Liver mets: resection, ablation, SBRT, Y-90, anything else?
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ABeautifulsunset
Nice shot! Also good luck with the second one. I didn't know you are from So Cal too💗
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ABeautifusunset may I also ask your IR's name? The one at COH? My close friend has Jonathan kessler
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Sandilee, my insurance covered it. In talking to my IR beforehand, he said that he usually needs to speak with the insurance company once or twice to get it precleared. I haven't really heard of anyone's insurance denying it.
I am considering another Y90. Grannax, do your doctors mention anything about the risks (potential toxicities) of a second go around? I think they consider the total dose given the first, as well as the location of the new tumors. I imagine my total dose may have been high. I need to schedule another appointment but may wait to see how this current combo of Navelbine and Tamoxifen is working. My MO recommended looking into it as well.
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JFL. When my liver mets were too small, back in October, IR said no. He didn't go into great detail but I got that he wanted me to wait, to get my best chance. I think there is a limit of how much y90 can be used, also location is key. He said No to microwave ablation because of location. I have not been reevaluated since my tumors have grown. My MO wanted the X to have at least two months to work before IR looks at it. I think he used a lot on my first one, too. He said "you had a lot of liver tumors".💞
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Ailurophile,
Dr John Park, City of Hope/ Duarte
Sunset
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Hi Ladies, Im almost 21 days from my first Doxil treatment... Not sure if it's working... I've noticed more aching in cancer areas then I did in the past. And I'm still dealing with Fatigue and lack of motivation quite a bit.
Next week I have radiation on my neck and I start my y90 procedure. This is my chance to get the cancer out of my liver because it doesn't seem to be happening with anything else. I'll keep you all posted!
Tina
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Good luck, Tina! I was on Doxil when I did Y90. I liked that because it didn't require the same chemo break that other treatments might require given its 28-day dosing schedule. I recall taking no break on my first Y90 lobe and a week long break with my second lobe.
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Tina. So glad you're getting y90. Keep us updated.💞
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I have to admit I know absolutely nothing about Y90. I was going to ask though if anybody gets regular radiation for the liver, and can they do cyberknife for that? I've been so depressed since the onc told me mine had spread to multiple spots and one big spot, both lobes. I feel like, if xeloda fails, that's just about it!! He said only one to two years! That's just dang depressing!
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Gracie read back on this thread for two years. You will know everything you ever wanted to know or need to know about y90. So many stories, so much hope. A few exceptions too. All real people experience not statistics. People you know and trust.
I don't know anything about external radiation to the liver except that y90 is much much stronger than anything they can use externally.
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I did go back and started reading. Am just really depressed.
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Gracie love, as soon as my liver mets became extensive, I got that's"two year" measurement as well. Took me a few weeks to get over being really depressed from that (I'm sure I still am). But now that I'm in active treatment (Y90 to start), I feel a bit more hopeful. X is good on liver Mets too. Hope it works for you. Please start looking into Y90 now as your next option. Not everyone will offer it
Sunset
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Thank you everyone... My mapping is Wed and 1st Lobe is Thursday. Does anyone know how long it takes to make a difference? I didn't realize until I talked to the PA's that it takes a bit? is that right?
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Tina. My IR recommended to wait at least 3 months to scan. Even three months may be too soon to get an accurate picture of how effective the y90.Everyone is different, at three months all my liver mets looked inactive on PET.
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Gracie, there is no specific time limit with liver mets. The reality is no one knows how each person will respond. Also, with new treatments, the time is extending longer and longer. I have had extensive liver mets for 4.5 years now, since mets diagnosis. There are a few with liver mets on these boards that are still alive over 10 years later. One went off all treatment a year or two ago as she no longer needs it. That being said, it is okay to let yourself be scared and depressed right now. This is scary for all of us.
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JFL
Reading your response to Gracie, made me feel better. I feel awful for my self because my best friend is suffering so much right now. She is scheduled for y90 but she just learned things are not good and she has other Mets in other parts. For some reason I always think I will go through the same because we were diagnosed together back in 2013. THANK YOU FOR BEING SO POSITIVE. Some of us can't be that strong and we need a JFL in our lives😉💗
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Thanks JFL. We don't have anyone close to us that does y90. At least I can't find anyone. My onc is such a great doctor, funny and caring and compassionate, but the prognosis just had me buffaloed! All at ince, that determination to live more than five years is gone. I don't know how to get back there!
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Are you still feeling well, Sunset? Have you experienced a lot of fatigue or any pain since your Y90?
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Hi. Yes, Sandi. I'm pretty well. Lots of fatigue. STILL dealing with discomfort from liver resection, but it's improving. The groin area, where they went in for the y90, became bruised purple and quite sore (like a big bruise would feel). Just starting to ease up.... in time for my second Y90 on Friday.
Unfortunately, my energy is low. I did make it to quite a few wedding events this weekend, but now that I have a choice...bed is preferred.
Sunset
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Hello Ladies, I'm writing from the UK.
Briefly... bone mets in lots of places diagnosed 4 years ago. I also now have a liver met. I have been turned down for cyberknife to the liver met and also RFA ablation on the grounds that I also have bone mets. They will only do procedures on the liver with a " curative" purpose, that is if I had liver mets ONLY. My oncologist said treating the liver won't extend my life as I already have it to bone. It's not clinically relevant.
I realise I am under the NHS funding which is overstretched. This might be why they won’t do it.
I read on here that many ladies in the USA have procedures to the liver ( Y90) for example, even if they have bone mets. Do your oncologists think it's relevant? I feel that mets to bone only is better than having organ involvement, therefore I want to try and get rid of it.
I would appreciate your thoughts and what your oncologists say about it
Thank you
Debs x
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Hi Debs
I’m from Denmark, and we have the same rule: If dissease in other parts of the body = No surgery/RFA. But
I have had 3 bone mets - not active anymore. And I’ve pursuated my Onc to let me have my two liver mets RFA’ed. I’m having it this month. Yes, I’m good at negoatiating 
and never, never give up!If you can afford it the procedure is made in Germany in Frankfurt by Dr Vogel. Look him up.
Best of luck to you!
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Mermaid, I have bone Mets, but they are fairly stable and won't be killing me any time soon. I also have extensive liver Mets that WILL kill me. MyONC knows I cannot live forever. There is no "curative" for me. BUt he can give me time. I am happy thathe understands an extra year or two is meaningful to me. Also, new stuff around the corner may extend that even more. So he did offer and approve Y90, which was also approved by my insurance. That is not always the case in the States. Many Places don't/won't offer Y90 for BC yet. And not all insurance should will approve.
We have to fight for what we want...and to may have to travel to find it. Good luck.
Sunset.
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Thank you sunset, it’s so hard to keep fighting but we must soldier on. I had to change hospital and oncologist to even get Faslodex. I don’t think the oncologists always realise that an extra 6 months to a year mean such a lot. We realise we aren’t going to be cured but time and good quality of life within that time is our goal.
My argument is that being proactive to the liver will reduce the tumour burden on my body,
Onwards and upwards
Take care
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Thank you for your reply.
My oncologist states it’s not “ clinically relevant” to have these procedures , however .... I’m sure if I offered to pay for the procedure privately, they would soon do it !!!!
Take care
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Sunset what day did you have your y90? My IR waited five weeks to do the second one. Be sure to tell him if you're not feeling well. There's no rush to have the second one. I so hope it works well for you.
It's so hard for me to understand why there's controversy between MO's, different countries and insurance companies. It is approved here in the states, on Medicare to have y90 for BC. And even if you have mets in other organs and bones. I'm living proof of that. So, it makes no sense to me why some of you are denied something that can give you the precious time you desire. Very frustrating for you and for me to listen to your stories when I know you should be allowed to have this procedure.💞
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Gracie & others —I just completed 5 treatments in 2 1/2 weeks of sbrt (basically cyberknife). I had one tumor in liver that was anout 6x5 cm and 1 or 2 lymph nodes near the liver. Mine just fell at the threshold for size. They typically will only do sbrt if you have a small # of Mets. I’m stage 4 de novo & initially I had 6-10 tumors that impacted each lobe, but I got to NEAD for 3 1/2 years. Once it came back it has only been Ins these 2 places varying in size based on response to treatment. I’m back on xeloda now We will do tumor markers early June but won’t scan for 2-3 mon
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Sunset, how far apart are your Y90 procedures? So quick to have the second. Good luck! The fatigue from my first Y90 took a good month to pass. I didn't have any major fatigue with the second Y90 to my left lobe, likely given the smaller size of that lobe.
Mermaid, I hope you can find a way to get your Y90. Generally, having mets in other areas is fine in the US but it is preferred that they be stable. However, that is not a hard-fast rule. I do agree that the prognosis for bone only mets is in most cases much more favorable than having liver mets or liver and bone mets. It seems like the percentage of anyone who could be "cured" of liver mets by surgery, SBRT, etc. is a very small percentage. Tough standard.
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JFL, it's been two weeks since my first Y90. After this one, we will wait two weeks to start chemo. I have already been off all treatment for almost two months at this point. I have mets elsewhere and they are free to roam right now, so time is actually an issue for me.
Sunset
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That makes sense, Sunset. I hope your mets that are free to roam right now do not in fact roam. Being off treatment can be an uneasy state. Glad you are on a good path with a great plan now.
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JFL,
Thank you for your thoughts on this matter
Take care
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