UK NICE Guidance Recommends SIRT in Neuroendocrine Tumors With Liver Metastasis

May 29, 2024—The United Kingdom’s National Institute for Health and Care Excellence (NICE) recently issued an interventional procedures guidance (IPG786) providing recommendations for selective internal radiation therapy (SIRT) for neuroendocrine tumors that have metastasized to the liver.

As noted in the guidance, SIRT uses microspheres containing sources of β radiation (either yttrium-90 or holmium-166) that are infused through the hepatic artery and carried by blood flow to the vessels that supply the tumor.

The NICE guidance includes the following recommendations:

• Use SIRT as an option for neuroendocrine tumors that have metastasized to the liver, with standard arrangements in place for clinical governance, consent, and audit.
• Patient selection should be done by a multidisciplinary team with experience in managing neuroendocrine tumors.
• The procedure should only be performed in specialist centers by clinicians trained and experienced in delivering SIRT.
• Clinicians should enter details about every patient having this procedure into an appropriate registry.

According to the document, evidence shows that SIRT controls the growth of tumors that have metastasized to the liver and reduces symptoms. Furthermore, although there may be serious complications with SIRT, they are well recognized and infrequent. For some patients with these tumors, SIRT may be better tolerated than other available treatment options. More evidence would help define which patients would benefit the most, advised the NICE guidance.

Comments from the NICE guidance committee include the following:

• SIRT may be particularly useful for patients with large metastatic neuroendocrine tumors who have symptoms of carcinoid syndrome.
• SIRT can be preceded or followed by other treatments when appropriate, including peptide receptor radionuclide therapy, and can be repeated.
• For some patients, SIRT can open options for alternative treatment afterward.
• SIRT may be a more suitable treatment for neuroendocrine tumors that have metastasized to the liver than other types of tumors in the liver because they are usually hypervascular.
• SIRT is likely better tolerated than other intraarterial therapies because it relies on radiation rather than embolic effect to kill the tumor cells.
• Experts advise that dosimetry methods are evolving

Supporting evidence for the guidance is available online on the NICE webpage for IPG786.