The National Institute for Health and Care Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on Selective internal radiation therapy for primary cholangiocarcinoma.

The committee agreed that two pieces of guidance would be produced following consideration of the overview for SIRT for primary hepatocellular carcinoma and primary cholangiocarcinoma. Please see NICE interventional procedure guidance 460


Hepatocellular carcinoma is a type of primary liver cancer (a cancer that begins in the liver). Cholangiocarcinoma, or bile duct cancer, is a rare type of primary liver cancer. The bile ducts (tubes) carry bile from the liver to the small bowel. Bile helps digestion by breaking down fat in food.

Selective internal radiation therapy (known as SIRT) aims to kill cancer cells, causing as little damage to the surrounding tissues as possible. Tiny radioactive ‘beads’ are injected into branches of the artery that supplies blood to the liver. The beads then become trapped in the small blood vessels supplying the cancer, releasing radiation directly into the cancer cells and killing them.

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

Y53.4 Approach to organ under fluoroscopic control


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)