This information will help you prepare for selective internal radiation therapy (SIRT) treatment at Memorial Sloan Kettering Cancer Center (MSK).
SIRT (sometimes called radioembolization) is a treatment that is used to destroy liver tumors. During your SIRT treatment, tiny radioactive beads are delivered directly to the tumor through the arteries (blood vessels) in your liver. The beads give off radiation over a very short distance. This concentrates the radiation inside the tumor, helping to reduce radiation exposure to the rest of your liver, as well as the rest of your body.
SIRT Mapping Procedure
About a month before your SIRT treatment, you will have a SIRT mapping procedure. Mapping is done to plan for your SIRT treatment. The first part of the mapping procedure will tell us which liver arteries bring blood to the liver tumors and whether there are arteries that carry blood outside of your liver to other areas in your abdomen. If these arteries are found, they are blocked so that the radiation will not harm your other organs. The second part of the mapping procedure will evaluate for any possible flow of radiation from your liver to your lungs.
Before Your SIRT Mapping Procedure
Ask about your medications
You may need to stop taking some of your medications before your procedure. Talk with your doctor about which medications are safe for you to stop. We have included some common examples below.
If you take medication that affects the way your blood clots, ask the doctor performing your procedure what to do. The doctor's contact information is listed at the end of this resource. Some examples of these medications are:
Whether he or she recommends you stop taking it will depend on the reason you are taking it. Do not stop taking any of these medications without talking with your doctor.
- If you take insulin or other medications for diabetes, you may need to change the dose before your procedure. Ask the doctor who prescribes your diabetes medication what you should do the morning of your procedure.
- If you are taking steroids, ask the doctor performing your procedure what to do
- Please review the information in the resource Common Medications Containing Aspirin and Other Nonsteroidal Anti-Inflammatory Drugs (NSAIDs). It includes important information about medications you'll need to avoid before your procedure and what medications you can take instead.
Arrange for someone to take you home.
If you will be leaving the hospital the same day as your procedure, you must have a responsible adult with you when you're discharged from the recovery area. If you don't have someone who can do this, please call one of the agencies below. They will help find someone to take you home.
In New York:
Partners in Care: (888) 735-8913
Caring People: (877) 227-4649
In New York or New Jersey:
Caring People: (877) 227-4649
Tell us if you're sick
If you develop any illness (fever, cold, sore throat, or flu) before your procedure, please call a nurse in Interventional Radiology at (212) 639-2236. A nurse is available Monday through Friday from 9:00 am to 5:00 pm. After 5:00 pm, during the weekend, and on holidays, call (212) 639-2000 and ask for the Interventional Radiology fellow on call.
Note the time of your appointment
A staff member from Interventional Radiology will call you 2 business days before your procedure. He or she will tell you what time you should arrive at the hospital for your procedure. If your procedure is scheduled on a Monday, you will be called on the Thursday before. If you don't receive a call by 12:00 pm the business day before your procedure, please call (212) 639-5051.
If you need to cancel your procedure for any reason, please call the doctor who scheduled it for you.
The Day of Your SIRT Mapping Procedure
- Do not eat anything after midnight the night before your procedure.
- Between midnight and up until 2 hours before your scheduled arrival time, you may drink a total of 8 ounces of clear liquids. This includes the liquids you will need to swallow any medications you were instructed to take the morning of your procedure. Examples of clear liquids include:
- Clear broth, bouillon, or consommé (no particles of dried food or seasonings)
- Gelatin, such as Jello®
- Clear fruit juices with no pulp, such as cranberry, grape, or apple
- Soda, such as 7-Up®, Sprite®, ginger ale, seltzer, or Gatorade®
- Coffee or tea, without milk or cream
- Starting 2 hours before your scheduled arrival time, do not drink anything, including water. Do not chew gum or suck on any hard candies.
Things to remember
- Take your medications the morning of your procedure as instructed by your doctor. Take them with a few sips of water.
- Do not apply cream or petroleum jelly (Vaseline®). You can use deodorant and light moisturizers.
- Remove any jewelry, including body piercings.
- Leave all valuables, such as credit cards and jewelry, at home.
- If you wear contact lenses, wear your glasses instead, if possible. If you don't have glasses, please bring a case for your contacts.
What to bring with you
- A list of the medications you take at home
- Medications for breathing problems (such as inhalers), medications for chest pain, or both
- A case for your glasses or contacts
- Your Health Care Proxy form, if you have completed one
- If you use a CPAP or BiPAP machine to sleep at night, please bring your machine with you, if possible. If you can't bring your machine with you, we will give you one to use while you are in the hospital.
Where to park
Parking at MSK is available in the garage on East 66th Street between First and York Avenues. To reach the garage, enter East 66th Street from York Avenue. The garage is located about a quarter of a block toward First Avenue, on the right (north) side of the street. A pedestrian tunnel connects the garage to the hospital. For questions about pricing, call (212) 639-2338.
There are also other nearby commercial garages on East 69th Street between First and Second Avenues, East 67th Street between York and First Avenues, and East 65th Street between First and Second Avenues.
Where to go
Please arrive at the main building of MSK at 1275 York Avenue between East 67th and East 68th Streets. Take the M elevator to the 2nd floor. Enter through the glass doors and check in at the desk.
What to expect
Once you arrive at the hospital, doctors, nurses, and other staff members will ask you to state and spell your name and date of birth many times. This is for your safety. Patients with the same or similar name may be having procedures on the same day.
After changing into a hospital gown, you will meet your nurse. He or she will place an intravenous (IV) catheter into a vein, usually in your hand or arm. At first, you will receive liquids through the IV, but it will be used later to give you medication to make you sleepy and ensure that you are comfortable during the procedure.
During Your SIRT Mapping Procedure
When it is time for your mapping procedure, you will be brought into the procedure room and helped onto an exam table. You will be attached to equipment to monitor your heart rate, breathing, and blood pressure. You will receive oxygen through your nose. While lying on your back on the table, you will be given sedation medication through your IV to make you sleepy and relaxed.
After you are sedated, you may have a catheter (thin, flexible tube) inserted into your bladder to drain your urine. Your groin will be cleaned, shaved, and covered with sterile drapes. A local anesthetic will be injected into the area where your doctor will be working. A catheter will be threaded through the artery in your groin up to the arteries that supply blood to your liver. You will be given a dye called contrast through the catheter and images will be taken. This will tell us if there are arteries that carry blood outside of your liver to other areas in your abdomen. If these arteries are found, they are blocked so that the radiation will not harm your other organs. Blocking these arteries will not harm the organs that they supply.
Next you will receive an injection of a radioactive imaging dye into your liver artery. Before you leave the procedure room, we will remove the catheter in your artery and seal the artery with a special device or by holding pressure on your groin for 15 to 20 minutes.
Your nurse will take you to a room in Nuclear Medicine for the last part of the procedure. There you will have a scan to see if any of the radioactive imaging dye injected into your liver artery traveled to your lungs or anywhere else outside of your liver. This will help us determine whether it will be safe to proceed with the SIRT treatment. The scan will take about 45 minutes.
After Your SIRT Mapping Procedure
After your Nuclear Medicine scan, you will be taken to the recovery area. You will be asked to lay flat with your right leg straight for 1 to 4 hours. Once you are able to safely sit-up, the catheter in your bladder will be removed. You will be in the recovery area for 3 to 4 hours before you go home. Your family and friends can be with you during this time.
Preparing for Your SIRT Treatment
A few weeks after your mapping procedure, you will have your SIRT treatment. The preparation for your SIRT treatment will be almost the same as the preparation for your SIRT mapping procedure. Please follow the instructions in the “Before Your SIRT Mapping Procedure” section above, as well as the additional instructions below.
You will need to have a blood test before you have your SIRT treatment to test your liver function. Your nurse will arrange this for you before your procedure.
5 days before Your SIRT Treatment
Your nurse will give you a prescription for a medication that will help prevent stomach pain, if you are not already taking a similar medication. Start taking this medication 5 days before you have your SIRT treatment. You will continue to take this medication after your treatment.
The Day of Your SIRT Treatment
Your SIRT treatment will be almost the same as your SIRT mapping procedure. Follow the same instructions on what to bring, where to park, and where to go.
What to expect
The SIRT treatment will be similar to your SIRT mapping procedure. After you are sedated, a catheter will be threaded through the artery in your groin up to the arteries that supply blood to your liver. This time, tiny radioactive beads will be given through the catheter. As with the mapping procedure, when the treatment is completed, your doctor will remove the catheter in your artery and seal the artery using a special device or by holding pressure on your groin. You will also go to Nuclear Medicine for a scan, although this may not be done immediately after the procedure. Your recovery time will be about the same as for the mapping procedure. You will also have a bladder catheter placed after you are sedated. The bladder catheter will be removed in the recovery area.
If you have cancer on both sides of your liver, SIRT may be given in 2 separate treatments. The second treatment is about 6 weeks after the first.
After Your SIRT Treatment
The radioactive beads will still be in your body after your SIRT, however you cannot harm other people you come in contact with after your treatment by briefly hugging, kissing, or shaking hands. You can be in the same room with anyone, including pregnant women. You cannot make something radioactive by touching it. The amount of radiation in your body will decrease slowly and will be gone in 2 weeks.
You will be given specific instructions from a radiation safety officer about safety precautions you should take around family and friends. He or she will also give you a wallet card to keep with you for 30 days after your procedure.
You should not breastfeed after having SIRT treatment. You should not become pregnant or father a baby while you are undergoing SIRT treatment. To find out more information about sexual activity during treatment, ask your nurse for the resource Sexual Activity During Cancer Treatment or go to the links below. There is a version available for men and a version available for women.
After leaving the hospital, some patients develop side effects from SIRT treatment, including:
- Abdominal pain
Call Your Doctor or Nurse if You Have:
- Pain, nausea, or vomiting that is uncontrolled or worse than it was before your mapping procedure or treatment
- A temperature of 101° F (38.3° C) or higher
- Any symptoms that are worrying you