The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on Selective internal radiation therapy for non-resectable colorectal metastases in the liver.

It replaces the previous guidance on selective internal radiation therapy for colorectal metastases in the liver (NICE interventional procedures guidance 93, September 2004).


Colorectal liver metastasis is cancer that has spread to the liver from the bowel. Selective internal radiation therapy (known as SIRT) uses radiation put into the patient’s liver to kill the cancer cells. Tiny radioactive ‘beads’ are injected into the artery that supplies blood to the liver (the hepatic artery). The beads become trapped (embolise) in the tiny blood vessels surrounding the cancer, releasing radiation directly onto it.

Coding recommendations

J12.3 Selective internal radiotherapy with microspheres to lesion of liver

X65.3 Delivery of a fraction of interstitial radiotherapy

Y36.4 Introduction of non-removable radioactive substance into organ for brachytherapy NOC

Y89.- Brachytherapy (where necessary)

Y53.4 Approach to organ under fluoroscopic control

In addition the ICD-10 code C78.7 Secondary malignant neoplasm of liver and intrahepatic bile duct and a code from category C18.- Malignant neoplasm of colon would be recorded.


Your responsibility

This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account. However, the guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.

Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

  • National Institute for Health and Care Excellence (NICE)