- Effective antitumour dose of traditional external beam radiation therapy is very toxic to normal liver parenchyma.
Colorectal liver metastases
- SIRT delivers yttrium-90 (Y-90) resin or glass microspheres via the hepatic artery, exploiting the dual blood supply of the liver.
- SIRFLOX, FOXFIRE, FOXFIRE Global randomised trials: Y-90 + chemotherapy did not improve OS vs chemotherapy alone in first-line mCRC, though hepatic progression-free survival improved
- Role is better established in chemotherapy-refractory patients with liver-dominant disease
- Can downsize disease to enable subsequent resection or ablation in selected patients
- Used as a bridge or salvage option, often in heavily pre-treated patients
- Best evidence in liver-dominant, chemotherapy-refractory disease
- Useful for conversion/downsizing, especially prior to surgery or ablation