Topic: UK NICE Guidelines - SIRT for ICC.

Selective internal radiation therapy for primary intrahepatic cholangiocarcinoma.

http://publications.nice.org.uk/selecti … oma-ipg459

Any advice or comments I give are based on personal experiences and knowledge and are my opinions only, they are not to be substituted for professional medical advice. Please seek professional advice from a qualified doctor or medical professional.

Re: UK NICE Guidelines - SIRT for ICC.

http://guidance.nice.org.uk/IPG459

Any advice or comments I give are based on personal experiences and knowledge and are my opinions only, they are not to be substituted for professional medical advice. Please seek professional advice from a qualified doctor or medical professional.

Re: UK NICE Guidelines - SIRT for ICC.

Hi, Gavin,
They do not say which SIRT(selective internal radiation treatment); I presume it will be radioembolization.

With regard to radioembo, I still have doubt on its effectiveness,side effects  and its  subsequent influence  on the decision making process of both the oncologists and surgeons when the tumor recur.

Gavin, be sure to say hi to your mum for me; sorry I have forget to mention her in recent messages as I always do due to the changing of my own situation, please forgive me.
God bless.

Please know that my personal opinion is not intended nor implied to be a substitute for professional medical advice. If  provided, information are for educational purposes.Consult doctor is a MUST for changing of treatment plans.

Re: UK NICE Guidelines - SIRT for ICC.

Thanks for that Percy. I too assumed it would be radioembolization. And you have absolutely nothing to apologise about what so ever!

Gavin

Any advice or comments I give are based on personal experiences and knowledge and are my opinions only, they are not to be substituted for professional medical advice. Please seek professional advice from a qualified doctor or medical professional.

Re: UK NICE Guidelines - SIRT for ICC.

The second link describes the procedure as
"Tiny radioactive ‘beads’ are injected into branches of the artery that supplies blood to the liver"
so definitely talking about radioembolization.

Percy:  My wife is being treated at Stanford, and radioembolization seems to be a likely treatment path.  I share some of your concerns.  I would be grateful if you could elaborate on this concern you have "its  subsequent influence  on the decision making process of both the oncologists and surgeons when the tumor recur."

What types of future procedures are impacted by radioembolization?

Thanks,

Jason

6 (edited by PCL1029 Thu, 25 Jul 2013 09:36:12)

Re: UK NICE Guidelines - SIRT for ICC.

Hi, Scott,
Stanford is one of the hospital that do radioembo a lot because either they push  for it to learn more or they thought it may be one of the tools they want to used at par with Northwestern university which spent lot of time on this procedure.

When this procedure came out  three years ago and patients on this board mentioned they had it done.(at least 6-8of them, check out 2000miles entries by just clicking his ID after you sign on. There will be more details.) I am very interested since they can , in theory, taking care of the cancer that cannot removed by surgery or it is too big for RFA (>3-4cm and more than 3-4 tumors and in tight spot.) .it sounds like an excellent choice. I personally communicated to at least three of them,most of them over 60 years old, and may had comobidities ( other health issues). All of them passed away within or around a 6-8 months period . This was why I raised the safety issue of radioembo issue and ask 2000 milers to help me for the stats just from our members.
The reason, as far as I am concern, is that , I am not sure how the beads or resin , which will stay inside the liver for a long time( 2-3days) will affects the outcome of recurrence; I am really not sure, even they report the radiation of the beads will affect both the tumor and healthy tissues , and at the most the radiation will only be radiated about 3mm beyond the tumor site, that means the maximum effects that will affect the health tissue that surround the tumor is 3mm at the most . but I did read a report that the range of the radiation may be more like 3-12mm. I think it is depended on the beads size and where the beads end up with in the liver. I know the resin type can go deeper, but what if the different size of the beads go into the tumor not as planed (ie: a few of the big beads goes in first and block the subsequent little beads to go deeper on the same intended to treat site. If so, the readioembo is not completely effective. Furthermore, if the above range of 3-12mm radiation zone is true, that means the procedure can affect and kill relatively  more a portion of the heavy cells which are not intended . Unlike RFA the burn off is around 4-5cm for a 3cm size tumor and over time they will fill up the hoe with regenerated cells, I don't know what the patients' own body will do with such a large dead tumor tissue inside the liver without surgically  remove the tumor later in the radio embo procedure and if the liver regenerated the same size of what the radioembo left, how does the body keeping or reabsorb such big dead mass in the body?
The really concern to sum this up is the total radiation the patient will have over the ENTIRE treatment period  from diagnosis to each recurrence and beyond. .
I  also knew one of the well known oncologist shares the concern about the effectiveness of radioembolization  just of short of disapproval of the whole procedure.
Besides, about the lung shunt, even if my is= to 6 and the acceptable is < 20.
I don't want to take that chance to get pneumonitis .
Scott, please remember, I am a patient only and not a doctor, I know Dr. Tse and his department is good at what they do, but it is all up to you to discern what the radioembo  really means to your wife.

The most concern for me with regard to radioembo,along with every 3 month CTscan and PET scan  and the future diagnosis and treatment like RFA, microwave, IRE, and chemoembolization(TACE) are all guided by Ct scan for the procedure and thus we, as patients ,should account for ALL of  these accumulative radiation too.
The liver is a very sensitive organ, you try to buy a fresh pig liver and put it in the microwave oven for 1,3,5 and 10 min; low,medium, and high. And you will see how sensitive the liver are . And radioembo usually applied to a relatively large part of the liver( the entire left or right lobe) and therefore a lot of radiation will deliver to the liver.
I am lucky in a way that I can use RFA for the small sizes of my tumors and therefore I used RFA instead of sectional radioembo for the 2.5x3cm area.
But I still will not rule out radioembo as my last resort .
God bless.

Please know that my personal opinion is not intended nor implied to be a substitute for professional medical advice. If  provided, information are for educational purposes.Consult doctor is a MUST for changing of treatment plans.

Re: UK NICE Guidelines - SIRT for ICC.

Many thanks Percy.  You have given me a lot to consider.

Jason

Re: UK NICE Guidelines - SIRT for ICC.

Selective internal radiation therapy
for primary intrahepatic
cholangiocarcinoma.

http://www.nice.org.uk/nicemedia/live/1 … /64613.pdf

Any advice or comments I give are based on personal experiences and knowledge and are my opinions only, they are not to be substituted for professional medical advice. Please seek professional advice from a qualified doctor or medical professional.