed because of the increased risk of causing radiation-induced liver disease and consequent liver failure. Assuming he had lesions in both lobes of his liver and both were treated 3 months ago, he generally would not be treated again with SIRT, save for unique circumstances where it was felt to be worth the additional risk. Though there are patients who have been treated with SIRT more than once, this is considered experimental at this time. As to your final question, he is not a transplant candidate at this time based on your description. There are criteria he must meet to get on a transplant list, commonly referred to as Milan criteria, which require a patient to have a single lesion less than 5 cm or up to three lesions no more than 3cm in size each. By your description, he has more than three, so wouldn't be able to get on the list.
Q : 13 10/01/2008	How long does a patient have to be off of Xeloda before the SIR-spheres can be started? Patient is 42 year old female with colangiocarcinoma. She responded to oxalyplatin, avastin, gemcytobine, and tarceva. She has been on Xeloda, Nexavar and gemcytobine for 2 months. Last dose was 9-22-08. She is 13 months out from diagnosis. Tumor is in both lobes and has multiple satellites and lymph nodes with increased size while on Xeloda, Nexavar and gembytobine. We generally follow the guidelines espoused by SIRTEX in the product insert, which suggests a 2-month interval between discontinuation of capecitabine and initiation of SIR-spheres treatment.
Q : 14 09/12/2008	My 85-year-old mother (in very good health) recently had the SIR-Spheres treatment for liver cancer. Approximately 1 month after the treatment, she began throwing up green bile and became very nauseous. This has lasted 3 months. Can anything be done to prevent this? Nausea typically occurs post-treatment, but is usually limited to the first week and generally self-resolves. In some cases, it can be more prolonged in which case anti-emetics should be prescribed in an effort to reduce nausea and vomiting. As you describe your mother, her onset was 4 weeks post-treatment and therefore may or may not be related to the treatment directly. Green emesis raises concern for an obstruction among other things. The differential diagnosis for vomiting is extensive, but the characteristics and timing of the emesis can help to discern the cause along with other work-up by your physicians. Your mother should be evaluated by a gastroenterologist given it has gone on for so long.
Q : 15 08/22/2008	My father, 74, had a liver transplant two years ago after diagnosed with hepatocellular carcinoma (several tumors, one very large). Now the cancer returned (several tumors, both lobes). He was given Sir-spheres treatment for both lobes six weeks ago. I am confused about how successful treatment was. His liver functions are perfect, tumors shrunk a little; they say tumors are "inactive." What does this mean? Should he have another treatment? Could he take nexavar? What other option does he have? Thank you so much in advance for your question and answer archive. Very helpful; wish I had found it before. It is reassuring that his liver function tests are normal. As to his tumors being "inactive." they may be referring to their radiographic appearance. There are several studies (PET scans and others) that can help to distinguish between viable vs. dead tumors, so my guess is they are making that statement based on such a study. Additionally, many patients have a tumor marker in the blood (AFP) which is good to follow for response if it was elevated pre-treatment. Generally, SIR-spheres is not repeated due to the cumulative radiation being excessive to the normal liver. However, he could get nexavar if his AFP and/or imaging suggested he had residual active disease after his SIRT treatment, or if there is a suggestion that he has extrahepatic disease.

1

2