Recommended in the guidelines

ESMO, EASL and NCCN guidelines acknowledge the potential benefits of SIR-Spheres® Y-90 resin microspheres for treatment of hepatocellular carcinoma.

Hepatocellular carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up (2018)1

SIRT is not recommended as first-line therapy for HCC patients in intermediate and advanced stage.

BCLC 0-A
SIRT may be considered instead of TACE to avoid drop out from a transplant list in reducing tumour progression

BCLC B
SIRT may be considered as an alternative treatment option in patients with liver-confined disease and preserved liver function after TACE (after TACE failure/ refractoriness)

BCLC C
SIRT may be considered as an alternative treatment option in patients with liver-confined disease and preserved liver function in whom systemic therapy is not feasible.

EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma (2018)2

BCLC A(/B)

  • SIRT showed better tumour control than TACE and could therefore reduce drop-out from transplant waiting list
  • SIRT induces substantial contralateral hypertrophy and might prepare or select patients with borderline resectable HCC for surgery

BCLC B (SIRT vs. TACE)

  • SIRT induces less toxicity
  • SIRT provides significantly longer TTP and better tumour control but no better OS
  • SIRT maintains higher QoL

BCLC C (SIRT vs. Sorafenib – SARAH / SIRveNIB)

  • No statistically significant differences in OS were observed
  • Response rates were significantly higher with SIRT
  • Survival benefit compared to sorafenib is still not proven hence SIRT should only be adopted after MDT discussion

NCCN Guidelines Version 2.2019; Hepatobiliary Cancers3

  • Loco-regional therapies# such as SIRT* should be considered in patients who are not candidates for surgical curative treatments
  • As arterially directed therapySIRT is relatively contraindicated in patients with bilirubin >3 mg/dL unless segmental treatment can be performed
  • SIRT with yttrium-90 microspheres has an increased risk of radiation-induced liver disease in patients with bilirubin over 2 mg/dL
  • All tumours irrespective of location may be amenable to SIRT

BCLC A 

  • SIRT should be considered as bridge for other curative therapies
  • SIRT may be used as monotherapy or in combination with ablation to treat lesions 3 to 5 cm to prolong survival
  • SIRT should be considered for unresectable/inoperable lesions >5 cm

BCLC B

  • See above: All tumours irrespective of location may be amenable to SIRT

BCLC C

  • SIRT should be considered in highly selected patients in the presence of limited tumour invasion of the portal vein
  • Sorafenib may be appropriate following SIRT in patients with adequate liver function once bilirubin returns to baseline if there is evidence of residual/recurrent tumour not amenable to additional local therapies

# Loco-regional therapies: ablation, arterially directed therapies, and radiotherapy
*SIRT: Selective Internal Radiation Therapy, also known as Radioembolisation (RE)
‡ Arterially directed therapies: bland trans-arterial embolisation (TAE), trans-arterial chemoembolisation [TACE, DEB-TACE] and radioembolisation (RE) with yttrium-90 microspheres

 

1. Vogel A et al. Ann Oncol 2018; 29: iv238–iv255.
2.Galle P et al. J Hepatol 2018; 69:182-236.
3.NCCN Guidelines version 2.2019 Hepatobiliary Cancers.
 




Now leaving sirtex.com

You are about to leave the Sirtex Web site. This link is provided to you as a service and will take you to a site maintained by a third party who is solely responsible for the content.

Please be aware that Sirtex takes no responsibility for content of these external sites, nor do we endorse, warrant or guarantee the products, services or information described or offered on other internet sites.

Click 'Continue' to proceed to the third-party Web site.

Continue

×

You are now leaving your current sirtex.com region

The Sirtex site you are linking to is intended only for healthcare practitioners and patients outside your current region. Any products discussed herein may have different approved product labeling; therefore, any information provided may not be appropriate for use in your region.

Click 'Continue' to proceed to the other Sirtex region Web site.

Continue

×

This content is intended for healthcare professionals only

By clicking "Yes" you are confirming that you are a healthcare professional. If you are not a healthcare professional, then please click "Go to Homepage" which will direct you to the Sirtex homepage.

Yes Go to Homepage