For liver cancer patients, who are declared inoperable due to large multiple tumours, selective internal radiation therapy (SIRT), where the radio-active substance directly reaches the tumour through the artery supplying blood to the liver, is proving to be a boon.
However, the high cost of treatment is a big deterrent, especially in the developing countries. One sitting of the therapy can cost upto Rs 6 lakh. "The medicine vial itself costs about Rs 4.5 lakh," said Dr Arun Gupta, interventional radiologist, Sir Ganga Ram Hopsital, the only hospital in north that performs the procedure.
The therapy, however, is gaining popularity due to its minimal side effects. "The medicine goes into the entire blood stream during chemotherapy resulting in serious side-effects such as hair and appetite loss and nausea, vomiting etc. Burning the tumour using radiation externally damages healthy tissues surrounding the tumour. In SIRT, the radiation is focused and reaches the tumour directly through the blood supply. A patient feels negligible side-effects such as abdominal pain for a few hours, making a person tolerate the treatment better," said Gilman Wong, chief executive officer, Sirtex Medical, an Australia-based oncology treatment company that created the technique.
A catheter that carries the radio-active substance, Yttrium-90, is inserted through the groin that reaches the liver via one of the two vessels that supply blood to it. The radiation, which is within the permissible limit, reaches the tumour through blood and shrinks its size, leaving normal tissues around it unaffected. In some cases, the size and number of tumour nodules have been reduced considerably, allowing the patient to undergo surgery.
The treatment, however, is suitable only for the treatment of liver cancer, as the organ has two sources of blood supply-the vein that carries 80% of the supply and the portal artery that supplies the remaining 20% blood. It is possible to block the artery to send in the radiation and still not let the liver get affected by lack of blood. The other organs will not sustain if their blood supply is blocked
The analysis of 325 patients from various European countries over a period of six years, who were put on the therapy, has shown increased life-expectancy and improved quality of life as compared to the conventional chemo and radio frequency ablation therapies.
The therapy is currently in use in nine countries, being the latest inclusion in the list last year. Thirty- two patients in Bangalore, Mumbai, Chennai and Delhi have been put on the therapy in the past one year with positive results. "The therapy works in the Indian scenario because 80% of the liver cancer patients here are inoperable because of late diagnosis. One doesn't get any symptoms till about 80% of the liver is damaged," said Dr MC Uthapa, director, interventional radiology and oncology, Global hospitals, who has treated 12 patients with the technique.