NICE has published final guidance on the use of selective internal radiation therapy (SIRT) for unresectable colorectal metastases in the liver.
The guidance acknowledges that the evidence on the safety of SIRT for this indication for unresectable colorectal metastases in the liver shows there can be serious complications, but these are well-recognised and infrequent.
In people who cannot tolerate chemotherapy or have liver metastases that are refractory to chemotherapy, there is evidence of efficacy but this is limited, particularly for important outcomes such as quality of life. Therefore, NICE recommends that in these people, this procedure should only be used with special arrangements for clinical governance, consent, and audit or research.
In people who can have chemotherapy, there is a lack of good quality evidence on overall survival and quality of life. Therefore, in these people, the procedure is only recommended in the context of research.
Clinicians wishing to do SIRT for unresectable colorectal metastases in the liver, in people who cannot have chemotherapy or have liver metastases that are refractory to chemotherapy, should:
- Inform the clinical governance leads in their NHS trusts.
- Give patients clear written information to support shared decision-making, including NICE's information for the public.
- Ensure that patients understand the procedure's safety and efficacy, as well as any uncertainties about these.
- Audit and review clinical outcomes of all patients having the procedure.
NICE advises that patient selection should be done by a specialist hepatobiliary cancer multidisciplinary team. The procedure should only be carried out by clinicians with specific training in SIRT, including techniques to minimise the risk of damage to surrounding tissue.