Hepatocellular carcinoma, known as HCC, is the most common form of primary liver cancer in England. Now NICE has approved a new way of treating advanced liver cancer using interventional radiology.
Selective internal radiation therapy (SIRT) is a new NHS funded option for treating HCC, yet is not necessarily a new treatment as it has already been used with great success in other areas.
It works by delivering high dose radiation treatment into the artery supplying blood to the tumour via a catheter and has now been greenlighted by the NHS for use in 11 specialist hospitals across the UK.
Dr Dominic Yu, Consultant Interventional Radiologist at the Royal Free Hospital, London says: “Interventional radiology is where we use imaging to do procedures, usually those which are minimally invasive. This means the risks to the patients are lower, there’s less chance of bleeding and a shorter recovery time, which is important for patients as they are less likely to get a hospital acquired disease.”
He adds, “We’re calling interventional radiology the fourth pillar of cancer care. It’s an additional option when it comes to treating this type of liver cancer which we welcome – it’s going to change patient care.”
The treatment itself is done via a pinhole puncture and aims to control the tumour by stopping it from growing. This can allow further treatment options to be considered, prolong life care in general or offer a better quality of life before palliative care, where required.
Innovation in the field
Dr Abid Suddle, Consultant Hepatologist, Kings College Hospital, London, says, “The innovative part about this treatment is that it can target specific areas such as the cancer, while avoiding complications in the healthy liver tissue. SIRT and other innovations are likely to radically change the treatment paradigm for patients and what NICE has done is to allow us as clinicians a position where we can define, under reasonable guidelines, where the use of SIRT should be in the treatment protocol. I think that has been a really positive step.”
What NICE has done is to allow us as clinicians a position where we can define, under reasonable guidelines, where the use of SIRT should be in the treatment protocol.
Dr Praveen Peddu, Consultant Interventional Radiologist specialising in liver and pancreatic cancer at King’s College Hospital, London, is also positive about SIRT. He says, “The decision by NICE has been long awaited however, in the UK we practice evidence-based medication. Intuitively we’ve believed it’s been a good option, but we wanted good quality evidence before we can offer it widely. Now NICE has said we can go ahead and the hospital will be reimbursed where there’s a valid reason for carrying out the treatment. But we must use it wisely.
“My view is that we should see it as another important tool in our armoury against liver cancer, but it is a complex procedure that must be done in high volume centres that have the multidisciplinary expertise to treat these patients.”
CT scan showing targeted area of liver to be treated by SIRT (in orange), sparing surrounding healthy liver.
Image provided by Boston Scientific
Exciting time for patients
Dr Nabil Kibriya, Consultant Interventional Radiologist, Kings College Hospital, London, says, “If a patient is offered a SIRT treatment, it means that it’s positive news and that they are going to get the most appropriate treatment for their type of disease. We know it’s a safe treatment as we’ve previously used it before although it’s always good to ask about the side effects. Compared to other options, these can be much more pleasant and what’s more the patient will only be offered this procedure if it will provide a better quality of life.
“Right now there’s a limited number of sites in the UK offering it. We’re hoping that over time if it’s proved to be effective and hospitals have appropriate patients and set-up, then more will open. However, I think that there is currently a good distribution of sites across the country with experience in the procedure, which should allow everyone to be referred on and treated. I think it’s quite an exciting time, not just for clinicians but more importantly for patients.”
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