SIRT du Soleil.

It’s been a rough year for selective internal radiation therapy (SIRT). First, the technique consistently failed to improve overall survival (OS) outcomes for colorectal cancer metastatic to liver. More recently, SIRT has contorted to entertain other liver indications. We now have reported outcomes of the phase 3 SARAH trial on the use of SIRT versus sorafenib in locally-advanced hepatocellular carcinoma (HCC) not amenable to surgery or ablation or refractory to at least two transarterial chemoembolizations (TACE). SIRT failed to improve the primary endpoint of OS with a median of 8 months with SIRT and 10 months with sorafenib. What’s more, there were 19 treatment-related deaths among the 184 patients treated with SIRT, which equates to a >10% grade 5 toxicity rate. Hopefully Sirtex Medical Inc. has been keeping up with its stretches because it's going to have to be flexible in whatever trick it has left up its sleeve.