Selective internal radiation therapy (SIRT) patient Information
Date issued: June 2026
Review date: June 2028
Leaflet section: Imaging
PDF: Selective internal radiation therapy (SIRT) Patient Information.pdf [pdf] 167KB
Interventional Radiology Department
We’ve given you this information sheet because we believe you may benefit from a cancer treatment called selective internal radiation therapy (SIRT). It explains what SIRT is, what the treatment involves, and what the possible benefits and risks are. We hope it will help to answer some of the questions you may have. If you have any further questions or concerns, please speak to a member of your healthcare team.
Before agreeing to the treatment, you will have a consultation with either an oncologist or a hepatology consultant and an interventional radiologist, who will perform the procedure, where you will have the opportunity to ask any questions you may have.
What is selective internal radiation therapy (SIRT)?
SIRT is a type of internal radiotherapy used to treat primary liver cancer (tumours that started in your liver) and secondary liver cancer (tumours that spread to your liver from another part of your body).
SIRT is split into two separate appointments over two weeks:
-
Stage one: Work-up angiogram
-
Stage two: Treatment
How does SIRT work?
During SIRT, millions of tiny radioactive beads are injected into a blood vessel that takes blood to the liver. The beads get stuck in the small blood vessels in and around the cancer cells in the liver, and release radiation which destroys the cancer cells. As the radiation only travels a few millimetres from where the beads are trapped, it causes little damage to the surrounding healthy cells.
Why might I need this treatment?
Tumours can be treated in a number of ways, including radiation therapy, chemoembolisation, radiotherapy and surgery. You will have been referred for SIRT because it is considered to be the best treatment option for your tumour.
Who has made the decision that SIRT may be appropriate for me?
Your oncologist or hepatologist has discussed your case with interventional radiologists and liver surgeons and we have decided that this treatment may be appropriate for you. We will invite you to a clinic appointment so we can discuss the treatment with you in more detail. We will only proceed with the treatment with your consent. We will give you time to decide and discuss with your relatives, if you so wish. We will never begin treatment at this first clinic appointment, so please don’t worry about making an immediate decision.
Who will administer the treatment?
The treatment will be administered by an interventional radiologist.
Where will the treatment take place?
The treatment will take place in the radiology department, in a specially adapted x-ray theatre (interventional radiology suite).
How should I prepare for the treatment?
Pre-assessment appointment
We will send you a letter in the post for a pre-assessment appointment. This will usually be a telephone appointment, but we may ask you to come into hospital if we need to perform a blood test. During this appointment, we will ask you questions about your health, medical history and home circumstances to ensure you are well enough for the treatment. We will also explain how to prepare for the treatment.
Medication
We will inform you during your pre-assessment appointment about which medications you will need to temporarily stop taking and which you can continue taking.
Food and drink
You must not have any solid food for six hours before each stage of SIRT. Clear fluids may be consumed up to 2 hours before each stage of SIRT after which you can have sips of water.
Do I need to stay in hospital?
The first stage of SIRT is usually done as a day case, so you will be able to go home the same day. Please arrange for a responsible adult to accompany you home after your appointment and stay with you overnight.
After the second stage of SIRT, you will need to stay in hospital overnight. This is so we can make sure you’re feeling well before you go home. Please bring an overnight bag with you, including all the medications you are currently taking.
Allergies
Please let us know during your pre-assessment appointment if you have any allergies, or if you have previously reacted to intravenous contrast medium (the dye used for x-rays and CT scans).
What will happen during each stage of the treatment?
Stage one: Work-up angiogram
When you arrive for your appointment, we will complete your admission documents and then check your blood pressure, blood oxygen levels, temperature, heart rate and respiratory rate. We will then ask you to change into a hospital gown.
We will begin the treatment by inserting a needle into a vein in your arm. This will allow us to give you painkillers and a sedative (medication that makes you feel sleepy and relaxes you), if needed. Once in place, you shouldn’t be able to feel the needle.
We will then take you into the interventional radiology room and ask you to lie flat on your back on an x-ray table. We will place a monitoring device on both your chest and your finger. We may also give you some oxygen through small tubes in your nostrils. We will clean the skin around your groin with antiseptic and cover the rest of your body with a theatre drape.
We will then inject some local anaesthetic into your groin. This may sting briefly before going numb.
We will then insert a very fine tube, called a catheter, into the main blood vessel in your groin. We will pass the catheter along this artery to the main blood vessel that carries blood to your liver. Through the catheter, we will inject a small amount of intravenous contrast medium, so we can carry out an angiogram (a type of x-ray used to examine blood vessels). The intravenous contrast medium will:
-
allow us to clearly see where the beads need to be placed during the treatment stage
-
‘light’ up the blood vessels that lead to other parts of your body (we may need to block these vessels with small coils during the treatment stage to prevent the beads from exiting your liver)
Through the catheter, we will then inject a test dose of radiation into your liver. Finally, we will remove the catheter from your groin and insert a closure device to stop any bleeding.
Stage two: Treatment
This stage is very similar to stage one. The only difference is that when the catheter is in the correct position, we will slowly inject radioactive beads as your treatment into your liver.
How long will each stage take?
Each stage within Interventional Radiology usually takes between one and two hours.
What will happen after each stage?
Stage one: Work-up angiogram
As soon as the procedure is complete, we will take you to have a scan in the nuclear medicine department to check where the test dose of radiation has been distributed. This scan will allow us to see if it is safe to proceed with the treatment stage. After the scan, we will take you back to the PIU day unit to continue your recovery. You will need to lie flat on your back for two hours. The ward nurses will monitor your blood pressure, heart rate and wound area. After four hours, you will be able to stand up and start moving around. You will then be able to go home.
Stage two: Treatment
We will take you back to the ward to recover overnight. The next morning, we will take you to the nuclear medicine department to have another scan, to check the distribution of the beads. If we are happy with the scan results and you feel well enough, you will be able to go home.
Personal hygiene
Your urine may contain small amounts of radioactivity for 24 hours after treatment. In this time please:
-
Sit while urinating
-
Flush the toilet twice
-
Wash hands thoroughly after using the bathroom
Follow-up care
Once you are at home, you should rest for three to four days. During this time, it is important that you continue to move around to help with your recovery. You will be invited for a follow up scan 3 months after your treatment at your local hospital.
Are there any risks or side effects?
We will discuss all possible side effects, as well as the risks and benefits, with you during your clinic appointment.
SIRT is generally well tolerated by most people. However, as with any medical treatment, there are some possible risks and side effects.
The most common side effects related to the treatment are:
-
extreme tiredness
-
a mild temperature
-
feeling sick
-
diarrhoea
-
a stomach-ache that lasts for a few days. Over-the-counter pain relief medication, such as paracetamol should help ease your symptoms
A much less common side effect is radiation induced ulcers and heartburn. To reduce the likelihood of these effects, if you are not already on Omeprazole or another drug of this kind you will be commenced on this following discharge for 8 weeks.
Bruising
It is common to have a bruise or a small lump (a haematoma) where the catheter was inserted. However, you should contact your specialist nurse straight away if the bruise gets bigger. Quite often a resorbable plug known as Angioseal® is deployed in your groin following the procedure, this is a closure device to seal the puncture site.
Inflammation of the gallbladder (cholecystitis)
This is a rare complication. Symptoms of cholecystitis include:
-
pain in the right side of your tummy (this pain may then spread to your right shoulder)
-
a fever
-
feeling or being sick
This usually gets better without treatment, but in rare cases, you may need surgery to remove your gallbladder. Contact your specialist nurse, interventional radiologist or GP for advice if you experience any of the symptoms above.
Radiation-induced liver disease
This is a rare, but serious complication. If the radiation from the treatment damages your liver, your liver may stop working properly. Symptoms of radiation-induced liver disease include:
-
extreme tiredness
-
pain in the upper right side of your tummy (just under your ribs)
-
yellowing of your eyes and skin
Symptoms usually develop two to eight weeks after the treatment. Contact your specialist nurse, interventional radiologist or GP for advice if you experience any of the symptoms above.
Exposure to radiation
All x-ray procedures involve exposure to varying amounts of radiation. Radiation increases your risk of cancer, but for this treatment, the risk has been assessed as low. We will not expose you to any more radiation than is necessary. We consider that the benefit to you from the treatment outweighs the low risk from the radiation.
The radiation to those around you from the work-up angiogram is very low and there are no restrictions for contact with anyone.
After treatment there may be some radiation protection precautions to limit the radiation received by those you share a house with or those you see regularly. This will depend on their age and how much close contact you have with them. The number of days where restriction applies will be longer for children, especially infants. If you perform care for anyone else or have children living in your household, you will need to limit close contact (less than 2 arms-lengths) for up to 17 days after treatment. Restrictions to other adults will only apply if we need to give you higher than average amounts of radiation to give you an effective treatment. Should this be required you would need to sleep in a separate bed for 4 nights after treatment.
After the work-up angiogram, the amount of radiation we will be giving you will be known, and a physicist will call you and go through specific radiation protection advice. If you are concerned about these restrictions or would like more information before your appointments, please contact the Nuclear Medicine Physics team on 01752 430222.
Contraception and SIRT
Your doctor will advise you not to get pregnant or make someone pregnant while having this treatment. This is because radiation may harm a developing baby. It is important to use contraception to prevent pregnancy for at least 4 months after you have SIRT.
Finally
We hope many of your questions have been answered by this leaflet but remember that this is only a starting point for discussion about your treatment with the doctors looking after you. Make sure you are satisfied that you have received enough information about the procedure.
Contact us
If you have any questions or concerns while you’re in hospital, please discuss these with the interventional radiology specialist nurse who can find the best person to answer your question.
-
Interventional Radiology Co-ordinator - 01752 430838
-
Interventional Radiology Bookings Clerk - 01752 432063
-
Nuclear Medicine team for Radiation Protection advice - 01752 430222
If you need any help within a week of leaving hospital, please call them using the details below
Hepatology cancer nurse specialist (Monday to Friday, 8am to 4pm)
Telephone: 01752 431962
If you are unwell outside of these hours or need immediate or urgent treatment, please call 999 or attend your local Emergency Department.
Useful links
Read about Selective internal radiation therapy (SIRT) at Cancer Research UK
Read about Selective internal radiation therapy (SIRT) at Macmillan Cancer Support
Other formats
If you need this leaflet in another format such as Braille, large print, high contrast, British Sign Language or translated into another language, contact the Patient Advice and Liaison Service (PALS):
-
01752 439694
