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Selective internal radiation therapies (SIRTs) for treating hepatocellular carcinoma

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1 Recommendations

1.1 The selective internal radiation therapies (SIRTs) QuiremSpheres, SIR‑Spheres and TheraSphere are not recommended, within their CE marking, for treating hepatocellular carcinoma in adults.

Why the committee made these recommendations

Treatment for hepatocellular carcinoma (HCC) depends on the stage of cancer and the liver function. It includes surgery, ablation, transarterial therapies, chemotherapy (such as lenvatinib and sorafenib) and best supportive care. Treatment does not cure the disease for most people.

QuiremSpheres, SIR-Spheres and TheraSphere are SIRTs. These are small radioactive beads that are injected into the liver's blood supply to treat liver cancer. In clinical trials, SIR-Spheres has not been shown to improve survival compared with available treatment options. There is very limited clinical evidence to compare the effectiveness of QuiremSpheres and TheraSphere with other treatments. Also, there are not enough data to compare the effectiveness of the 3 SIRTs with each other.

There is not enough evidence to consider SIRTs a cost‑effective use of NHS resources for early and intermediate stage HCC. For people with advanced stage HCC, the economic analysis shows that SIRTs are less clinically effective and cost more than lenvatinib or sorafenib. Because of this, SIRTs are not recommended.