Liver disease / Selective Internal Radiation Therapy for Liver Cancer
SIR-Spheres®

The Interventional Radiologists at RVA are experts in minimally invasive, image-guided therapies for patients with cancer. Using state-of-the-art equipment including digital fluroscopy and the latest advancements in MR, CT and ultrasound, we can efficiently plan and treat our patients. We pride ourselves on the responsiveness to patient and physician inquires and we work closely with both primary care physicians and specialists in providing a coordinated, multi-disciplinary approach to the evaluation and treatment of our patients. Our Interventional Radiologists have one of the largest experience in the United States and World with SIR-Spheres®. We have the dedication, experience, and knowledge that has made us one of the busiest centers in the World in regard to SIR-Spheres®.

We have developed an excellent team of Physicians, Nurses, Technologists and Radiation Physicists at RVA and Durham Regional Hospital. Intial consultation and follow up are handled in our RVA office at Independence Park and the treatment and most of the imaging procedures are performed at Durham Regional Hospital, part of Duke University Health System.

For patients undergoing treatment:

1. Typical patient flow.
2. Patient precautions during treatment (radiation precautions)
3. What to expect during treatment.
4. Typical patient instructions during treatment
   

How a Typical Treatment Progresses

1. Patients may be referred by local oncologist or self-referred. Call RVA office for initial evaluation and consultation. As many patients come from far away, you may ask to discuss your case with the Physician prior to making the trip to be sure you are a potential candidate for this treatment.
2. Please bring all imaging studies, doctor’s notes and laboratory results with you or have them sent prior to your initial consultation.
3. You will be scheduled for an office consultation where the information will be reviewed and you will be examined.
4. You will be scheduled for a CT scan and possibly a PET scan.
5. You will be scheduled for an angiogram and shunt study to evaluate the blood vessels supplying the liver and to evaluate for safety of the Sirsphere treatment. You will be discharged from the Hospital approximately two hours after this procedure. We will tell you if you are a candidated for this treatment before your discharge.
6. It takes 2-3 weeks to order the SirSphere dose.
7. Sirspheres are administered during a procedure similar to the planning arteriogram. You will remain overnight following this treatment for observation and management of side effects of the initial treatment. You will be discharged the following morning. We advise that if you are out of town you allow yourself one day in a local Hotel to recover before travelling.
8. We will expect to hear from you if you are having problems. We will see you back in the RVA office in 4-6 weeks.
9. Appropriate laboratory and imaging tests will be scheduled before your return visit.

PATIENT and FAMILY PRECAUTIONS POST SIR-SPHERES TREATMENT

Information regarding the above is found on pages 73-76 of the SIR-Spheres User's Manual. This is section 6.3 entitled “Radiation Safety with the Patient” and covers immediate post-implant care, accommodation, general nursing care, medical testing and other interventions, visitors and contacts and patient discharge.

In addition, conservative advice would be:-

a) no pregnant women should be closer to the patient than 2 yards for a period of 2 weeks;

b) no children under 10 years of age should be closer than 2 yards for 2 weeks although brief contact with the patient for a few seconds is acceptable;

c) spouse, partner or family to try and stay at least 2 yards distance for 2 weeks. Brief contact with the patient is acceptable;

d) sleeping with partner is not advised for 10 days post-treatment and for the following week partner is recommended to sleep on the left side of the patient.

What You Will Experience During Treatment

• The initial arteriogram and shunt study will be performed at Durham Regional Hospital. You will be asked to not eat or drink after midnight the night before the procedure. Please take all of your usual medications the morning of the procedure unless you are specifically told not to by your physician. You will be contacted by a member of our team before this procedure and all of this will be reviewed with you.
• The first procedure will involve placing small tubes (catheters) in the arteries of the abdomen. A contrast agent will be injected into the blood vessel to allow x-rays to obtain a “map” of your blood vessels. Certain non-essential arteries will be blocked using small coils injected through the catheter so that the Sir-Sphere® injection will not go to areas where it would be unsafe such as the stomach or intestine. This procedure is not painful and the minimal risks will be reviewed with you before the procedure.
• Once the anatomy has been established and the blood flow routed in the proper direction, an injection of a radioactive particles similar in size to the Sir-Spheres, but much less radioactive will be injected into the artery that leads to the liver.
• The catheter will be removed and you will be taken to a different imaging machine where images will be obtained to show the distribution of the particles. The amount of shunting to the lungs will be calculated. The level of shunting will be used to decide dosing of Sir-Spheres as well as whether or not the procedure can be safely performed.
• If everything works out, you will be scheduled for your treatment in 2-4 weeks from the time of the arteriogram.
• During the treatment a catheter is again placed in the artery to the liver and images are obtained of the arteries. The blood flow is double-checked and sometimes additional blood vessel branches may need to be blocked before treatment.
• Sir-Sphere® dose is injected. Some patients experience pain and/or nausea during this injection and appropriate medications will be used to address this.
• All patients experience at least some pain and nausea after the treatment. This generally peaks at about 6-8 hours and by the following morning it is usually much better. While in the hospital injectable narcotics and anti-nausea drugs are used to manage symptoms.
• After discharge the following morning you will undergo the following regimen of treatment:o For pain: Dilaudid 2mg. every four hours as needed for pain control.
  
  • For nausea: Phenergan 25 mg every six hours as needed.
  • For fever and pain: Ibuprophen 600 mg every six hours.
  • To help prevent stomach ulcers: Prilosec OTC as directed.
• You can expect at least some pain, fever and malaise after the procedure that may last several weeks. Fevers above 101, shaking chills, jaundice, increasing severe pain or severe malaise may be indicators of a serious problem and we ask that you contact us if you are experiencing any of these problems.
• Additional treatments may be recommended at your one-month follow up. We have a number of patients who have received several doses of Sir-Sphere® during treatment.

To set up an appointment, contact us here.

For more information:
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