Authors' objectives: To assess clinical effectiveness, acceptability, costs and organisational aspects of SIRT for the treatment of liver metastases from CRC.

Authors' recommendations: We included one small open label randomized trial carried out on 46 patients. The study is small and its generalizability is unclear. In our survey the majority of hospitals provided SIRT in one session. Choice of number of sessions depended on cost and on extension of metastatic disease (unilobar, bilobar), reduction of technical complications potentially related to several sessions, different vascular supply of liver metastases and different response of each metastatic nodule to chemotherapy. Fifty percent of liver involvement is the highest acceptable threshold in all hospitals. An increasing number of Centers are employing SIRT early (2nd or 3rd line). Considering the therapeutic potential of SIRT, the impact of SIRT in Italy should be tested with a larger use of prospective studies, similarly to clinical strategies promoted by other countries. Moreover, our survey shows that the number of patient yearly treaded is relatively small with no more than 12 patients treated per year. We calculated the total cost of SIRT procedure by adding the costs of diagnostic work-up, treatment and follow up. The median cost is 15,229 euro ranging from 13,582 to 17,370. The costs of an individual dose of radioisotopes amounts to 10,000 euro. For the patients being able to undergo radioembolization means having a further chance. The attitude toward it is usually positive and the probable side effects are regarded as tolerable. Any future study comparing radioembolization with other therapies should always include QoL as a secondary outcome measured with standardized and internationally validated instruments. We recommend that the results of completed and nearly completed trials currently still active, be reported at the earliest opportunity. A national resource optimization plan is needed.

Project Status: Completed

Year Published: 2013

URL for published report: http://www.salute.gov.it/imgs/C_17_pagineAree_1202_listaFile_itemName_26_file.pdf

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Italy

Organisation Name: The Italian National Agency for Regional Health Services (Agenas)

Contact Address: Agenzia nazionale per i servizi sanitari regionali, Via Puglie 23, 00187 Rome, Italy

Contact Name: hta@agenas.it

Contact Email: hta@agenas.it

Copyright: Italian Ministry of Health and Agenas