Following on from our earlier News Item – and given the degree of interest this topic has generated on our social media platforms and Facebook Forums; we hope that this update will provide further clarity and information.
SIRT is a potential option for neuroendocrine tumours (NETs) that have spread to the liver: it does NOT treat NETs outside of the liver.
The procedure involves injecting tiny radioactive spheres into the blood vessels that supply the liver metastases to control the growth of these tumours and reduce symptoms, all while limiting exposure to healthy surrounding tissue.
Our SIRT Webinar, alongside other informational videos, is available to watch on our YouTube channel here: https://youtu.be/4SFiWKaVuMU?si=Nj20655nfTgo8ygS
The 2024 NICE Interventional Procedure Guidance (IPG) concluded that SIRT can help to control the growth of liver metastases from a neuroendocrine cancer primary (known or unknown) and reduce symptoms, furthermore, it may be particularly useful for patients with large metastatic neuroendocrine tumours who have symptoms of carcinoid syndrome.
SIRT can be given before or after other treatments, when appropriate, including peptide receptor radionuclide therapy, and can be repeated if clinically suitable.
General inclusion criteria:
- Inoperable liver-only or liver-dominant* NET
- Life expectancy is more than 12 weeks
- ECOG/WHO performance status 0-2**
- Adequate liver function (i.e. < bilirubin 34 µmol/L, i.e. 2.0 mg/dL)
Liver dominant* disease is where there is more NET inside the liver than outside of it: a clinical assessment is required to ensure that liver function is within safe levels for treatment. Ascites or other clinical signs of liver failure on physical examination is a contra-indication.
Further tests to check blood flow through and beyond the liver, alongside full blood count and tumour behaviour, as well as overall health assessment and other medical conditions is required before SIRT can be considered for you.
ECOG/WHO performance status 0-2**: is an assessment tool used to describes a patient’s level of functioning in terms of their ability to care for themself, daily activity, and physical ability (walking, working, etc.):
The 2024 NICE IPG was very clear in stating that the decision about whether you are suitable for this treatment, or not, should only be made by a multidisciplinary team WITH EXPERIENCE IN MANAGING NEUROENDOCRINE TUMOURS.
. . .and the procedure itself SHOULD ONLY BE PERFORMED IN SPECIALIST CENTRES BY CLINICIANS TRAINED AND EXPERIENCED IN DELIVERING SIRT.
However, despite this guidance recommending the use of SIRT, there is NO mandatory requirement for the NHS to centrally fund it, neither is there any specialised commissioned service currently in place for it.
This is why a collaborative working group of patients, clinicians, researchers, and key organisations such as UKINETs, the MRT Consortium, and Neuroendocrine Cancer UK have come together and submitted a Preliminary Policy Proposal to the NHS.
A Preliminary Policy Proposal (PPP) is a submission to the NHS to request the development of new or revised commissioning policy: often for a specialised service / treatment that may not be available or has not gained fully funded approval. It can be used to provide further evidence of clinical effectiveness, cost benefit and highlight where a clinical need is not being met, for example equitable access to SIRT for those with neuroendocrine cancer liver metastases.
We will keep you update as this proposal process progresses – but it may take time some time.