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Commissioning through Evaluation (CTE) is an NHS England initiative which enables new treatments with limited evidence to be commissioned in a small number of centres with a planned evaluation.

Selective internal radiotherapy (SIRT) uses radioactive yttrium 90 microspheres delivered through a microcatheter into the hepatic artery, to target tumours within the liver. Ten sites in England were selected by NHS England to conduct SIRT as part of CTE. The programme was focused on SIRT as third line treatment for colorectal liver metastases and intra-hepatic cholangiocarcinoma. As part of the CTE arrangement, all centres submitted data to a national registry. 

Cedar's role

Cedar managed this project, including data management, analysis, and reporting. Cedar collated and analysed data on how well SIRT works as a third line treatment for liver metastases. We carried out a full systematic review of the clinical and economic evidence. Cedar also conducted a cost-effectiveness evaluation of SIRT compared to standard care.


Our final evaluation report has now been published by NHS England here:

White J., Dale M., Morgan H., Sewell B., Carolan-Rees G. Commissioning through Evaluation: Selective internal radiation therapy (SIRT). NICE Commissioned report for NHS England 2017. Availble at:

The following journal articles have been published:

White, J., Carolan-Rees, G., Dale, M., Morgan, H. E., Patrick, H. E., See, T. C., ... & Sharma, R. A. (2019). Analysis of a national programme for selective internal radiation therapy for colorectal cancer liver metastases. Clinical Oncology31(1), 58-66.

White, J., Carolan-Rees, G., Dale, M., Patrick, H. E., See, T. C., Bell, J. K., ... & Sharma, R. A. (2019). Yttrium-90 transarterial radioembolization for chemotherapy-refractory intrahepatic cholangiocarcinoma: a prospective, observational study. Journal of Vascular and Interventional Radiology30(8), 1185-1192.