{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T17:44:58Z","timestamp":1783187098464,"version":"3.54.6"},"reference-count":29,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2023,12,5]],"date-time":"2023-12-05T00:00:00Z","timestamp":1701734400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Current Oncology"],"abstract":"<jats:p>The aim of this study was to investigate trends in selective internal radiation therapy (SIRT) for hepatocellular carcinoma (HCC), cholangiocarcinoma (CCC), and liver metastasis in Germany. We analyzed the nationwide German hospital billing database from 2006 to 2019 for the diagnosis of HCC, CCC or liver metastasis in combination with SIRT. For analyses of SIRT on the hospital level, we used the reimbursement.INFO tool based on German hospitals\u2019 quality reports from 2008 to 2021. Linear regression analysis was performed to detect changes over time. We included a total of 14,165 SIRT procedures. The annual numbers increased from 99 in 2006 to 1605 in 2015 (p &lt; 0.001; increase by 1521%), decreasing to 1175 cases in 2019 (p &lt; 0.001). In 2008, 6 of 21 hospitals (28.6%) performed more than 20 SIRTs per year, which increased to 19 of 53 (35.8%) in 2021. The share of SIRT for HCC increased from 29.8% in 2006 to 44.7% in 2019 (p &lt; 0.001) and for CCC from 0% in 2006 to 9.5% in 2019 (p &lt; 0.001), while the share of SIRT for liver metastasis decreased from 70.2% in 2006 to 45.7% in 2019 (p &lt; 0.001). In-hospital mortality was 0.2% after the SIRT procedure. Gastritis (2.7%), liver failure (0.4%), and sepsis (0.3%) were the most common in-hospital complications reported. We observed an increase in SIRT procedures in Germany, with the number of hospitals offering the procedure going up from 21 in 2008 to 53 in 2021. While the treatment of liver metastasis remains the most common indication, SIRT for HCC and CCC increased significantly over the last few years. The mortality and complication rates show that SIRT is a relatively safe procedure.<\/jats:p>","DOI":"10.3390\/curroncol30120752","type":"journal-article","created":{"date-parts":[[2023,12,5]],"date-time":"2023-12-05T11:27:06Z","timestamp":1701775626000},"page":"10325-10335","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Trends in Selective Internal Radiation Therapy (SIRT) for Treating Hepatocellular Carcinoma, Cholangiocarcinoma, and Liver Metastasis: A Total Population Analysis from 2006 to 2021 in Germany"],"prefix":"10.3390","volume":"30","author":[{"given":"Smita George","family":"Thoduka","sequence":"first","affiliation":[{"name":"Department of Nuclear Medicine, Philipps University of Marburg, 35043 Marburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1477-9161","authenticated-orcid":false,"given":"Luka","family":"Flegar","sequence":"additional","affiliation":[{"name":"Department of Urology, Philipps University of Marburg, 35043 Marburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christer","family":"Groeben","sequence":"additional","affiliation":[{"name":"Department of Urology, Philipps University of Marburg, 35043 Marburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7243-8958","authenticated-orcid":false,"given":"Johannes","family":"Huber","sequence":"additional","affiliation":[{"name":"Department of Urology, Philipps University of Marburg, 35043 Marburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole","family":"Eisenmenger","sequence":"additional","affiliation":[{"name":"Reimbursement Institute, 30354 H\u00fcrth, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tobias","family":"Paulus","sequence":"additional","affiliation":[{"name":"Department for Diagnostic and Interventional Radiology and Nuclear Medicine, St. Josef Hospital, Ruhr-University Bochum, 44791 Bochum, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katharina","family":"Vogt","sequence":"additional","affiliation":[{"name":"Department of Radiology and Interventional Radiology, University Hospital Freiburg, 79110 Breisgau, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus","family":"Luster","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, Philipps University of Marburg, 35043 Marburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nasreddin","family":"Abolmaali","sequence":"additional","affiliation":[{"name":"Department for Diagnostic and Interventional Radiology and Nuclear Medicine, St. Josef Hospital, Ruhr-University Bochum, 44791 Bochum, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,12,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e16296","DOI":"10.2196\/16296","article-title":"Clinical Application of Radioembolization in Hepatic Malignancies: Protocol for a Prospective Multicenter Observational Study","volume":"9","author":"Helmberger","year":"2020","journal-title":"JMIR Res. Protoc."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1007\/s11548-018-1877-5","article-title":"Multimodal image registration for liver radioembolization planning and patient assessment","volume":"14","author":"Spahr","year":"2019","journal-title":"Int. J. Comput. Assist. Radiol. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"449","DOI":"10.7861\/clinmedicine.17-5-449","article-title":"Selective internal radiation therapy for liver tumours","volume":"17","author":"Sundram","year":"2017","journal-title":"Clin. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1159\/000449341","article-title":"Selective Internal Radiation Therapy (SIRT) as Conversion Therapy for Unresectable Primary Liver Malignancies","volume":"5","author":"Cappelli","year":"2016","journal-title":"Liver Cancer"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"641","DOI":"10.1016\/j.hpb.2018.01.006","article-title":"Selective internal radiation therapy (SIRT) before partial hepatectomy or radiofrequency destruction for treatment of hepatocellular carcinoma in cirrhotic patients: A feasibility and safety pilot study","volume":"20","author":"Lemaire","year":"2018","journal-title":"HPB"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Yang, B., Liang, J., Qu, Z., Yang, F., Liao, Z., and Gou, H. (2020). Transarterial strategies for the treatment of unresectable hepatocellular carcinoma: A systematic review. PLoS ONE, 15, Erratum in PLoS ONE 2020, 15, e0230369.","DOI":"10.1371\/journal.pone.0230369"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1002\/hep.21980","article-title":"Safety and efficacy of 90Y radiotherapy for hepatocellular carcinoma with and without portal vein thrombosis. 2008, 47, 71\u201381","volume":"47","author":"Kulik","year":"2008","journal-title":"Hepatology"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1080\/13651820410025084","article-title":"Selective internal radiation therapy (SIRT): A new modality for treating patients with colorectal liver metastases","volume":"6","author":"Stubbs","year":"2004","journal-title":"HPB"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"755","DOI":"10.1055\/a-1729-0951","article-title":"Availability of Interventional Oncology in Germany in the Years 2018 and 2019\u2014Results from a Nationwide Database (DeGIR Registry Data)","volume":"194","author":"Radosa","year":"2022","journal-title":"Rofo"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1715","DOI":"10.1007\/s00345-022-04017-z","article-title":"Treatment trends for muscle-invasive bladder cancer in Germany from 2006 to 2019","volume":"40","author":"Flegar","year":"2022","journal-title":"World J. Urol."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Krieg, S., Essing, T., Krieg, A., Roderburg, C., Luedde, T., and Loosen, S.H. (2022). Recent Trends and In-Hospital Mortality of Transarterial Chemoembolization (TACE) in Germany: A Systematic Analysis of Hospital Discharge Data between 2010 and 2019. Cancers, 14.","DOI":"10.3390\/cancers14092088"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Birgin, E., Rasbach, E., Seyfried, S., Rathmann, N., Diehl, S.J., Schoenberg, S.O., Reissfelder, C., and Rahbari, N.N. (2020). Contralateral Liver Hypertrophy and Oncological Outcome Following Radioembolization with 90Y-Microspheres: A Systematic Review. Cancers, 12.","DOI":"10.3390\/cancers12020294"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Garg, T., Shrigiriwar, A., Habibollahi, P., Cristescu, M., Liddell, R.P., Chapiro, J., Inglis, P., Camacho, J.C., and Nezami, N. (2022). Intraarterial Therapies for the Management of Hepatocellular Carcinoma. Cancers, 14.","DOI":"10.3390\/cancers14143351"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Craciun, L., de Wind, R., Demetter, P., Lucidi, V., Bohlok, A., Michiels, S., Bouazza, F., Vouche, M., Tancredi, I., and Verset, G. (2020). Retrospective analysis of the immunogenic effects of intra-arterial locoregional therapies in hepatocellular carcinoma: A rationale for combining selective internal radiation therapy (SIRT) and immunotherapy. BMC Cancer, 20.","DOI":"10.1186\/s12885-020-6613-1"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"iv238","DOI":"10.1093\/annonc\/mdy308","article-title":"Hepatocellular carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up","volume":"29","author":"Vogel","year":"2018","journal-title":"Ann. Oncol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"10075","DOI":"10.3390\/curroncol30120732","article-title":"Update on Locoregional Therapies for Liver Cancer: Radiation Segmentectomy","volume":"30","author":"Dadrass","year":"2023","journal-title":"Curr. Oncol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1001\/jamaoncol.2019.3702","article-title":"Radioembolization Plus Chemotherapy for First-line Treatment of Locally Advanced Intrahepatic Cholangiocarcinoma: A Phase 2 Clinical Trial","volume":"6","author":"Edeline","year":"2020","journal-title":"JAMA Oncol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1097\/MEG.0000000000002255","article-title":"Selective internal radiation therapy in older patients with hepatocellular carcinoma: A retrospective analysis","volume":"34","author":"Benguerfi","year":"2022","journal-title":"Eur. J. Gastroenterol. Hepatol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"690","DOI":"10.1002\/hep.29354","article-title":"Hospital volume and mortality after transjugular intrahepatic portosystemic shunt creation in the United States","volume":"67","author":"Sarwar","year":"2018","journal-title":"Hepatology"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1016\/j.jvir.2007.02.002","article-title":"Gastrointestinal complications associated with hepatic arterial Yttrium-90 microsphere therapy","volume":"18","author":"Murthy","year":"2007","journal-title":"J. Vasc. Interv. Radiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1387","DOI":"10.1016\/j.jhep.2021.07.037","article-title":"Liver function after combined selective internal radiation therapy or sorafenib monotherapy in advanced hepatocellular carcinoma","volume":"75","author":"Ricke","year":"2021","journal-title":"J. Hepatol."},{"key":"ref_22","first-page":"123","article-title":"Selective internal radiotherapy in Germany: A review of indications and hospital mortality from 2012 to 2019","volume":"9","author":"Mertens","year":"2023","journal-title":"J. Clin. Transl. Res."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1079","DOI":"10.21037\/jgo.2017.09.10","article-title":"Safety of selective internal radiation therapy (SIRT) with yttrium-90 microspheres combined with systemic anticancer agents: Expert consensus","volume":"8","author":"Kennedy","year":"2017","journal-title":"J. Gastrointest. Oncol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1053\/j.gastro.2009.09.006","article-title":"Radioembolization for hepatocellular carcinoma using Yttrium-90 microspheres: A comprehensive report of long-term outcomes","volume":"138","author":"Salem","year":"2010","journal-title":"Gastroenterology"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1186\/s40658-017-0192-5","article-title":"Predictive SIRT dosimetry based on a territorial model","volume":"4","author":"Spahr","year":"2017","journal-title":"EJNMMI Phys."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2093","DOI":"10.2967\/jnumed.113.119768","article-title":"In vivo dosimetry based on SPECT and MR imaging of 166Ho-microspheres for treatment of liver malignancies","volume":"54","author":"Smits","year":"2013","journal-title":"J. Nucl. Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1007\/s00270-018-2133-7","article-title":"Holmium-166 Radioembolization in Hepatocellular Carcinoma: Feasibility and Safety of a New Treatment Option in Clinical Practice","volume":"42","author":"Radosa","year":"2019","journal-title":"Cardiovasc. Interv. Radiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1177\/1526602821996719","article-title":"Radioembolization With Holmium-166 Polylactic Acid Microspheres: Distribution of Residual Activity in the Delivery Set and Outflow Dynamics During Planning and Treatment Procedures","volume":"28","author":"Drescher","year":"2021","journal-title":"J. Endovasc. Ther."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"110423","DOI":"10.1016\/j.apradiso.2022.110423","article-title":"Cold kit for Rhenium-188 microspheres based selective intra-arterial therapy (SIRT): Preparation, characterization and feasibility study","volume":"190","author":"Shukla","year":"2022","journal-title":"Appl. Radiat. Isot."}],"container-title":["Current Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1718-7729\/30\/12\/752\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:33:39Z","timestamp":1760132019000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1718-7729\/30\/12\/752"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,12,5]]},"references-count":29,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2023,12]]}},"alternative-id":["curroncol30120752"],"URL":"https:\/\/doi.org\/10.3390\/curroncol30120752","relation":{},"ISSN":["1718-7729"],"issn-type":[{"value":"1718-7729","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,12,5]]}}}