Selective Internal Radiation Therapy (SIRT) 

What is Selective Internal Radiation Therapy (SIRT)?

SIRT, also known as transhepatic radioembolisation (TARE), is a nuclear medicine treatment designed for primary and metastatic liver cancers including hepatocellular carcinoma (HCC).  

In this procedure, tiny radioactive beads (microspheres) made of glass or resin are injected directly into the liver arteries that supply the tumours. These beads lodge in the tumour’s blood vessels, where they release radiation over several weeks. The radiation from these beads damages the cancer cells, while minimising damage to normal cells.   

SIRT is usually recommended for patients whose liver tumours cannot be surgically removed or treated with other methods. SIRT may be used to reduce the size of a tumour before other treatments such as surgery.

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Why would my doctor refer me for SIRT?

SIRT is often recommended when surgery or ablation are not suitable for your liver tumour.  

If you have been diagnosed with liver cancer such as hepatocellular carcinoma (HCC) or liver metastases from another cancer (such as colorectal cancer or breast cancer), SIRT might be an option.   

However, it’s important to understand that SIRT is not suitable for all patients, especially people with severe liver failure. Your doctor will assess your liver function and overall health to determine if SIRT is appropriate for you.  

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How do I prepare for SIRT? 

Before the procedure, you’ll undergo a series of tests, including imaging scans (such as CT or MRI) and blood tests, to determine your suitability for SIRT.  

You’ll be asked to discuss your medical history and have blood tests to make sure your liver function is OK.  

Your doctor will advise you on the hospital admission process and any necessary preparations, such as fasting before the procedure.  

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What happens during SIRT?

The procedure is performed in a radiology angiography suite in two sessions, each lasting about 2 hours.   

In both sessions, a small catheter is inserted into the artery through the groin or wrist and guided through the blood vessels to the liver tumour using X-ray. This provides a roadmap of the blood vessels supplying the tumour. This first session is a “test run” to ensure that the treatment will be safe and effective, with a “test dose” of radiation injected into the liver via the tiny catheter. A special nuclear scan will be done to make sure the radiation only goes to the tumour and not to other areas such as the lungs.   

If the “test run” confirms your eligibility, you will have a second procedure, usually 1 to 3 weeks later. This second session involves the actual infusion of the spheres, followed by another nuclear scan to check whether the treatment is working.  

Over the next 1-2 weeks, you may need to take some minor safety precautions:   

• Hand Hygiene: Wash your hands thoroughly after using the toilet, as some radiation may be present in your urine or stools during the first 24 hours.  

• Clean Spills: Clean up any spills of body fluids (such as blood, urine, or stools) and dispose of them in the toilet.  

• Avoid Close Contact: Avoid prolonged, close physical contact with children and pregnant women for the first week. This includes not sharing a bed or sitting close for extended periods.  

• Sleeping Arrangements: It is often advised to sleep alone for the first couple of nights after treatment.  

• Sexual Activity: Avoid sexual contact for the first few days after treatment.  

• Breastfeeding: If you are breastfeeding, do not breastfeed or use expressed breast milk for a few weeks after treatment.  

You will be given specific instructions from your treatment centre.  

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What are the side effects of SIRT?  

Serious side effects related to SIRT are rare. However, you may experience some of the following side effects:  

• Pain in the abdomen that may last for a few hours  

This can be well controlled with pain medication.  

• Nausea  

This can be caused by the dye that is injected into the vessels or because of the spheres in the liver. The nausea should only last a few days and can be well controlled with anti-nausea medication.  

• Reduced appetite  

Some patients may not be hungry for several days.  

• Tiredness  

This may be caused by the effect of the radiation on the liver tumours and may last several days to weeks. 

• Fever  

The liver tumours essentially decay and breakdown, and the by-products of this may cause a short-term fever (up to a week). This can be well controlled with paracetamol or a similar over the counter analgesic.  

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What are the benefits of SIRT  

SIRT offers several benefits for patients with liver tumours, including:  

• Liver tumour size reduction  

SIRT can reduce the size of liver tumours, making them easier to manage or remove surgically.  

• Quality of life improvements  

Many patients report better overall quality of life following SIRT, when compared with other treatments for liver cancer.  

• Liver transplant and Liver surgery eligibility  

In some cases, SIRT may shrink a liver tumour enough to make patients eligible for liver transplant or liver surgery, providing a potential cure.  

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What are the risks of SIRT?  

SIRT is generally considered safe as it is a minimally invasive procedure and carries fewer risks than traditional open surgery. However, like all medical procedures, there are some risks associated with the procedure. Your interventional radiologist will discuss these risks with you in detail before proceeding:  

• Radiation exposure to nearby organs  

There is a small risk that the radioactive beads could reach other organs, such as the stomach or pancreas, potentially causing ulcers or inflammation.  

• Radiation pneumonitis  

If too much radiation is delivered to the lungs, patients may develop a condition called radiation pneumonitis, which causes a dry cough or lung irritation.  This is why it is important to have the test run before the full procedure. 

• Liver damage  

In rare cases, too much radiation to healthy liver tissue can lead to radiation hepatitis. Patients with poor liver function may be at higher risk and may not be suitable for SIRT.  

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How much does SIRT cost?  

There is limited availability of SIRT in public hospitals, and it is not available in every state under the public system. If you are treated within the public system, you will not pay for your SIRT.  You can ask your medical team if SIRT is available in your state. 

In much of Australia, SIRT is only available in the private hospital system. While the cost of the SIRT beads may be largely covered by health insurance, other out-of-pocket expenses in the private system can be significant, especially if additional tests or hospital fees are involved. You should talk to your doctor about the best option for you. 

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Resources

Liver Foundation Nurse Led Support Line: call 1800 841 118 or email support@liver.org.au to talk to a friendly, expert hepatology nurse.  

Reviewed Jan 2026