SIRT- Treatment Issues

Lung Shunting:

Admin Activity: GBq	Lung Shunting %	Lung Radiation Dose: Gray
1	10%	5
1.5	10%	7.5
2	10%	10
2.5	10%	12.5
3	10%	15

1	15%	7.5
1.5	15%	11.25
2	15%	15
2.5	15%	18.75
3	15%	22.5

1	20%	10
1.5	20%	15
2	20%	20
2.5	20%	25
3	20%	30
If >10%, reduce dose by 20% If >15%, reduce by 40% If >=20%, do not treat

Dosimetry:

Empiric Method- Based Upon Clinical Experience
Estimated Degree of Tumor Involvement in the Liver	Recommended Y⁹⁰ Amount for Treatment
< 50% 25% to 50% <25%	3.0 GBq 2.5 GBq 2 GBq
Note: Dose reduction required if lung shunt is greater than 10% 10-15% shunt (20% reduction) 15-20% shunt (40% reduction) >20%= no RX

BSA Method
Patient Weight % of Liver Tumor Involvement Activity of SIR-Spheres in GBq= (BSA-0.2) + % of tumor involvement 100
Example: BSA (2.0-0.2)= 1.8 +30% tumor involvement 100% Whole liver dose= 2.1 GBq Lobar= Right Lobe (60%) - 1.26 GBq Left Lobe (40%) - 0.84 GBq

SIRT Side Effects:

Pain during the administration due to embolic effect of the spheres
Nausea – anti-nausea medication is needed
Lethargy – for 1-2 weeks after treatment, will subside with time and is a normal response to abdominal radiation
Gastritis – due to reflux of spheres during administration

Exposure:

Bremsstrahlung radiation is typically 15 mSv per Gbq at 15 cm from the patient’s right side (initially)

Post – Treatment

23-hour hospital stay
Single use room or low traffic area
Non-pregnant nursing staff /visitors
Nursing from left hand side of patient
Minimize visitor number and time
Shielding unnecessary

Discharge Instructions

Augmentin 500 mg or Cipro 500 mg for 5 days
Anti-nausea suppositories
Panadol Forte
8 glasses of water per day
Make contact if nauseous/abdominal pain/fever greater than 102ºF
Resume light activity as soon as you feel like it