NICE has concluded that selective internal radiation therapy (SIRT) should not be used for unresectable primary intrahepatic cholangiocarcinoma outside of the research setting.
The guidance is based on a rapid review of the published literature on the efficacy and safety of SIRT, which comprised three systematic reviews and meta-analysis and seven case series, along with data provided by the SIRT Commissioning through Evaluation registry study. Key safety outcomes were identified, namely bleeding, infection, unintended radiation toxicity, and hepatic failure.
The new interventional procedures guidance states that current evidence on the safety of SIRT for unresectable primary intrahepatic cholangiocarcinoma shows there are “well-recognised, serious but rare safety concerns” and the evidence on its efficacy is “inadequate” in quantity and quality.
Consequently, NICE advises that this procedure should only be used in the context of research and only in specialist centres, by clinicians trained and experienced in managing cholangiocarcinoma.
It also recommends that clinicians should enter details about all patients having SIRT for unresectable primary intrahepatic cholangiocarcinoma onto a suitable registry.
The latest guidance replaces NICE interventional procedures guidance on selective internal radiation therapy for primary intrahepatic cholangiocarcinoma (IPG459).