26 juli 2013: Inmiddels is SIRT - Selective Internal Radiation Therapy, ook wel Yttrium-90 genoemd een vorm van behandelen (inwendige bestralig) die ook vaak wordt toegepast i.p.v. TACE - TRans Arteriele Chemo Emobilisatie, althans in Nederland. Zie ook gerelateerde artikelen.

1 mei 2008: Bron: 1: ANZ J Surg. 2006 Aug;76(8):696-703.en 1: HPB (Oxford). 2004;6(3):133-9.Click here to read  en 1: Eur Radiol. 2007 May;17(5):1320-30. Epub 2006 Dec 6

 
Een vaste bezoeker van onze site wees ons enkele weken geleden op een behandeling van levertumoren met SIRT - Selective internal radiation therapy (SIRT): een vorm van selectieve inwendige lokale bestraling bij levertumoren. We hebben drie studies uit Pubmed gehaald die laten zien dat deze aanpak van ook inoperabele levertumoren tot zeer goede resultaten kan leiden. In alle studies werd SIRT gevolgd door TACE en/of LITT. De overall overleving in alle studies was significant hoger dan statistisch mocht worden verwacht of in vergelijking met controlegroep. Zie abstracten hieronder.
 
De FDA gaf al in 2002 officieel toestemming om deze aanpak als officiele behandeling te gebruiken maar wereldwijd blijkt deze aanpak nog weinig te worden gebruikt althans we kunnen er weinig van terugvinden op websites van ziekenhuizen. Vraag toch eens na bij uw oncoloog als u inoperabele levertumoren hebt of er wellicht ook de mogelijkheid van SIRT is. Lees ook nog eens de artikelen waarin bepaalde voedingsuppletie of natuurlijke middelen of bv. Chinese kruiden worden gebruikt naast TACE en LITT. Bv. bepaalde aminozuren (zitten ook in antineoplastontherapie van dr. Burzsynki) en bv. ook melatonine die voor een significant beter effect en langere overlevingstijd zorgen naast TACE en LITT. 
Alles verzamelend en in overleg met oncoloog en orthomoleculaire arts kan o.i. een goed behandelplan gemaakt worden met grotere kans op langere overleving en betere kwaliteit van leven. Zie onder voeding en voedingsuppletie in alfabetische lijst onder darmkanker - LITT
 
1: ANZ J Surg. 2006 Aug;76(8):696-703.Click here to read  

 

Comment in:
ANZ J Surg. 2006 Aug;76(8):675.
Selective internal radiation therapy with 90Y microspheres for colorectal liver metastases: single-centre experience with 100 patients.

Wakefield Gastroenterology Centre, Wakefield Hospital, Wellington, New Zealand. rsstubbs@wakefieldclinic.co.nz

BACKGROUND: Many patients with colorectal liver metastases die from liver-only disease. Selective internal radiation therapy (SIRT) is an evolving method suitable for treating patients with non-resectable metastatic liver disease. METHODS: One hundred patients with advanced colorectal liver metastases were treated with SIRT. A single dose of between 2.0 and 3.0 GBq of (90)Y microspheres was given into the hepatic artery either by a surgically implanted portacath or a percutaneous femoral catheter. When a port was used (n = 87), SIRT was followed by hepatic arterial chemotherapy with 5-fluorouracil. RESULTS: Treatment-related morbidity occurred in 11 patients. Responses to SIRT were assessed by serial computed tomography scans and carcinoembryonic antigen (CEA) measurement. Median CEA level 3 months after SIRT (expressed as percentage of initial CEA) was 18%. Only 5 of 80 patients (6.25%) scanned at 3 months showed disease progression. Survival was significantly more in those who experienced a good tumour marker response and in those who were slow to develop extrahepatic disease. Survival was independently influenced by the use of ongoing hepatic arterial chemotherapy, the extent of liver involvement and the lymph node status of the original primary tumour. CONCLUSION: Selective internal radiation therapy is a very effective and well-tolerated regional treatment for colorectal liver metastases, which should be considered for those with liver-only metastatic disease.

PMID: 16916386 [PubMed - indexed for MEDLINE]

1: Eur Radiol. 2007 May;17(5):1320-30. Epub 2006 Dec 6.Click here to read

Mid-term results in otherwise treatment refractory primary or secondary liver confined tumours treated with selective internal radiation therapy (SIRT) using (90)Yttrium resin-microspheres.

 

Department of Clinical Radiology, University of Munich, Grosshadern Campus, Marchioninistrasse 15, 81377, Munich, Germany, tobias.jakobs@med.uni-muenchen.de.

The purpose was to determine the response and survival and to analyse the feasibility of single-session, whole-liver SIRT in patients with non-resectable, otherwise non-responding liver cancer. Thirty-nine patients qualified for SIRT. Eighteen patients suffered from colorectal-cancer metastases (CRC), breast-cancer metastases (MBC, 7), HCC (5) and other tumours (9). Response was assessed by tumour-markers and CT-imaging. At 2-4, 5-7 and 8-9 months follow-up in 3/17, 5/15 and 5/10 of CRC-patients CEA-levels were higher than before. In the MBC group 1-3 and 4-6 months after SIRT tumour-marker-levels were higher in 2/6 and 3/3 patients, respectively. In all HCC-patients AFP-levels dropped 1-3 months after SIRT. Using RECIST, in the CRC-group progressive liver disease (PD) was found in 4/17, 2/12, 2/10 and 2/5 patients at 2-4, 5-8, 9-10 and 12-14 months follow-up. Concerning MBC, after 3 months 7/7 patients presented with stable-disease (SD) or partial-response (PR). At 5-6 months, 1/5 patients showed PD. All HCC-patients showed SD/PR at 2-3 months with no PD at 5-8 months. In the mixed-group 5/6 patients presented with SD/PR at 3-4 months and with SD in 2/3 patients at 5-6 months. The median time-to-PD was 6.5, 8.5 and 8 months for the CRC-, MBC- and mixed-group, respectively. SIRT is a promising, liver-targeted approach for patients with otherwise treatment-refractory liver tumours.

PMID: 17149621 [PubMed - in process)

Selective internal radiation therapy (SIRT): a new modality for treating patients with colorectal liver metastases.

Wakefield Gastroenterology Centre, Wakefield Hospital Wellington New Zealand.

BackgroundSelective internal radiation therapy (SIRT) is a new and developing modality for treating non-resectable liver tumours. Evidence is emerging that it is very efficacious in patients with hepatocellular cancer and colorectal liver metastases.DiscussionSIRT generally involves a single delivery of (90)yttrium micro-spheres into the hepatic artery. Preferential uptake is achieved into liver tumours, because of their predominant hepatic arterial blood supply. Average tumour doses of radiation in excess of 200 Gy are achieved. The treatment is generally well tolerated and has been documented by a number of groups internationally to achieve response rates of around 90% in patients with extensive colorectal cancer (CRC) liver metastases. Since the product obtained FDA approval in the USA in 2002, it is being more widely employed and investigated. Unlike other ablative therapies being applied to non-resectable liver tumours, SIRT is indicated even in patients with an extensive burden of liver tumour. Indications, dosing schedules and expected outcomes will become better defined as more groups take up the treatment.

PMID: 18333066 [PubMed - in process]

 

 


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