Liver mets: resection, ablation, SBRT, Y-90, anything else?
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Just sat up. My back was killing from lying down so long. My sister snuck in some tuna and cheese. Nurse said he had to look away cause not allowed here. I never follow silly rules well
Onto my scans now!
Babs
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Yay babs!
>Z<
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Babs, I think it is funny that you have your phone in recovery and updating us. So happy for you that it is done.
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Babs, congrats to you!!! So excited for you!
BabyRuth, thanks for checking on me! I stopped pain meds, eveb tylenol, a few days ago. I still dont feel back to normal, but its definitely better. My appetite is slowly coming back, but I needed to lose a few pounds anyway
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Babs - Glad you are done. The only thing more effective than your hands-on reporting would have been to have a Go Pro videocam strapped to your forehead throughout the procedure! So happy to hear your TM’s have dropped!
My cousin had Y90 done yesterday for primary liver cancer and is doing great also. Thanks to all who shared their experiences here— it really helped me encourage her.
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I was told at 11:45 that scans wouldn’t be until 2, not sooner. There was no way I was going to stay there for over 2 hours! So I went home until 2. (Luckily I live 3 blocks away).
The scans took about 2 hours. I’m home now resting and feeling good but tired. Hope my writing helps all those who go after me with Y90!!!!
Jaime Marie glad you’re feeling better
Go go go BC girls!!!!
Babs
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Babs
It’s wonderful that you’re felling so well after the procedure! Thanks for sharing with us.
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Babs, glad it went well! When does the IR want you to have a scan to assess results? Nice you were able to go home to wait for today's scan. I am told I need to stay and lie flat for 6 hours after procedure, which I also had to do after mapping. Did you have any lie flat requirement?
My right lobe Y90 is on Monday, April 9. The date has bounced back and forth between Monday and Tuesday a few times. I mentioned this on another thread - at my mapping, my IR found more disease than he expected in the right lobe and decided to flip the order and do the right side first. He also pushed out my second session for the left lobe to 2 months in an abundance of caution. He said liver failure presents around 6 weeks after the procedure and he wants to pass that point before doing the other side. I don't think I have much if any more cancer than on my most recent scan but the scans used in the mapping are more sensitive and pick up more detail than a PET scan. He also said my tumors were very vascular and highjacking all the blood flow from the hepatic artery so that very little was going to healthy tissue. In Y90 terms, that is a very good scenario. He said when Y90 doesn't work, it is often because the tumors don't have a lot of vascularization.
Has anyone heard about HAIC (hepatic arterial infusion chemotherapy)? It is continuous chemo administered directly into the hepatic artery to the liver via a port. It is often used for colon mets in the liver and there have been some positive results in breast cancer use over the years. I had not heard anything about it but came across an old study where a woman with over 50% of her liver comprised of breast cancer mets underwent HAIC that included various chemos and immunotherapy and went NED in the liverfor 7-8 years. I couldn't find info on how long her NED status lasted beyond that point (and whether the cancer ever returned) but am wondering why this treatment hasn't received more attention and advancement in breast cancer. There were also other recent reports of compete responses in breast cancer liver mets.
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JFL.Goid luck on Monday. How was your visit with your sister?
I had to lie flat for 2 hours in recovery after the y90. As far as scans the Ir wants it done in about a month but I’ll be going to Paris with my dd to babysit my grandson for 2 weeks then. Plus I’d rather not get scanned til I’m back anyway. If I have progressio anywhere or if for some reason the Y 90 wasn’t successful I’d rather know when I’m home and can deal. Otherwise my trip will be full of anxiety.
Babs
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JFL - If you have a link to that study I will read it. I thought at first that HAIC was TACE, but it is very different. More like chemo infusions that you do every three weeks but the drugs are fed into an artery that goes primarily to the liver. I had a hard time reading the articles I found because I got a little shaky reading the details. Anything you learn, I will read with interest.
>Z<
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JFL-I think one of the reasons for scans post Y90 is to checks the lungs as some amount of radiation will go there. There is an acceptable level. Best, MJH
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Babs-it is awesome that you are done and doing so well. I love that you were texting and sneaking in food during recovery! I love your feisty spirit!
JFL-I did not have to lay flat at all. My IR went though the artery in my left wrist so when the procedure was completed I was released to go home within 30 minutes. I did have a harder recovery(it took me about 6 weeks to overcome the fatigue) than others seem to and now I wonder if this had anything to do with it. I doubt it but just a thought.
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Babs - how fun to go babysit your grandson in Paris! I totally understand delaying the scans. I ended up delaying my 6 month scans to 7 months so I wouldn’t chance getting bad news before our vacation to Hawaii last month.
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I need to push back on this 6 hour lie flat thing. After my mapping, I had to do scans for 1 hr 45 mins. Not looking forward to more of that. I was hoping that was for the mapping only. Mapping went smoothly but the post mapping sequence was pretty tough. I had to go 20 hours without food or water because my appointment was in the afternoon and I had a splitting headache all day, mostly because my wig was squeezing and pulling my head on the stretcher for all those hours. During the scans, my blood pressure went down to 85ish over 40ish and the nurses scanning me were concerned I told them it was fine, that my BP drops when I am lying and still for so long and that I just needed to eat and drink something. They tried to tell me (incorrectly) that I wouldn't be permitted to eat during the 6 hour wait period (I was becoming majorly “hangry"!). After scans, I was left alone in a dark, deserted hallway for 45 min because no one was available to wheel me up 1 floor to recovery, feeling like I was about to pass out because I was weak and hungry with splitting headache, and wishing I would pass out because I was so uncomfortable. I finished at 4:45pm and everyone clocked out at 5pm in the scan area and walked by me on the way out. The phone kept ringing at the nurses station and no one would answer. I kept thinking it was someone calling to coordinate my pickup. Next time I will make sure my phone is closer to me, actually next to me on the stretcher, so I can text my DH to wheel me up himself if need be. He has privileges at that hospital and will have his badge with him at the time.
For anyone who did Y90 via the groin, did you have a lot of bruising on the area? Mine looked fine after the mapping but a large area of bruising showed up several days later and now, as the swelling has gone down in the area, I notice a long, thin, palpable bump which freaked me out. My DH checked it out and said it is the artery itself which appears to be swelled and enlarged a bit, but is fine. He checked it out for clots - actually put a stethoscope to the artery and compared it against the other side. I hope this is all normal. I suspect the IR will be using the groin on the other side on Monday.
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JFL I had to lie flat for 2 hours after the mapping and both y90s. All 3 times they entered through the same side of my groin. I was lucky I never had any issues. Scans post y90 took about 1-1 1/2 hours. I snuck food in between the y90 and the scans
Pm if you have any questions
Babs
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JFL, I’m so sorry you had to go through all of that! It makes me so angry.
After my embolization, I didnt have any bruising in my groin, so it may be something to ask about? I had to lie flat for four hours after, but I could eat and drink. But I didnt have post-scans, either. With the ablation fhe next day, my scans are at the end if the month to see how everything went.
Im sorry I cant be of more help. Am thinking about you, though!
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JFL. I didn't have any bruising with mine. I didnt have scans except for what they did during the procedures. They did use some sort of "plug" in the artery to keep it from bleeding. I did have to lay flat for awhile but i dont think it was six hours. I had lots of staff paying very close attention to me. My first one i was there till they closed because of an allergic reaction and more meds.
I hope your Dr.DH can be with you on Monday. Or someone! I would be a squeaky wheel on all of that experience, telling all the nurses and your doc all about it, starting with the first person you see tomorrow. that's unacceptable!
They used the same artery all three times with me.💞
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Babs, JamieMarie, Grannax, BabyRuth and others, thanks for sharing your experiences! It is so helpful to "compare notes" to determine what is normal and what is not. Babs, I need your tips on sneaking food and other items!
Z - Below is a link to the full article I mentioned, as well as the abstract. of the case where a woman had breast cancer taking up over 50% of liver and had a complete response to HAIC with chemo/hormone/immunotherapy for the entire 8-year follow-up period. Something interesting is that the study mentions the potential benefit to explore further of treating early, before the cancer becomes resistant to the chemos and other treatments. I also included a second article that is much more recent about a complete response to HAIC with chemo in someone who was heavily pretreated (but no info about follow-up periods yet). The first article is from the 1990s and the second from 2018. There were other studies that showed favorable results that were not as pronounced as these as well.
Multiple Liver Metastases of Breast Cancer: Report of a Case Successfully Treated with Hormone—Cytokine—Chemotherapy
The prognosis of patients with hepatic metastasis from breast cancer is usually extremely poor. We present the case of a 39-year-old Japanese woman diagnosed with multiple liver metastasis from breast cancer. A novel approach consisting of hormone—cytokine—chemotherapy with an arterial infusion therapy was carried out. Computed tomography and ultrasonography revealed that the multiple liver metastases were reduced with remaining calcification. Tumor markers decreased rapidly. Complete regression was achieved after these treatments. To date, there has been no relapse during the 8-year follow-up period. These results suggest that the hormone—cytokine—chemotherapy might be a rational modality of treatment against multiple metastatic breast cancer.
Abstract:
About half of patients with metastatic breast cancer (mBC) have unresectable liver metastases (LMs) or liver-predominant disease (LPD). Unfortunately systemic chemotherapy has limited tumor response due to LMs are supplied by hepatic artery. Hepatic intra-arterial (HAI) have antitumor activity in pretreated patients with LMs. Here we report the case of a 55-year-old woman affected by BCLPD and heavily pretreated. LMs responded to treatment based on HAI with 5-fluorouracil and nab-paclitaxel systemic chemotherapy, and they completely disappeared on a CT-scan. We conclude that this combination chemotherapy is safe and may be very useful for the treatment of patients with BCLPD. Therefore, this combination should be evaluated in a large study.
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JFL Once I was allowed to "sit up" I had my dh get me tuna and sliced jarlsberg. I ate it as soon as the nurse walked out of the room. I was STARVING!!!!!!! The nurse walked in and saw it and told me I wasn't allowed to eat there so I told him to turn around- that if I didn't eat I'd probably faint and he's have to deal with that!
Babs
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Oh Babs you are awesome. I'll bet tuna a Jarlsberg never tasted so good. I speak for many people when I thank you for taking the time to share these kind of details about your treatment. It helps us all. The fact that you are hilarious is just an added bonus.
And JFL, you are awesome, too. HAIC is so cool. I've started reading and digging into this and even with my current limited mental capacity, I think we're on to something. I am trying to figure out where that Japanese group went with it, since 1999. I have not stumbled upon HAIC going on in the US. If it is, the addition of an immunotherapy agent is probable not a thing here. Some logistical details to work out, but this is important.
>Z<
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Finished Y90 today. In recovery, lying flat for a few more hours. Feel great! Like Babs and others have said, the Y90 was easier and shorter than the mapping. For those who had nausea, how long did it take to crop up?
Z, I am curious where the 1999 Japanese research went as well. How could results that significant not be pursued further?! If you find anything, please share. I will do the same.
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Congrats JFL! So glad things went well andyou feel great!!!
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Happy dance for JFL! Sounds like a much better experience than mapping.💞
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JFL-glad you are done! I actually got nauseous during the Y90 treatment. I told the IR and he requested medication through the IV which helped at the time. I was really anxious to go home and told the outpatient nurse that I felt fine when I knew I was still queasy. By the time I got home it all hit and I could not keep anything down. I think I let it get out of control. It was a hard couple of days for sure. My procedure was delayed until very late in the day due to some emergencies that my IR was called into. I always wondered if the lack of food played a part in my issues. I had not eaten since 9:00pm the night before.
I hope things continue to go smoothly for you. We are all here cheering you on!
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JFL. Great you did so well. Last time I was queasy and nauseous for 2-3 weeks. I’m feeling the same way now. But it was manageable!
Bab
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JFL - I am so pleased it was easy. Thanks for the update.
>Z<
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Hi ladies!
In February, I found out I had liver mets. It was 1 small spot and only 9 mm. I asked my MO if I could also try some type of ablation therapy or localized treatment. He laughed and laughed. Then he said that if it made me feel better I could try whatever made me happy, but nothing other than systemic therapy would help.
A few days later I made an appointment with an IR with no referral. The IR said he could perform a microwave ablation on the tumor. I found a new MO a few days later. She was more positive and open to my ideas and discussed my plan with a team of doctors. They agreed that I was a candidate for the localized treatment.
Two weeks later, I had the microwave ablation. It was supposed to be an easy surgery with very little pain, but I was in lots of pain for several days. On Friday, I will have my first MRI of my liver since the ablation.
I want to thank everyone for your posts and discussions. I am learning so much!
Hugs to everyone!
~Kar
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Karpc-I am so glad you were able to see an IR and get the ablation. It is crazy that so many are having to go around their MO's to get localized treatment. I hate that you had pain but it sounds like you are doing better now. Keep us updated on the results of your mri.
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Welcome, KarPC. Good luck with your MRI Friday! Keep us posted.
Today is first day after Y90. Stayed home but worked all day from my computer, like a machine. Realized it was the prescribed post-procedure steroids that have me amped up. It is insane and a bit disturbing. Going back to work tomorrow with plans to "lay low" to the extent possible and try to leave early. My belly feels very wonky and I noticed that I cannot intake as much food as usual because it feels like it just sits in my stomach. Sometimes when my belly hurts, my body's reaction is to try to eat, in thinking it will make my belly feel better. Will need to remind myself to eat less tomorrow so as not to make things worse. All and all, pretty tolerable.
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Kar, good luck woth the MRI! I just had ablation two weeks ago and my experience was similar to yours. I was under the impression it would be easy, I was going home same day, etc. but I also had a lot of pain. It took me a week to get off the pain killers and a few more days to stop tylenol. So you arent alone- it makes me feel better that maybe I wasnt crazy and unprepared! :
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