Optimising peri-procedural care and discharge planning of all patients is very important. This is especially so for patients receiving SIR-Spheres® Y-90 resin microspheres as most of these patients are treated in the palliative setting where quality of life is an important consideration.
The following clinical recommendations have been developed by physicians experienced in treating patients with liver cancer using SIR-Spheres Y-90 resin microspheres.
Gastrointestinal prophylaxis to prevent GI inflammation and ulceration
A proton pump inhibitor (e.g. omeprazole or pantoprazole) or H2-blocker (e.g. ranitidine) commencing one week prior to treatment with SIRT and continuing for 4 weeks post treatment is recommended. While the Interventional Radiologist must ensure that SIR-Spheres Y-90 resin microspheres do not enter the GI tract, radiation from large volume tumours in the left lobe of the liver overlying the stomach may be sufficient to irritate the stomach and cause gastritis and ulceration.
Anti-emetics (e.g. ondansetron or granisetron) for post treatment nausea are recommended and should be commenced on the morning of the day of SIRT treatment.
Post-embolisation syndrome prophylaxis
Fever, malaise and lethargy can occur as a result of the radiation injury and embolic effect of the SIR-Spheres Y-90 resin microspheres on the tumour neo-vasculature. Provided the patient is not diabetic - and oral steroids are not otherwise contraindicated - a tapering dose of oral corticosteroids (e.g. Methyl-prednisolone or Dexamethasone) is recommended.
Oral analgesia (e.g. ketorolac) may be required for 1 week following treatment to relieve pain from radiation injury and the embolic effect of SIR-Spheres Y-90 resin microspheres, and liver capsular pain from tumour oedema.
The use of empirical antibiotic prophylaxis is not routinely recommended and should be based upon assessment of each patient's individual infection risk.