Liver mets: resection, ablation, SBRT, Y-90, anything else?
I'm interested in who has had local treatment for liver mets and what was your experience and outcome. I've been talking about this with my onc, and he seems a little hesitant. I have my regular appt. for a 2-mth MRI of brain and followup with rad onc. I plan to ask him about the possibilities. I think that some of the procedures must be done by an interventional radiologist. I assume that's a different person. Do most teams contain an interventional radiologist separate from the rad onc?
I would appreciate if you would share your experience with any procedures. I always like to hear first-hand experience.
All the best to everyone. Hugs, Trish
Comments
-
Hi Trish - I'm so glad you posted this. I am also trying to figure out the best option for local treatment for liver mets. I was diagnosed stage iv from the get go in February with one liver met that was 2.5 cm. I am just finishing up my first line chemotherapy and the liver met has shrunk down to about 1 cm. my oncologist recommended that I stay on chemotherapy until it shrinks to nothing and to avoid local treatment. But my body has had it so I have decided to call it quits with the chemo and get the local treatment. My doctor referred me to a Cyberknife 'radiation surgeon' that uses SBRT and a liver surgeon. I met with both of them and they both agreed to treat me. The liver surgeon actually recommends RFA over resection because he says it is much easier, less risky, and just as effective for small tumors (under 3 cm). When he is in there he will also do a scan of my liver with ultrasound to see if there are other small spots that could have been missed by a CT or PET scan. This can all be done laproscopically. My understanding is that RFA is a great choice if the tumor is not near a blood vessel and it is small enough. The good news is that it is a 1 day outpatient procedure for me without the unpleasant side effects of radiation. And it leaves me a lot of options in the future to treat that area again if more tumors arise. SBRT is also an option for the liver but you'll want something like the Cyberknife technology that can follow the tumor as you breath. The cons to that option for me is that there was some risk of causing rib damage since my tumor is so close to my ribs. Having an effective option that doesn't include radiation like RFA really appealed to me. Also, the Cyberknife doctor thought I'd have an 80% chance that the cancer wouldn't grow back in the same location where the RFA doctor thought it to be close to 95% with RFA. Again, this is all so specific to each individual case but I thought I'd chime in with what I found since I've been trying to make a similar decision. Good luck with everything!
0 -
Hi Trish…
I had a liver ablation (RFA) in 2010. It was pretty easy, as procedures go. The worst part of it for me was that I got sick from the pain medication they gave me. They kept me overnight for observation, and did an x-ray the next morning to be sure all was okay. The best part is that my liver has been clear since then! Prior to the RFA, I was on chemo which shrunk a very large met down to 3 cm. And yes, I believe the procedure was done by an "interventional radiologist."
RFA is an excellent option if you qualify. There are a few women here who have had good results with it. Wishing you all the best!
Rose.
0 -
Hello, Ladies - I have stage 4 breast cancer which has now spread to liver so I am considering Y-90. Can you tell me anything about the procedure, pros & cons, etc? If you had the procedure, how was it & is it worth the "risk?" Please share your thoughts. Thanks, & all the best to you all!
0 -
Hello out there, my Fellow BC Warriors - I'm fighting stage 4 breast cancer which has now metastasized to my liver. Considering Y-90 procedure, so I would like to hear from any- & everyone who has had this procedure performed. How was it, did it work, would you recommend Y-90 or not? Please share your experiences with me, & thanks for all your input! Blessings to all my Fellow BC Warriors!
0 -
Hi steelrose,
It is so encourage to hear that after the RFA, your liver is pretty clear since then. My wife is dx Stage IV BC that mets to liver. After chemo, she is NED now. A doctor suggest her to take RFA, if it come back. I think it is a right choice.
0 -
I'm finding this thread sooo interesting. because when I ask my onc about liver surg he said the stats were that it wasn't successful in keeping the cancer away. I no longer have him as a dr so will ask current onc his opinion. Maybe its the opinion of the cancer hosp not ocn personally. I go to Levine in Charlotte. April
0 -
I had the Y90 procedure Dec 1st of 2015. It got rid of one tumor and made my second tumor smaller. One year later and I am still going strong.
0 -
Does anyone know of the locations where they do the Y-90 procedure. Apparently not done in Charlotte NC.
0 -
Check Emory in Atlanta; I've been told is not an option for me but I've heard of other patients
http://news.emory.edu/stories/2016/06/saint_josephs_Y90_procedure/
0 -
thanks Gramen don't know if I will qualify now either. would have a while ago but was told by onc that there are no medical procedures that were successful. a technicality since Y-90 isn't really surgery.
0 -
sharethehope, definitely look into it, also check this place, I wish I did before, but was hoping the famous her2+ drugs would work their magic but wrong...
http://radonc.med.ufl.edu/patient-care/information...
0 -
Perhaps the information below from my MBC Guide may be of some help. You (and others) are welcome to request a complimentary copy of the 126-page booklet by visiting the top of this page: https://community.breastcancer.org/forum/8/topics/831507?page=2#idx_32
With best wishes!
Liver metastasis may be treated with chemotherapy and/or hormonal therapy and/or targeted therapy based upon the cancer's profile. Other potential liver-directed treatments are described below.
From: http://beatlivertumors.org/Liver_Directed_Therapies.html
treatments for liver metastasis
- Ablative Therapies
- Cryotherapy
- NanoKnife
- RadioFrequency Ablation (RFA)
- HAI Chemotherapy
- NKTR-102 (Etirinotecan Pegol) – Not Yet FDA-Approved
- Radioembolization or SIRT/Yttrium 90 Microspheres (Theraspheres)
- Transarterial Chemoembolization (TACE)
The above procedures are described below:
- Ablative Therapies:Ablative therapies can be performed percutaneously (through the skin) or as an open surgical procedure by a surgeon who specializes in oncology.A special probe is used to access the tumor, and the specific method of treatment as described below is delivered by the probe.Ablation is generally safe and well tolerated.It may be an effective treatment for patients with inoperable metastatic tumors, but this treatment is limited by the size and number of tumors present.
- Cryotherapy:Cryotherapy, also called cryosurgery, cryoablation, or targeted cryoablation therapy, uses the application of extreme cold to destroy the liver tumor.
- NanoKnife: NanoKnife works by applying electrical energy directly into tumors and opening cell walls of the tumor. The cancer cells die; and the healthy tissue remains unharmed.
- Radio Frequency Ablation (RFA):Radiofrequency ablation, also known as RFA, is a technique of heating up liver cancers with probes inserted into the tumors.
- HAI Chemotherapy: Hepatic Arterial Infusion (HAI) involves a drug delivery system that is implanted under the skin.A catheter from the pump is connected to the gastroduodenal artery, which joins the hepatic (liver) arteries, allowing the pump to infuse only the liver with chemotherapy. One study reviewed the treatment histories and outcomes of nine patients with heavily treated breast cancer liver metastasis who received hepatic arterial infusion (HAI) of floxuridine (FUDR)/dexamethasone (Dex) and systemic chemotherapy. Patients received a median of five HAI treatments, and there were seven (78%) objective responses.Four patients had grade 3 elevations in liver enzymes attributable to HAI.There were no treatment-related deaths.Median survival after starting HAI was 17 months and median Overall Survival from the original breast cancer diagnosis was 110 months. Furthermore, one patient is alive with stable disease on systemic therapy alone. Therefore, HAI and systemic chemotherapy are feasible and can benefit selected patients who have progressed on prior therapies.Patients undergoing the procedure require close monitoring for treatment-limiting toxicities.From: http://www.ncbi.nlm.nih.gov/pubmed/23173748
- NKTR-102 (Etirinotecan Pegol) – Not Yet FDA-Approved: In a clinical trial called BEACON, 852 patients with advanced breast cancer who had any type of ER/HER-2 status were enrolled. Patients were randomly assigned to receive either NKTR-102 or a physician's choice of standard chemotherapy. The study found that NKTR-102 increased Overall Survival in patients with liver metastases when compared to the physician's choice chemotherapy.Furthermore, NKTR-102 was less toxic than standard chemotherapy. As of Jan. 2017, several clinical trials are underway for patients with metastatic disease.
From: http://www.healio.com/hematology-oncology/breast-cancer/news/online/{f8e52d75-2273-432b-9473-b50f936c0765}/novel-chemotherapy-drug-demonstrates-activity-in-advanced-breast-cancer and https://www.clinicaltrials.gov/ct2/show/NCT01991678?term=nktr102&rank=4
- Radioembolization, SIRT/Yttrium 90 Microspheres (Theraspheres):This is a relatively new treatment suitable for use even in patients with extensive liver involvement.Radioactive spheres (very tiny radioactive "seeds") are injected into an artery in the liver.After they are injected through the liver artery, the seeds travel into smaller arteries that feed the tumor.Once they reach the tumor, they give off radiation for about three days.The radioactivity causes damage to cancer cells with little damage to the healthy liver tissue.Radioembolization was safe and provided disease stabilization in 98.5% of the patients' treated liver tumors in a recent study.From: http://www.sciencedaily.com/releases/2014/03/140324133234.htmThat said, the author has read several patient accounts commenting that the procedure was not successful for them, and many patients disclosed that they were greatly fatigued afterwards.Therefore, anyone considering this procedure should gather as much information as possible about the success rate and after-effects experienced by prior patients at the clinic that offers this procedure.One person whose liver mets were allegedly too large for the procedure wrote this valuable tip: "I had trouble finding a doctor who would do it given the size of my tumors as well as some insurance coverage issues - and I got 3 "no's" from different doctors until I contacted the company who makes the radioactive beads, SIRTEX. Their sales representative hooked me up with a highly skilled interventional radiologist named Ryan Majoria who eventually accepted me.SIRTEX has great customer service and can also provide the name of one of their representatives in the patient's geographic area who will call and talk to the patient personally about their product and whether or not the patient might be a good candidate (of course they are not doctors, but these reps know EVERYTHING from my experience including who the most experienced doctors are who perform the procedure.) SIRTEX's telephone number is: 1-888-474-7839. Patients should ask for the representative in their area to call them.My Y90 procedure went well, and my main side effect is fatigue."For those who may be interested, an excellent video about Radioembolization is located at:
https://www.youtube.com/watch?v=3WwSfGPQq9g - Transarterial Chemoembolization (TACE):In this technique an interventional radiologist injects a chemotherapeutic agent directly into the arteries supplying the tumors within the liver.Embolization therapies such as TACE have been used for the last two decades by interventional radiologists to treat liver tumors.
0 -
I had the Y90 procedure(SIRT) in Marietta, Georgia. The procedure itself was not hard but the recovery was much more than I had anticipated. I was very fatigued and nauseous. The fatigue lasted for a couple of months. I was told by my internal radiologist that if needed I could do it again. Not sure if I would but I am glad the option is still there. My doctor used a stent through my wrist instead of going through the groin. That prevented me from having to lay flat for 5 hours after the procedure. Let me know if I can answer any of your questions on the procedure. I am glad to be of assistance.
0 -
Babyruth
Did your insurance cover your Y 90 procedure? How are you now? I hope you are doing great.
0 -
sharethehope- Yes. My insurance did cover the procedure 100%. I have Blue Cross/Blue Shield of Georgia. I am doing good right now. I am still on herceptin and perjeta every 3 weeks. I am also getting faslodex injections. Are you having problems getting your insurance to cover the procedure?
0 -
BabyRuth
No its the onc who says insurance won't cover Y90 for bc. Posted you on another site. Did you have any med anywhere else ever. April
0 -
I presented all these options to my mom's oncologist and our second opinion oncologist at City of Hope. Sadly they both agreed that none of these options would be appropriate for her due to the widespread nature of the disease. City of hope said that if the tumors were only in one or two spots of the liver and nothing in the bones then one of procedures could be an option. Because of the many bone mets and multiple liver mets- they agreed that chemo is the only option. It was quite depressing news- Especially after so many drugs have already failed :
0 -
Daughter-So sorry to hear that. I do know that they do not like to do the Y90 if there are a lot of tumors. It is a hard procedure to recover from. I hope that the chemo will work with your mother. I will keep you in my prayers.
0 -
I'm hoping some of you still have this thread on your favourites! I have three tiny mets on my liver they have followed and can see on CT scan. I was planning on having RFA but they did an ultrasound with contrast to prepare for it and can't see anything. I met with the radiologist today who says my liver is "dense" after chemotherapy and they may never see them I'm ultrasound.
My choice was: keep watching with follow up CT scans or do 5 fractions of targeted radiation. I have no other known mets...side effects are pain a fatigue mainly...I have said, 'Let's do it," I'm trying to look forward to this moment with no regret. (Well if I have liver failure that wouldn't be nice but cancer in my liver is deadly)
Have any of you had this treatment? He says Y90 is not for me as it's for more diffuse mets...
0 -
I guess it is SBRT....I need to get a better picture of myself with out that wig! I'll work on it
0 -
Good luck bstein.
0 -
SBRT is on my short list of local treatments. I have a friend who had it done. Not only were the targeted mets removed but the procedure provoked an immune response that took out a met on her throat that could not be radiated and other little spots around her lung. The procedure put her into remission even though they were only targeting one fast growing lung met that was threatening her ability to breathe.
Her recovery has not been easy. She is out of town for two weeks as I write working with a complementary doctor to complete the healing from the radiation, but the liver regenerates more easily than other organs. Her scans have been awesome for 18 months now since she had the procedure .... and she is doing no other standard of care systemic therapies. She has renal cell cancer, so her treatment options are very limited.
Renal cell cancer is more immuno-active than breast cancer and therefore more likely to exhibit a systemic response to SBRT. But among breast cancers, I believe that ER-PR- is immunoactive (factcheck!?!). Immunoactive means that the white blood cells penetrate the tumors and can potentially attack the cancer. Breast Cancer, generally, creates an extremely hostile environment for white blood cells.
In any case, I would not hesitate to try SBRT. Right now I don't have any mets that are clearly a good target for SBRT.
>Z<
0 -
A little bit more about SBRT, from Dr. Brian Lawanda, my favorite radiation oncologist.
There are multiple devices/technologies that can be used to deliver stereotactic body radiation therapy (for example):
- Trilogy/iX/TrueBeam (with RapidArc)
- Novalis
- Tomotherapy
- CyberKnife
- Proton beam
All of these devices/technologies are essentially equivalent in terms of their ability to precisely and accurately deliver a high-dose to the tumor while minizing doses to the surrounding normal tissues. No clinical studies have demonstrated superiority among these machines, so don't be swayed by the name of the machine (i.e. CyberKnife, Triology, TrueBeam, Tomotherapy, Novalis, etc.) when selecting the radiation oncology practice for your treatment. Again, they all do essentially the same thing, and no studies have demonstrated that any one of them is clinically superior.
The most important factors in selecting the right team are the reputation, training and experience of the radiation oncologists and their support staff (physicists, dosimetrists, therapists, nurses, etc.) in treating lung cancer using SBRT.
>Z<
0 -
Thank you for all your information you are such a great support! I too think I might as well try everything! I am scheduled for CT simulation on Friday. Then the experts figure out all the angles and such which takes a few days then fractions will be Monday, Wednesday, Friday, Monday, Wednesday aweek or so later. Not sure if I need to miss work for this but likely a few weeks after as the treatment takes effect.
0 -
thanks... many people supporting you here and very interested in the details of your experience.
Z
0 -
Bstein, best wishes with this treatment. So you will have five sessions total? And I suppose radiation fatigue? It sounds do-able. How satisfying to zap the little bas-- (Oops, I almost typed something I shouldn't.)
0 -
Bestbird, thanks for posting the info above, and the link.
Radioembolization may be my next treatment if/when my new combo does not work, as disease is only seen in the liver, and it is multifocal.The radiologist says the treatment would possibly buy me a chunk of time the same way a chemo would. One of the appeals is that it would not cause hand-foot syndrome or neuropathy as many chemos would, which would enable me to enjoy my dancing for a longer time. I am at an NCCN center. Usually I research the heck out of everything, but in this case I feel like if my onc and the radiologist say go, I am ready to do it. There is a window of opportunity to catch, as the risks are low if the disease is not too extensive and the patient is otherwise healthy. They do it in two sessions, one for each lobe, so if something goes wrong, you still have half a liver working. I know radiation fatigue from whole breast radiation. BabyRuth, how long did the nausea last, and did meds not help?
0 -
Shetland I will have 5 sessions to the three lesions in my liver. I was going to have radioembolization too but they have to visualize the lesions using ultrasound. My ultrasound last week couldn't see the lesions. Apparently my liver is dense and "they will never see them"?? Happens with chemo they say, I had 8 rounds of Taxotere. The radiologist said they are both targeted treatments and there is no evidence one is better then the other...so here I go. Not sure what to expect but will find out tomorrow! I just thought ablation takes only one day and would be nicer, radiation takes longer. I'm just grateful they are dong it!
0 -
oops yes 5 sessions to three lesions
0 -
good luck!
0
