New treatment for patients with liver cancer


A new treatment for patients with primary liver cancer and certain types of liver metastases has started up at Karolinska. The treatment, while allowing delivery of high radiation doses directly into the tumor, is associated with relatively few side effects and may prolong survival.

The new treatment, known as SIRT (Selective Internal Radiotherapy) was carried out for the first time at Karolinska in January 2022, but preparations prior to this have been ongoing for over a year.

The treatment is used in patients with primary liver cancer and certain types of liver metastases that, for various reasons, are unsuitable for surgery or other treatment methods.

Before the actual treatment, a diagnostic evaluation with radiological methods including conventional angiography is performed. After the injection of a small dose of a radioisotope to simulate the treatment, examination with gamma camera is performed, which allows mapping of the tumor and calculation of the radiation dose to be given during actual treatment. During the procedure, the performing radiologist establishes vascular access through an artery in the groin, after which a catheter is passed up through the aorta and into the liver artery suppling the tumor. Through this catheter, radioactive microparticles are then injected into the tumour, with the goal of killing tumour cells.

Inger Keussen

Using this method, a much higher radiation dose can be delivered into the tumour, compared with conventional external radiotherapy.

– The side effects are mild, while the treatment is very effective, says Inger Keussen, consultant radiologist at the Department of Interventional Radiology and Ultrasound.

Amar Karalli

– This is mainly a palliative treatment method, but tumour size may be substantially reduced, which in some cases can make surgery possible, increasing the patient's chances of survival, says Amar Karalli, consultant radiologist and Head of the Department of Interventional Radiology and Ultrasound.

The introduction of the treatment method has been possible through multidisciplinary collaboration. The procedure involves many different specialties such as radiation oncology, nuclear medicine, neuroendocrine surgery, hepatology and interventional radiology.

The patient´s eligibility for the treatment is discussed at a multidisciplinary conference. Several patient-specific parameters are taken into account. For patients deemed suitable, treatment should be performed within one month after the decision has been made to offer treatment.

After the treatment, the patient is followed up by radiological and clinical examinations.

– The treatment is usually performed only once, unlike local chemotherapy treatments, which often require repeat sessions, says Inger Keussen.

The first treatment was successful and hopefully more patients may now be treated with this method.

– Another positive effect of the introduction of SIRT is that we will now be able to do research in the field and further expand our knowledge base, says Amar Karalli.