Dr Chow (standing, second left) joins the participants for a group photo, taken after the session.
KUCHING (April 26): Late-stage diagnosis of liver cancer continues to limit treatment options in Sarawak, prompting calls from medical experts for greater awareness and wider access to advanced therapies.
To strengthen local capability, SIRTeX on Friday night conducted a session involving 25 Sarawak General Hospital (SGH) doctors from various disciplines, including nuclear medicine, surgery, physicians and interventional radiology, focusing on the latest developments in Selective Internal Radiation Therapy (SIRT) and its clinical application.
The session featured oncology expert Prof Dr Pierce KH Chow, senior consultant surgeon at the National Cancer Centre Singapore (NCCS), who presented findings demonstrating that higher, targeted doses of Yttrium-90 (Y-90) used in SIRT could drastically improve tumour response in patients with locally advanced hepatocellular carcinoma (HCC), the most common primary liver cancer.
“When we analysed different dose levels, we found clear differences in outcomes. Higher doses led to better responses without added toxicity,” said Dr Chow, a former St Joseph’s School Kuching student.
He noted that while traditional practice aimed for a minimum radiation dose of around 120 Gy (a unit of absorbed radiation), the optimal level had remained unclear.
Citing data from 2019 to 2024, he said patients receiving higher doses showed markedly improved outcomes.
“Tumours treated with more than 200 Gy achieved complete response, while doses above 120 Gy resulted in disease control in all cases.”
He added that extending follow-up imaging to nine months helped capture delayed responses, particularly in lower-dose cases.
“Median survival among advanced liver cancer patients in the study reached about 44 months,” he said.
Dr Chow also highlighted SIRT’s ability to downstage tumours, potentially making previously inoperable cases suitable for surgery.
He said outcomes also compared favourably with conventional treatments such as transarterial chemoembolisation (TACE), particularly in delaying disease progression.
However, translating such advances into local practice remained a key challenge.
SGH consultant interventional radiologist Dr Dhayal Balakrishnan said efforts were underway to integrate SIRT into Sarawak’s treatment pathway through closer multidisciplinary collaboration.
“We want all teams to work together – clinicians to refer, nuclear medicine to plan the dose, and surgeons to assess whether the patient is fit for surgery,” he told The Borneo Post when met after the session.
He added that many patients in Sarawak presented at advanced stages with large tumours, limiting treatment options.
“If we could treat them earlier, we could move from palliative care to potentially curative surgery,” he said, noting links between liver cancer cases and high rates of cirrhosis and hepatitis in East Malaysia.
He also said TACE remained widely used due to lower cost, albeit being largely palliative.
Dr Dhayal stressed that awareness remained a gap, as some patients were unaware that advanced treatments like SIRT were already available locally.
“Cost remains a major barrier, with each SIRT treatment estimated at about RM50,000.
“With funding support, especially from the state, we can treat more patients and offer this as a first-line option,” he said.
Both specialists emphasised that improved outcomes would depend on stronger multidisciplinary collaboration, earlier detection, and better access to advanced liver cancer therapies.
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