Liver mets: resection, ablation, SBRT, Y-90, anything else?
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I remembered JFL saying on another thread that she takes chemo for liver and hormone therapy for bones, so I logged on to search for that post as I thought Sunset might want to think about something similar. And I am glad to see that JFL has already posted about it here! So Sunset, it’s good to have the MRI evidence that the liver mets are improving and you are apparently no longer at the very edge of a cliff right now. But not good to hear the spinal mets are so bad! It must be hard to appreciate the Y90 success when you are in pain from the bone mets. I hope the zapping gives you good pain relief. Dr. Nagourney analysed the liver mets, but it may indeed be that the bone mets are different. I wonder if you could recycle whatever hormone therapy was least recent. Was there a hormone therapy that did not fail on bones for you?
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Hi to all!
Just reporting back on my liver ablation that I had this morning at Hopkins. It was to blast out the largest of my 5-6 liver tumors, which was between 2 and 2.5 centimeters. The interventional radiologist used microwave ablation. For those of you who are considering this, so far, so good. My procedure, which was done under CT guidance in a dedicated CT suite, was fairly easy to tolerate. It took about an hour from start to finish. I was in twilight sleep, and I felt nothing except for when they started to generate the microwave heat -- I called out to the nurse and she upped my sedation, and then I was fine. Afterwards, I was in a recovery room for about two hours. I slept most of the afternoon. This evening, I have some slight soreness in my side, but nothing that is too tough.
I am going to have an MRI of my abdomen in about a month to check on things, and then I'll see the IR doc at that time as well. At that time, I plan to talk to him about the possibility of ablating the other tumors in my liver.
Bev
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thanks for the update BevJen.Rest up and continued healing..
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Just did tumor markers (2 months after SBRT) & they continue to go down (now firmly in normal range). They are actually the lowest they've been since April 2015. I know it is a guide not guarantee, but provides some hope that the scan next month will be good.
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Nancy -- just curious -- where did you have this done? And who did it? a radiation oncologist or an interventional radiologist? I still need to deal with some more tumors. Also, did your MO let you do this while on Ibrance? How did you deal with the possibility of decreased white blood cell counts?
Thanks, and great news about the tumor markers.
Bev
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BevJen - I had it done with the radiation oncologist associated with my oncology group. I'm currently on Xeloda. They had me stop it during the 5 SBRT treatments over 2 1/2 weeks, but restarted Xeloda once done. My counts are good generally on the Xeloda, and they stayed okay during the SBRT.
(The Xeloda is listed on my meds when I go to my profile, but don't know why it isn't showing in my signature)
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Thanks for the information, nbnotes. Also, kudos to you for being able to have 5 treatments over 2 1/2 weeks. My one microwave ablation treatment last Friday is really kicking my butt -- still sore and not a lot of energy. I wish more MOs would talk to patients about the various radiation and interventional radiology treatments that folks could think about. I would know nothing about all of this if it wasn't for these boards.
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Bev Jen. I agree with you. More patients, especially with liver mets need to know about all the options available to us. Why some MO do not tell their patients is beyond me. When I go with Say Yes to Hope, this topic is my platforms. It's the message I want to get out when I'm interviewed.
I'm having my PET tomorrow. It's the first one I've had since I started X, on cycle 5 now. Ill get the results on Monday. I sure need it to be working. My new MO said we'd talk about another y90 depending on what my PET says. She says I would have to go off X while having y90.💞
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BevJen - Sending you prayers for healing from your recent microwave ablation. I had a resection of a liver met (1.7cm) four and a half weeks ago. The first week was painful, the second less so, and I'm feeling much better now. Even though my liver may have a number of small tumors brewing, I'm very relieved and thankful that the quick growing tumor has been removed. I developed liver mets while on Xeloda (a great treatment for liver mets) which freaked me out. I hope that you will feel better soon.
Grannax - I'm praying that your scan will be excellent and that Xeloda will work for you for a long time with tolerable side effects!
I'm very thankful to everyone on this thread for sharing your experiences/expertise! I had to push for local liver treatment. Without the knowledge obtained from you all, I would not even have been aware of the options. It's so very sad that local liver treatment options are not readily available to breast cancer patients. My research shows that they can buy us more precious time.
Theresa
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BevJen - While SBRT is more dose dense than regular radiation, I think it is probably way easier than an ablation. Though, I was surprised by how much pain I had. I guess I should have realized when they said it could be swollen/inflammed for up to 3 months, that there could be pain. At the end of each week, I pretty much had to spend 1 day down & out with fatigue, but I would do it again if the opportunity arose.
Very thankful to all on this thread as it was here & BCO in general that let me know that these type of specific targeted treatments were even available to those with liver involvement. My MO did call me to discuss the possibility of SBRT a few days after I expressed concern in her office that we were running through treatments quickly with only 1 liver tumor that had grown to 6 cm & 1or 2 lymph nodes. I appreciate that she thought about it & discussed it with the radiation oncologist before bringing it to me, though. My MO has been a rock star regarding listening and working with me.
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I agree with you about this thread. Thanks so much to all who have posted here!
When my liver mets showed up in May scans, and I asked about local options, my long time oncologist proclaimed to me that "never in her 30 years of practice had she ever suggested any of these options to anyone." Wrong response. She is no longer my oncologist. But I would not have known about any of this without this thread on BCO. I see my new oncologist next week and my interventional radiologist in 3 weeks, and will be discussing all of the possible options for local treatment for my remaining, supposedly "tiny" liver spots.
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BevJen - Curious as to why ablation and not surgery. I am scheduled the 5th of August for surgery of a 1 small liver met. In your case, Wondering why ablation and not surgery
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AMP47,
Well, I literally switched oncologists right as I was diagnosed with liver mets. From BCO, I knew that there could be possibilities for local treatment. My new MO, at Hopkins, said that if I wanted, she would run it past the liver tumor board, which I gather includes a surgeon, an interventional radiologist, and maybe some others. The surgeon said no go on surgery -- I never talked personally to him/her, so I don't have the rationale. I jumped on the IR's readiness to do something. His original suggestion was chemoembolization to all of the lesions, but not all at once. At the same time, I had sent my scans to Dr. Robert Lewandowski at Northwestern who has done a lot of work with BC folks. He was the one who suggested the microwave ablation of the largest lesion (about 2 cm). I have about 5 more smaller ones across both lobes. Dr. L. suggested getting control of the largest one first, and then figuring out the rest later -- he wasn't even sure that they were independently vascularized. So I went back to the Hopkins IR and talked with him about that (I live in Maryland) and he agreed to go with it. I still need to deal with the other lesions, so we'll see what happens next. Another person on here (theresa45) had surgery on her liver met, so I guess it really depends upon your docs.
Bev
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Bev Jen Lots of good researching and planning your local TX. Hats off to you. I'm so glad you are self advocating. You go girl.
l get PET results late Monday. Scanxiety is in full blown stage for me. At least the miserable PET prep is over. I'm pretty worried about this one became of some SE I've had. UGH I hate the waiting.
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Grannax,
Truth be told, your postings gave me the idea to start researching local liver treatments!
Good luck with your results on Monday -- fingers crossed for you.
Bev
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Thanks BevJen💞
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thinking andcwaitingvwith you Grannax2.
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Thanks LFF. Glad to have you ladies with me during the hard parts.💞
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Bad news last Monday, PET showed worsening of mets in liver and mediastinal node.
Now what?!?! She said she wanted to review my chart, etc. Before she gives me my options. I guess she's still thinking because I have not gotten a call. Garr
Of course my brain goes to y90. But, because of all the other ones in my lung and mediastinal node, my I R thinks I need systematic first. Also, all of them are getting more symptomatic. My shoulder blade, SOB and hiccups. Hiccups are a symptoms of mediastinal mets pressing on nerves that go to vocal chord. jnh lost her voice because of this. Yikes! Also, some lose their ability to eat and swallow.
All of this makes me want/demand a big guns TX that will at least slow these monsters down before they cause major problems. Actually, Nothing has touched them for 9 months. Come on People, I need some help here!
Anyone, have any suggestions?
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Grannax2 you are much wiser than I am but if Taxol is an option I’d say go for it. I have been on it for 4 months and feel great. Both Ibrance and Xeloda both failed. I also had y90 but unlike you it didn’t work for me. With Taxol I only had to do steroids the first two rounds. Even the second dose was reduced. My scans showed 50% reduction in my liver mets and lymph node. It’s the only treatment that’s help so far. I’m praying for you and I’m frustrated at how long you’re having to wait for a plan. You’re strong and inspiring as always!
Michelle
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Thanks Michele. I'm thinking Doxil or Taxol might be next. 💞
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grannrx2- I am on taxol and have been since October. It’s very tolerable and worked on my liver Mets.
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grannax, have you heard about whole-body hyperthermia? U Maryland has a dept. of hyperthermia as does Cleveland Clinic and Wash U in St Louis. They can heat your whole body or an area of he body. 107-108 cooks cancer cells but healthy cells are ok to 111. Maybe someone has done it on these boards
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No, I've not heard .of that, I'm going to ask.LFF Glad to know about Taxol for you. Did you lose your hair?
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Since I live in Maryland, I looked up the U Md Department of Hyperthermia. It sounds very interesting; however, there are some restrictions. This is what it said (not sure if this applies to ALL centers using this -- I only checked Maryland):
"'When it comes to attacking cancer cells, incorporating heat can be effective in enhancing treatment. The Department of Radiation Oncology at the University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center (UMGCCC) is now offering external thermal therapy, also known as hyperthermia.
External thermal therapy is highly recommended when treating breast cancer patients with chest wall reoccurrence, as well as other superficial or palpable cancers, especially occurring in an area of previous radiation.
External thermal therapy involves heating tumors to between 40 – 45º degrees C. The heat sensitizes tumor cells to other forms of standard therapy, including radiation and chemotherapy. It is a non-invasive procedure, and requires no general anesthesia. Patients undergo one hour-long sessions 2-3 times a week for roughly 4-5 weeks... External thermal therapy is used exclusively in conjunction with radiation and/or chemotherapy; it is not a stand-alone therapy."
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Grannrx2- Ishaved my head after it started to thin ( I looked like I had a bad comb over). This is what it looks like now. It started to grow back. O have dinecrafiationnthin spots but it looks pretty goo especially coming from a bald head.
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Still no news for me, but I've decided I'm going to ask her for anything she has confidence in that my mets will respond to. Harsh, not harsh, hair, no hair. I just need to see reduction of tumors, stable tumors. Anything except what I've seen for the past nine months. I desperately need a TX, a scan that shows improvement, not worsening.
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grannex2- hugs. That is how I feel about my brain. May you get the call tomorrow and have a plan. Thinking of uoy
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Grannax, It must be very frustrating to have to wait so long. I hope you hear about your new treatment plan tomorrow and that you start treatment soon. I think your thoughts are good - go with the treatment that best suits you and your circumstances , hair or no hair! As an aside, my wig looks better than my own hair did, and it’s a heck of a lot easier to take care of!
Hugs and prayers from, Lynne
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Thanks. We all know what our limits are. We have feelings about what we need. I think I'm there. I know I cannot go on the same way it's been going. Something better has to happen. Peddling as fast as I can, only to realize I'm going backwards, is no longer acceptable.
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