Liver mets: resection, ablation, SBRT, Y-90, anything else?
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Wow Z that might answer my question.
Does anyone know how long y90 full response is supposed to last on average? I’m at one year out from y90 with no uptake. I want it to be a cure, for liver, but don’t know the stats.
I’m now much calmer than I was after my appointment with mo. I focused on my report and realized how good it is. I’m even daring to think if I have this much response on my next scan, I might even get to NEAD. Active tumors are only in the chest and lung.
Of course that can only happen if liver mets stay inactive. Well, that’s my new dream. NEA
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I just wrote a post and it disappeared.
I’m wondering how long I can expect no uptake in my liver. One year post y90 and I’m still no uptake. But does anyone know the statistics on that? Maybe it will be mentioned in the article you shared Z.
I’m much calmer now than the first few days after my mo appt. I’ve been focusing on how good my report is. If it responds this much on my next scan, I might get to NEAD. Wow. That would be something to hope for.
Of course, my liver would have to stay no uptake.
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Grannax2-I do not think there is any way of knowing the answer to your question. You and I have both had great results so far. You are one year out and I am 2 and 1/2 years out. We are both still on active treatment so hopefully we can continue down this awesome path we are on. I never thought I would get these clear results for so long. As much as I hated the Y90 at the time and how bad it made me feel afterwards, I have nothing but praise for the results!
I am so thankful for your good pet scan news!
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JFL-my fatigue lasted around 6 weeks. I have always continued to work full-time during treatment so I struggled during those weeks and lost weight. Others have seemed to bounce back much quicker so I think it just varies for us all.
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Baby Ruth. Are you considered NEAD? Where are your other mets? What treatment are you on? Lots of questions. It's like I'm exploring new ways to look at my cancer. The thought that I could become NEAD on just Ibrance is mind opening. May you and I could be the ones who get to live five or ten years. My brain just explodes at that thought. 😂
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Grannax2-Yes my MO considers me NEAD. I do not have any other mets. I only had the 2 in my liver that the Y90 bombed the crap out of! I am triple positive so my MO told me I will stay on herceptin and perjeta as long as I am alive. I am thinking I might want to revisit that at some point. I have been on hercepetin for 5 years and perjeta almost 3 years. I also started the faslodex injection 2 years ago. I am beyond happy to be where I am now but I know it can change in a second. My MO told me at my last visit that I had surpassed the expectancy of the original clinical trial results. I told her I was going to blow those stats right out of the water!
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Yes, Baby Ruth, let's both blow the stats out of the water. They might have to re do the stats because of us!
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Go for it ladies. I expect you will.
>Z<
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I hope you both blow those stats and that I’ll be right behind you!
Babs
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And I will be holding up the back behind the three of you
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Grannax, BabeRuth and Babs.
Joy filled my heart as I read your great wonderful news. I've been traveling for awhile and took a break from BC which I felt I needed, however, I feel very encouraged after reading these posts. Next week is the first scan after Y90 treatment.
JFL, Thinking about you and crossing fingers that your scan went well.
-k
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max otto. I hope you get great results. How many months has it been since your y90? Let us know, we all feel joy when any of us have good news.
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Z Are you considered NEAD yet? I haven't heard an update on brain TX recently.
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i am NEAD in the sense that nothing lights up in a PET scan;; however, PET is not great for evaluating liver mets. The SUV of normal liver cells is 3+. You can have cancer alive and well and growing in the background SUV of the liver. Ive learned by experience that PET is better for evaluating everything but the liver.
My liver is smaller but not normal size. My latest TMs dropped but nothing spectacular, my liver markers improved but not alot. I had a strong initial response to Abraxane but afraid it is slowing down and won't get me to BED.
Z
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Max Otto, I hope your scan goes well!!
I went in for my pre-left lobe Y90 bloodwork today and found my AST and ALT jumped (doubled) from under 3 weeks ago and are now out of normal range, in the hundreds. They are rarely out of normal range and remain more or less stable on an ongoing basis. I am bit nervous - not sure if it is from the Doxil, progression or right lobe Y90 I had 7 weeks ago. Did anyone w/ had Y90 (Grannax, BabyRuth, Max Otto and the others) have temporarily higher liver enzymes after your Y90? I suspect (and hope) it is the Doxil itself causing this as a transient side effect based on some research I did today but one never really knows. This Doxil - Y90 combo has been rough and tough. I would be demoralized if it is not working. My feet are pretty burned up and and blistered right now from the Doxil and I am imagining the liver lesions looking the same way.
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JFL,
I had a ct scan May 15th prior to leaving on a trip. My MO was concerned about how to differentiate between the Y90 treatment and the systemic treatment. The question was whether the systemic was working. She requested a detailed report in addition to the original report on the untreated left lobe. It appears the left lobe was stable on the report. My ALT and AST did jump out of normal range for the first time but they have dropped, one is normal again. I will get a better idea when I have the MRI next week, it will be at 6 weeks. If my left lobe is still stable. I am going to discuss holding off the Y90.
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JFL my liver enzymes have been normal through everything, go figure. That sounds scary, I hope you get to have left y90.
Z I remember when the PET didn't show your liver mets. Freaked me out. You get MRI now, right? Abraxane is slowing down? I'm still praying for NEAD for you.
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Just a quick update - had my second ablation yesterday. Was much much easier and less painful than the first. IR is chalking it up to only needing to ablate a small area versus the size ablated in the first- whatever it is, I’m very happy and thankful its not the same pain level or recovery!
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Grannax - Today I met with an onc I consult with periodically. He was puzzled over the fact that my liver was NEAD after a month on Abraxane. The liver is still moderately enlarged today, TM's are not zero, liver markers moderately elevated. MRI of the spine that was done at roughly the same time as the PET scan picked up a lot of tumors. I have cancer, it's just not showing up in the PET. What that means is unclear. That is how we left things today. Driving home from the appointment (this guy is 2 hours away) of course I came up with 10 more questions to ask ...
I want to sit down with my radiologist buddy at the local hospital and go over all these images with him, but I also want to have a life. There is the balance one needs to find.
In any case, I stopped trusting PET scans to monitor the liver last year and now insist on MRIs. PET scans are great everywhere else, but the background SUV of the liver is 3+. 3 would register as cancer elsewhere in the body.
>Z<
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I have always heard that PET doesn't show micromets and mets under approximately 1cm. Not sure if that is exact science but I believe it may not show small metastasis. However, if one takes time to run through the independent CT portion of the PET/CT (without the PET overlay), the small mets should show up. I suspect many doctors only look at the scan report, not the images. If they do look at the images, most only look at the PET images and do not take the time to run backward and forward through the plain CT slices. My DH goes through the plain CT portions of my scans with me so I have a good sense of the layout of my tumors, regardless of whether active. If it weren't for him, I would really have no idea what is going on in there. No one ever tells me how bad the tumor load is in my liver. I only know it from going through the CT portion with my DH and seeing all the lesions as they ebb and flow myself.
Z, I am not surprised that your mets went inactive after a month, especially given this was your first chemo and you had not been on full-blown, "standard of care" treatment for a while before you started. Great sign that you are so responsive to treatment. The Abraxane put the brakes on the runaway train. The first month or two may be grabbing the low hanging fruit, with the major improvement, but I suspect it will continue to work for a good, long run of time, it may just taper out into a slow and steady progress mode. Also, shrinking the lesions takes a lot longer than shutting off the metabolic activity.
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all I know is from my experience. When I saw the liver specialists, one upon my first metastatic diagnosis and the time I had my liver resection, the liver specialists always ordered an MRI of my liver prior to treatment. They said that the MRI was the only imaging that gave them the information they needed.
This goes along with what Z is saying.
My MO uses a CT scan with contrast to follow mynliver mets. If there is any question if treatment is working/not, she will then follow up with a MRI.
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Z so sorry to hear that. I don't even know where to put that info. Maybe I need to ask for MRI? JFL do you ever let people borrow your DH? Ha I don't think my MO goes through the slices, she's never shown anything to me. I guess PET is better if used with CT contrast. We all know how I react to that stuff. For now, I guess ill keep that info in my pocket to use later.
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z- I surely hope all those things they saw are sleeping dead giants. I really wish the medical world would realize how much their news and words affect us as individuals. I will be thinking about you and hoping fir the best.
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Jamiemarie - So great to hear it wasn't as painful this time.
Z - What a rollercoaster trying to determine what's going on. I feel so encouraged by your improvement since starting Abraxane and optimistic that the improvement will continue.
JFL - My AST and ALT elevated after my ablation before dropping back to normal levels. I think the trauma to the liver could cause this.
My liver specialist has been following my liver with a CT scan with contrast. I want to know his reasoning behind his method, but there's not enough time to ask in my 20 second time allotment. So, I am trying to go with the flow - for now.
~Kar
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Cross posting this-I went for chemo and a CT scan today. CT scan ordered because my CA15-3 went from 566 to 722 in a month. CT scan found nothing in my liver but my spleen is enlarged. It's 15cm, normal is 11cm. My oncologist said that sometimes diffuse liver mets don't show up on scans. He also said that the spleen will enlarge when you have liver issues. AST 67, ALT 67, ALP 118. Has anyone had this issue? Diffuse mets sound scary. Has anyone ended up with diffuse liver mets that didn't show up on CTscans? I have an MRI scheduled for next Thursday-Jill
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KarPC,
A ct scan with contrast does not show the detail as clearly as a MRI with contrast.
Generally, Ct,s are good for lungs, and MRI,s for the liver. I would discuss this on the next appointment or call the clinical assistant to the IR. I Have seen two IR specialists at different institutions and their clinical assistants have been top notch in getting answers.
Also, your MO can order the MRI.
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Max-Otto - thanks for the information. I will ask about the MRI. Wishing you good news on yours.
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KarPC, thanks for sharing your experience with AST and ALT levels.
Honestly, it might be too traumatic for me to see all the detail that a liverMRI would show! But, yes, I have also heard they are the most sensitive.
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I have my second Y90 tomorrow. Left lobe. Hoping all goes well!
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JFL - I KNOW it will go well...
Z
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