Prof. Dr. Turgay Çelikel
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Ablation & Embolization
Sirt therapy
What SIRT therapy is, how Y-90 microspheres target liver tumours via the hepatic artery, what clinical evidence says about survival and tumour control, approximate costs in Turkey compared with the UK, US and Germany, candidate eligibility, procedure stages from mapping to bead infusion, recovery, potential risks and how to choose an accredited interventional oncology hospital.
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SIRT therapy in Turkey: what it is and how radioembolization works
SIRT therapy (selective internal radiation therapy), also known as transarterial radioembolization (TARE), is a targeted interventional oncology procedure for inoperable primary liver cancer and liver metastases. The technique delivers millions of microscopic radioactive beads directly into the hepatic arterial branches feeding liver tumours. Loaded with Yttrium-90 (Y-90), these microspheres lodge inside tumour capillaries, releasing high-dose beta radiation locally while sparing healthy tissue. Hospitals in Turkey offer this treatment within multidisciplinary oncology treatments in Turkey for patients needing targeted local tumour control.
Because healthy liver tissue receives most blood from the portal vein whereas liver tumours rely on the hepatic artery, radioembolization exploits this unique circulation. SIRT therapy is not a whole-body chemotherapy, nor is it a cure. It acts locally to slow disease progression, relieve symptoms, or downstage tumours for future surgery. This guide outlines how selective internal radiation therapy works, clinical evidence, comparative costs, candidacy, procedural stages, recovery milestones and hospital standards.
How do Y-90 microspheres target liver tumours?
The procedure relies on precise vascular access and radiation physics. An interventional radiologist inserts a thin microcatheter into the femoral or radial artery under local anaesthesia and guides it under fluoroscopy into the hepatic artery. Once positioned within the vessels supplying the tumour, the radioactive microspheres are slowly infused.
Measuring twenty to thirty micrometres—about one-third of a hair's width—the biocompatible glass or resin spheres become trapped in the terminal arterioles of the malignancy. The Yttrium-90 emits beta radiation with an average tissue penetration of 2.5 millimetres. This short range delivers lethal radiation to cancer cells over ten to fourteen days, halting tumour growth while protecting surrounding healthy liver cells fed by the portal vein.
Does SIRT therapy actually work, and what does the clinical evidence show?
International guidelines from ESMO, NCCN, and CIRSE recognise SIRT therapy as an effective locoregional treatment for selected inoperable liver tumours. It is primarily used for hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma, and colorectal liver metastases resistant to standard chemotherapy.
What the evidence supports: clinical registries and multicentre trials show that radioembolization achieves meaningful disease control, delays tumour progression, and preserves quality of life with fewer systemic side effects than chemotherapy. In borderline cases, SIRT can downstage tumours to allow surgical resection, or induce radiation lobectomy to help the healthy lobe grow before surgery.
What the evidence does not support: SIRT does not cure widespread metastatic cancer outside the liver, nor does it suit patients with severe liver failure or decompensated cirrhosis. Honest clinics present SIRT as a targeted palliative or downstaging tool rather than an absolute cure.
SIRT therapy cost in Turkey compared with the UK, US and Germany
The cost of SIRT reflects specialised technology: custom Y-90 microsphere manufacturing, interventional angiography suites, nuclear medicine imaging, and a multidisciplinary team. Below are approximate cost ranges for a treatment cycle. These are broad estimates rather than fixed hospital quotes.
| Country | Approximate cost range |
|---|---|
| Turkey | €14,000 – €24,000 |
| United Kingdom | €22,000 – €38,000 |
| United States | €35,000 – €75,000 |
| Germany | €20,000 – €35,000 |
The sirt therapy price depends on whether one or both liver lobes require treatment, the microsphere type (resin or glass), pre-procedure mapping, and hospital stay. An international package usually includes preparatory mapping, the therapeutic infusion, nuclear SPECT-CT scans, nursing care, routine medications, and local transfers.
SIRT therapy, TACE or radiofrequency ablation: how do treatments compare?
Interventional oncology offers several locoregional options for inoperable liver lesions. The choice depends on tumour size, location, vascular involvement, and liver function.
| Treatment method | Best suited to | Typical limits |
|---|---|---|
| SIRT (Radioembolization) | Multifocal or inoperable tumours; portal vein branch invasion | Liver-dominant disease only; requires low lung shunting |
| TACE (Chemoembolization) | Intermediate-stage tumours without vascular invasion | Repeated sessions needed; unsuitable if portal vein is blocked |
| Radiofrequency Ablation | Small, focal tumours typically under 3 to 4 cm | Limited by tumour size, count and proximity to major vessels |
Unlike TACE, which blocks blood flow to cause tissue death, SIRT relies primarily on radiation without completely cutting off arterial circulation. This allows SIRT to treat patients with partial portal vein branch invasion. For small, isolated tumours, see our guide to radiofrequency ablation, which destroys lesions using thermal energy.
Who is a suitable candidate for SIRT, and who is not?
Eligibility requires multi-specialty evaluation alongside other oncology treatments in Turkey to determine whether locoregional treatment is appropriate.
Good candidates typically present with:
- Inoperable primary liver cancer or liver-dominant secondary metastases (colorectal, neuroendocrine).
- Preserved liver function (Child-Pugh Class A or selected B) with total bilirubin under 2.0 mg/dL.
- Good performance status (ECOG 0–1) and life expectancy over three months.
- Favourable vascular anatomy and safe lung shunt fraction (under twenty per cent) on mapping scans.
Who is not suitable: patients with widespread extrahepatic disease, decompensated cirrhosis (jaundice, ascites, encephalopathy), complete main portal vein occlusion, or untreatable blood shunting to the digestive tract. Pregnant or breastfeeding women cannot undergo radioembolization.
The two-stage procedure: mapping angiogram and therapeutic bead infusion
SIRT involves a coordinated two-stage protocol to ensure therapeutic precision and patient safety.
Stage one is the preparatory mapping angiogram, performed seven to fourteen days before treatment. Under local anaesthesia and light sedation, an interventional radiologist navigates a catheter into the hepatic artery. Any small vessels directing blood towards the stomach or intestines are closed with tiny metallic coils (preventative embolization). A test tracer, Technetium-99m MAA, is injected, followed by a SPECT-CT scan to calculate lung shunting and verify safe dose distribution.
Stage two is the therapeutic administration. Once calibrated Y-90 microspheres arrive, the radiologist re-catheterises the hepatic arterial branch and slowly infuses the beads over twenty to thirty minutes. The session takes one to two hours. The puncture site is closed, and the patient rests comfortably in recovery.
Realistic scan results and expectations after radioembolization
Unlike surgery, which extracts tumours immediately, radiation-induced cell destruction occurs gradually over several months. Managing expectations requires understanding post-treatment scan timelines.
At six to eight weeks post-procedure, routine CT or MRI scans often show the tumour unchanged in size or slightly larger due to treatment-related edema and necrosis. Nuclear medicine specialists assess response using contrast-enhanced imaging or PET-CT to check for reduced blood flow and cellular inactivity rather than immediate shrinkage. Meaningful tumour reduction and disease stabilization typically appear between two and four months. For downstaging patients, repeat scans determine if surgery or ablation has become viable.
Your trip to Turkey and sirt therapy recovery milestones
Undergoing sirt therapy in Turkey typically requires a stay of seven to ten days for a combined mapping and infusion itinerary, or two shorter visits spaced one to two weeks apart.
Patients spend one night in hospital after the therapeutic infusion for monitoring and Bremsstrahlung SPECT-CT imaging. Sirt therapy recovery proceeds through clear stages:
- Days 1 to 3: Mild post-embolization symptoms are common, including fatigue, slight nausea, reduced appetite, and right-sided abdominal aching. These are managed with standard antiemetics and painkillers. Basic radiation hygiene precautions (brief distance from young children) are followed for forty-eight hours.
- Days 4 to 7: Nausea and discomfort resolve. Patients can take light walks and eat normally. A discharge consultation confirms stable liver enzymes before flying home.
- Weeks 2 to 4: Most people resume light work and normal routines, though mild fatigue can linger.
- Months 2 to 3: Follow-up imaging and blood tests evaluate treatment response with your local oncologist.
Potential side effects and complications of liver radioembolization
While less exhausting than systemic chemotherapy, SIRT is an invasive radiological procedure with known clinical risks, detailed by professional bodies such as CIRSE and SIR.
The most common reaction is post-embolization syndrome (fatigue, mild nausea, low fever, and abdominal aching), affecting thirty to fifty per cent of patients. These symptoms are temporary and respond well to standard medications. Temporary liver enzyme elevations are also common.
Serious complications are uncommon in experienced centres and relate mainly to non-target embolization. If microspheres escape into gastric or duodenal vessels, ulcers or pancreatitis can occur; preparatory coil embolization prevents this. Excessive lung shunting can cause radiation pneumonitis. Radioembolization-induced liver disease (REILD), causing jaundice and fluid retention weeks later, is rare and avoided through careful dosimetric planning.
How to choose a specialist liver tumour centre and red flags
SIRT demands specialised facilities: an accredited interventional suite, on-site licensed nuclear medicine, and a tumour board including interventional radiologists, hepatologists, and oncologists.
Red flags to watch for include:
- Treating without a prior mapping angiogram and lung shunt scan.
- Promises of tumour cure, survival guarantees, or claiming the procedure carries no risk.
- Quotes given without reviewing recent contrast-enhanced scans and liver blood panels.
- Absence of a multidisciplinary tumour board or licensed nuclear specialists.
- No clear written plan for post-procedure follow-up care.
Questions to ask your clinic:
- Will a multidisciplinary liver tumour board review my case before treatment?
- Which microspheres (resin or glass) do you recommend for my tumour, and how is the dose calculated?
- What precautions are taken if mapping identifies aberrant vessels or elevated lung shunting?
- How do you coordinate follow-up with my oncologist at home?
Read how it works to understand how treatment abroad is organised. You can submit medical records for a free quote and clinical evaluation. Contact our medical coordinators for a free quote tailored to your case.
Hospitals with Oncology in Turkey
Frequently asked questions
SIRT therapy, or selective internal radiation therapy, is an interventional oncology procedure for inoperable liver tumours. An interventional radiologist delivers microscopic radioactive beads loaded with Yttrium-90 into the hepatic artery. The beads lodge inside the tumour capillaries, delivering high-dose local radiation while sparing healthy liver tissue.
Yes, clinical trials and international oncology guidelines confirm that SIRT provides effective local tumour control for inoperable hepatocellular carcinoma and colorectal liver metastases. It delays disease progression, relieves symptoms, and can downstage borderline tumours to make surgical resection or ablation feasible. It is not, however, a cure for widespread metastatic disease.
SIRT therapy in Turkey typically ranges from €14,000 to €24,000, compared with €22,000 to €38,000 in the UK and higher in the United States. The exact price depends on whether one or both liver lobes need treatment, the type of microspheres used, mapping scans, and hospital accommodation.
Early scans at six to eight weeks often show the tumour appearing stable or slightly larger due to radiation-induced inflammation and tissue necrosis. Functional imaging, such as contrast-enhanced MRI or PET-CT, demonstrates reduced blood flow and cellular death within the tumour, with visible shrinkage usually confirmed after two to four months.
No single treatment suits all cases. Radiofrequency ablation is ideal for small, isolated lesions under three to four centimetres. TACE suits intermediate liver tumours without blood vessel invasion. SIRT is particularly valuable for larger or multifocal tumours and cases where cancer has grown into branches of the portal vein.
Suitable candidates have inoperable primary liver cancer or liver-dominant metastases, preserved liver function (Child-Pugh Class A or early B), and good general physical fitness (ECOG score 0 to 1). Patients must also pass a preparatory mapping angiogram showing low lung shunting and no uncorrectable blood flow to the digestive tract.
Most patients leave hospital after one night and rest for three to four days. Mild fatigue, reduced appetite, and slight abdominal discomfort are common during the first week. Most people return to light daily activities and desk work within one to two weeks, while full physical energy returns over several weeks.
The procedure is performed under local anaesthesia with mild sedation, so you should feel minimal discomfort during catheter placement. Mild aching in the right upper abdomen, nausea, or low-grade fever may develop over the following days due to post-embolization syndrome, which is managed effectively with standard prescribed medications.
Yttrium-90 has a half-life of roughly 64 hours. Most of its therapeutic beta radiation is delivered to the tumour within ten to fourteen days. After one month, negligible radioactivity remains in the body, although the biological tumour-destroying effects continue to evolve over the following two to three months.
Patients usually stay seven to ten days if the preparatory mapping angiogram and the therapeutic radioembolization are performed during a single consolidated trip. Alternatively, some patients make two shorter visits of three to four days each, separated by one to two weeks, allowing full safety checks and dose calibration.
Patient stories