SIRT is a liver-directed treatment, not a generic cancer therapy
Charité describes SIRT as a treatment directed at malignant disease in the liver, including primary liver tumors and liver metastases. Yttrium-90-loaded microspheres are delivered by catheter into tumor-feeding hepatic arteries so that radiation is concentrated within the treated liver territory.
A mapping procedure comes before treatment
The treatment pathway normally includes a dedicated pre-treatment evaluation rather than going directly to microsphere administration.
- Review of diagnosis, previous therapies and current CT/MRI
- Liver and kidney laboratory tests
- Angiography to define hepatic arterial anatomy
- Protection or coil embolization of selected extrahepatic branches when needed
- 99mTc-MAA test injection
- SPECT/CT or equivalent assessment of microsphere distribution and lung/extrahepatic shunting
- Patient-specific activity and dosimetry planning
Patient selection belongs in a multidisciplinary tumor board
The EANM guideline states that the decision for radioembolization should be made by a multidisciplinary tumor board and aligned with current disease-specific clinical guidance. The relevant question is not simply whether a liver lesion can technically be catheterized, but whether radioembolization fits the overall cancer strategy.
- Primary cancer and histology
- Liver-dominant versus widespread extrahepatic disease
- Tumor burden and treated liver volume
- Baseline liver function and portal hypertension
- Arterial anatomy and lung shunt
- Previous liver surgery, ablation, embolization or radiation
- Current or planned systemic treatment
One treatment session is not always enough
Depending on tumor distribution and the planned liver volume, treatment may be delivered selectively, to one lobe, or in staged sessions. Charité notes that some patients require separate treatment of the two liver lobes rather than both sides at once.
Plan follow-up and radiation-protection logistics before travel
Centers may use inpatient pathways because radionuclide treatment is subject to German radiation-protection rules. Charité describes post-treatment imaging, laboratory follow-up and later CT/MRI response assessment. International patients should clarify admission length, discharge restrictions, follow-up blood tests and which imaging can be completed at home.
Risks include both catheter and radiation effects
Common short-term effects can include fatigue, upper-abdominal discomfort, nausea or fever. Catheter-related bleeding or vascular injury can occur, and non-target microsphere delivery may damage stomach, bowel, pancreas, lung or healthy liver tissue. The center should explain individual risk in the context of liver reserve, shunting and planned dose.
Official sources
Sources last checked 2026-09-07.
- Selective Internal Radiotherapy (SIRT) — Charité – Universitätsmedizin Berlin ↗
- Treatments – radioembolization and transarterial liver therapies — European Metastasis Center Charité ↗
- EANM procedure guideline for intra-arterial radioactive compounds — European Association of Nuclear Medicine / EJNMMI ↗