Here We Go !

This morning I received insurance company approval for the SIR Spheres treatment! Needless to say I’m happy about that. On Tuesday I go for the rescheduled CT scan and the first part of the SIRT will be on March 18th. Tomorrow I’ll receive my last chemo treatment for a while. I promised you more details about the procedure so here it is. It will probably be boring for most people but hopefully it will be helpful for patients and other people fighting this disease. SIR stands for Selective Internal Radiation. Sometimes the acronym SIRT is used which stands for Selective Internal Radiation Therapy. The procedure was developed by a company called Sirtex located in Australia. The procedure involves three sessions. Each session is a long day at the hospital. We were told to expect to be there from 6:30 in the morning until 6:30 in the evening. At least I’ll be high for part of it. Prior to the first session I need to have a blood test and a CT scan. The CT scan will be used to study my vascular anatomy leading to and from the liver and plan what has to be done in the first session. The blood test determines whether or not the liver is functioning well enough to withstand the treatment and continue viably after the treatment. In the first session, referred to as a “mapping” session, they will insert a catheter (I believe this instrument is classified as a catheter) into my femoral artery. This is the main artery that supplies blood to the lower part of the body. It will be accessed through my groin on the right side, very close to my hernia incision if not right on it. With this instrument they will seal off (embolize) blood vessels that lead to other organs. This is done to prevent the radioactive particles from traveling to organs other than the liver. Should that happen, the particles would likely end up in my stomach which would cause ulcers. This is basically all that is done on the first day. It is done under very light sedation but requires six hours of recovery. The long recovery is needed because of the invasion to the femoral artery. They have to make sure it closes up properly so I don’t go home and bleed out. The second step actually takes place a week later. Again they insert a catheter through the femoral artery but this time it is guided to the liver, through the hepatic artery, and the SIR Spheres are injected. The spheres are microscopic polymer beads (spheres) that contain a radioactive substance called yttrium 90. The spheres will lodge themselves in the blood vessels that supply blood to the tumors. The spheres will do two things. Their physical presence will block the flow of blood to the tumors, effectively starving them. At the same time they will release the yttrium 90 into the tumors thereby radiating them. The physical blockage is permanent. The radioactivity lasts several days. One might wonder why this doesn’t affect the good liver tissue and kill it as well. I don’t have a lot of knowledge about this but here is my understanding. The liver is one of only two organs in the body that gets its blood supply from both an artery and a vein. The lung(s) is the other organ. The tumors in the liver are supplied primarily by the hepatic artery so when the spheres are injected into the artery they reach the tumors. The healthy liver tissue continues to receive blood from the portal vein. During this second day only one side of the liver is done. I don’t recall if it’s the left side or the right side. There is another six hour recovery. After another three or four weeks it’s another full day procedure to do the second side of the liver. The spheres are only radioactive for a very short time. They must be flown in from Australia and used within a day or two so scheduling is critical. I hope we don’t get another snow storm. There are some expected minor side effects, primarily several days of lethargy, loss of appetite and low grade fever. There is about a twenty percent chance that some of the beads will end up in my stomach which will cause ulcers. There is a smaller chance they will find their way to other organs causing more serious damage including possible death. I’m not concerned. I’m facing possible death now. Come to think of it, we’re all facing certain death. No guarantees but I think I’ll gain some benefit from this. So here we go. ----------------------------------------------------------------