The consultation period on draft NICE guidance on the use of selective internal radiation therapy (SIRT) for unresectable colorectal liver metastases, has closed.
The draft guidance says that, in people who cannot tolerate chemotherapy or have liver metastases that are refractory to chemotherapy, there is evidence of efficacy with the procedure but this is limited, particularly for important outcomes such as quality of life. For these patients, the treatment should only be used with special arrangements for clinical governance, consent, and audit or research.
In people who can have chemotherapy, the procedure should only be used in the context of research.
Clinicians wishing to do SIRT 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 has called for further research which should report details of patient selection, whether the primary colorectal tumour arose in the left or right side of the colon, extrahepatic disease, and tumour-to-liver volume.
The final guidance is due next month.