NHS England have announced that selective internal radiation therapy (SIRT) will be available on the NHS in England for patients with advanced colorectal cancer (bowel cancer) that has spread to the liver and cannot be removed with surgery and is not responding to standard chemotherapies
The use of SIRT in the NHS was assessed by NHS England from January 2014 to March 2017, as part of their Commissioning through Evaluation (CtE) scheme and the results of the assessment were published by NICE and NHS England in October 2017.
The findings were also published online as a full scientific paper in the journal Clinical Oncology by Professor Sharma and his colleagues in September 2018, which confirmed that the real-world experience of SIRT in the NHS is consistent with the published literature.
Since 2017, NHS England has been considering the case for routine commissioning of SIRT and they have reached the conclusion that the evidence base on SIR-Spheres resin microspheres is sufficient to offer SIRT as a routine treatment for patients with colorectal cancer that has spread to the liver who meet certain criteria.
In the Clinical Commissioning Policy paper: Selective Internal Radiation Therapy (SIRT) for chemotherapy refractory / intolerant metastatic colorectal cancer (adults), NHS England recommends that adults with chemotherapy refractory or chemotherapy intolerant unresectable, liver-only metastatic colorectal cancer that meet all of the eligibility criteria will be able to be treated with SIRT using yttrium-90 microspheres.
Patients with advanced bowel cancer will have to meet certain criteria to be eligible for the treatment on the NHS. Specialist liver centres in England which satisfy the criteria specified by NHS England will be able to routinely offer this procedure.
“The NHS England decision to fund internal radiation therapy to treat liver tumors is a significant development that offers new hope for patients with aggressive bowel cancer. We were very concerned for those patients who needed the treatment but who were unable to fund it privately or raise funds to receive it. Patients in England with liver cancer that has spread from their bowel and who have exhausted other treatments, now have access to a therapy which can extend their survival so that they can spend extra time with their loved ones and enjoy more life. These patients have very few treatment options so this is a really important step” said Vanessa Hebditch, Director of Communications and Policy at the British Liver Trust. “SIRT can be used for other types of cancers in the liver, such as cancer that started in the liver (primary liver cancer). But this isn’t available on the NHS at the moment. NICE is currently considering whether SIRT should be provided through the NHS for these patients and we will be making representation to NICE on patients’ behalf.”
For these other types of cancer, or if you live in other countries of the UK, your doctor might be able to submit a funding request to see if you can have SIRT on the NHS. Or you might be able to have it as part of a trial (if there is one available). Or you might be able to pay for it privately.
Patients who think this treatment may be relevant for them should speak to their consultant.
“The decision by NHS England to locally commission SIRT from April is an enormous relief for patients with bowel cancer that has spread to the liver. These patients often need disease control within the liver and have limited treatment options. As long as patients meet NHS England’s clinical criteria for SIRT, treated in expert liver centres - there is likely to be benefit in controlling the liver spread.” said Dr Harpreet Wasan, Consultant in Medical Oncology, London. Dr Wasan was co-chief investigator for the FOXFIRE trial of SIRT in liver metastases.
The liver metastases should be inoperable and the disease should not be responding to standard chemotherapies. For patients with other cancers that may benefit from SIRT, such as primary cancers of the liver, the policy proposals are still being reviewed.
“In specialist centers we have the possibility to treat patients with innovative treatments such as SIR-Spheres Y-90 resin microspheres which is a unique way to treat liver tumours with internal radiation therapy without damaging the healthy liver. It is great news that we have now the possibility to discuss this treatment option during the multidisciplinary team meetings for all patients who could benefit from it (meeting eligibility criteria)” stated Dr Jon Bell, Consultant Interventional Radiologist at the Christie NHS Foundation Trust, Manchester.
Professor Ricky Sharma, Consultant Radiation Oncologist, Chair of Radiation Oncology at University College London, commented: “We are delighted by this announcement. Our study has confirmed that the real-world experience of SIRT as a cancer treatment in the NHS is consistent with the published data from other countries. There is still scope for improving access to this specialist treatment for patients with a variety of cancers, not just bowel cancer, and across all the nations of the UK, not just England.”