Liver mets: resection, ablation, SBRT, Y-90, anything else?
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Grannax, I have been in your shoes. Once you have a powerful chemo that actually knocks back the mets, you may have a newfound appreciation for chemo. I found that to be the case. Chemo is not something anyone wants to take and I do get concerned about its impact on the immune system but it can be very powerful in putting a stop to out of control growth. It lets one breathe easy again, at least for some period of time.
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Se called last night at 9PM. She said the thought about a hormonal but decided I need more, especially worried about the ten new ones in my liver. We're on the same page. PTL.
So, I'm going to be on Gem/ Carb. My cycle will be Day 1, 8 and 15. I have to go in today or two to get the nurse to consent /educate me. I don't know which day I'll start.
Goodbye hair ( for the fourth time)💞
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grannex2- glad you have a plan. I hope you can breath a little better. I will be thinking if you and the cancer going away on the new treatment.
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Grannax, sounds like the right kind of tough combo that will help beat down your liver mets. I believe Gemzar does not cause hair loss (at least that is what my MO told me recently). I don't know about Carboplatin but have heard that at least some people do not lose their hair.
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That would be awesome. My friend offered to pay for cold cap but it's expensive. Thanks. 💞
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Received a reply from Dr. Lewandowski at Northwestern that he would recommend Y90 for me. From what I have read on this thread, I think I am prepared to do it. Would require two trips to NW a week apart. I live in Florida and don’t yet know if there is anyone nearby who does it.
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Meadows, where in FL are you located? I had mine at Miami Cancer Center/Miami Vascular at Baptist, which is affiliated with MSK. I was prepared to travel anywhere in the country to have it performed by the best and ended up local due to a recommendation from the head of radiology at U Penn. His advice was that I didn't need to travel and he would recommend Miami Vascular. The IR I selected, Dr. Ghandi, focuses in oncology and has been doing Y90 on breast cancer for many years. They have a ton of IRs and I went through the bios of each of them and found the one with the most experience in this area. I found articles he wrote on the subject as well. He trains other doctors on how to perform Y90 using the Sirtex Y90 beads on behalf of Sirtex. I found an article where he did the procedure back on a breast cancer patient in 2013 or so, before Dr. Lewandowski published the seminal article on Y90 in breast cancer. Moffitt may also be a good option in Tampa although I don't have any specific names. I was initially considering MSK, U of Washington, MD Anderson and Moffitt but never made it to the stage of finding IRs at those facilities.
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Has anyone had Y90 done at MD Anderson in Houston? This may be my next step if my liver continues progressing on my clinical trial. I'm keeping my fingers crossed that it may be pseudo-progression, since that happens with immunotherpy sometimes, but I won't know for sure until after my next scan in August.
Thanks!
Katty
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No, when I was a patient there, I was seeking surgery for my C3 mets. I ended up using a Neurosurgeon in Dallas. I'm sure their I R would do a great job for you. Or if you want to use mine in Dallas, his name is Travis Van Meter, MD.💞
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Grannax, I remember you spoke so highly of Dr. Van Meter, but I really have to stay in Houston. They will probably just say that all of their IR doctors are excellent, but I'm hoping I can find someone who's actually had the procedure there.
Thanks!
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I've been in an immunotherapy trial since December and have had a fantastic response (44% decrease in target tumors), until now. Yesterday was my last day in the trial because of an increase in size and number of my liver tumors. Progression showed up in my June scans, but they were hoping it was psuedo-progression, so I was allowed to stay in the trial until my scan this week confirmed more progression. My two largest hepatic tumors increased from 2.2 x 2.4 cm to 3.3 x 3.4 cm and 2.5 x 1.8 cm to 3.2 x 2.3 cm. and I have several smaller diffuse (correct term?) lesions. Other non-liver nodes have minute progression or remain stable.
So I'm at a crossroads. My gut tells me to get a referral for an IR doctor at MD Anderson to see if I'm a viable candidate for Y9, because unless I do something that is proven in many cases to slow progression in the liver (I've been following the Y90 etc thread for months), I'll be looking at liver failure in *several* months. My liver values are all good as is the rest of my bloodwork and general health. In conjunction with or after both lobes are done, I could try another convention systemic treatment to keep the hounds at bay.
BUT, my study doctor offered another Phase 1 immunotherapy trial which in my panic I consented to, but can withdraw at any point. Dr. J doesn't know why my initial trial started failing after months of success. I am the only patient in his trial who had such a good response. He postulates that my tumors may have become *cold* and therefore unrecognizable to the immunotherapy drugs. This trial would stimulate inflammation (making them *hot) in my largest tumors which would then theoretically spread to other tumors making them more succeptable to the immotherapy. Here's the short form: Preclinical Characterization of BMS-986299, a First-in-Class NLRP3 Agonist with Potent Antitumor Activity, Alone and in Combination with Checkpoint Blockade
It's a pretty hairy, invasive regime for my liver. Once a week for 5 weeks, I would have the study drug injected directly into my liver tumor. It would be treated like a liver biopsy with conscious sedation and a SIX hour recovery with possible overnght stay in case of fever. He would scan me after a month and at that point, if my tumors looked receptive, he would add Nivolumab (which I've been on) and Ipilimumab (which I know nothing about yet. I'll be up there a minimum of two-three days per week for 5 weeks and unless I bail out before, I'll start the first week in September.
I always have questions AFTER my appointments, because it takes a while for things to percolate with me. If you have any suggestions of questions to ask or any thoughts on what direction you think I should go, (Y90 + conventional or trial ) please chime in! I feel like things are happening too fast and I want to make the most informed decision I can. And, it just figures, my former MO prior to the clinical trial is leaving MDA early next week, so I won't have him to bounce these ideas off of.
I don't rattle easily, but I am well and truly rattled right now.
I'm crossposting on Y90 thread and my clinical trial thread.
Thanks to one and all,
Katty
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Katty. I know sort of how you feel, at least about progression.
In regard to y90, I'm a y90 fan and one of the ones who got 18 months of inactive liver mets because of y90's. Your liver numbers are good, that's key. That's part of the criteria to be a candidate for y90. This would be very good timing for you to consult with an IR.
I know you're in a quandary because of the trial but this may be your only chance to get a y90. The timing is everything.
Sounds like a difficult decision. Another day in our lives, this is what we do.💞
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Katty,
So I had about 5-6 liver mets when diagnosed stage 4 in May. In early July, I had a microwave ablation of the largest met (about 2 cm), and we'll see what's going on with the others (which were supposedly tiny) when I have an MRI in late August (which will also show if the ablation of the largest met was successful, I guess.) There are several things that interventional radiologists can do, one of which is Y 90. In the course of talking with IR docs, they also mentioned to me something called chemoembolization (aka TACE) (which sounds oddly like what you described as would happen every 5 weeks in what you described). My IR from Hopkins pushed that first. They have to work sequentially to inject the drugs, and he said he wouldn't go in more than once a month, if I could handle that, and work on different lobes of the liver at different times so as to not cause liver failure -- but it was not with a study drug; it was with known drugs that are used in chemotherapy. He also said that sometimes it becomes a bit like whack-a-mole to hit whatever tumors pop up. Y 90 is another option, but it's not the only option. So my suggestion is to get into an IR doc ASAP and see what options you have with your situation. Another thing to think about: another poster here had SBRT, which is targeted radiation, to her liver tumors. That is done by a radiation oncologist, NOT by an interventional radiologist. I actually called my old radiation oncologist from the early 2000s and asked her about it. I don't know the size restrictions -- she was looking at my scans with the supposedly "tiny" lesions on it. You should probably check that out too.
Good luck!
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Thank you, BevJen!
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Katty,
I also saw Cure-ous's response on the other thread, and I think what she ways makes a lot of sense. But for you, you probably want to talk to everyone you can in order to see what feels right for you. Hopefully, this will settle your mind.
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Kattysmith, you have a tough choice but what seems to be two good options. Good luck making a decision. I don't know what I would do in your position but wanted to lend my support.
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Thanks JFL! By the way, I was THRILLED about your PET scan results! Hearts and hugs coming your way!
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My SBRT was in late April/ early May, and I have my petscan this coming Monday with doctor visit on Friday. Having lots of anxiety right now even though my tumor markers each month have come down significantly. Fingers crossed for good results!
Katty - That is a really hard decision. Since you are not fully sold on the trial maybe you could get in with an IR just to see if any of those options are open for you before you make the decision
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I like what Cureious said, too. I would love to have a chance to try immunotherapy someday, not many of us get that chance. She certainly knows way more about immunotherapy than I do.
Please let use know what you decide, I'm curious TOO. 💞
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Nancy,
Good luck with your PET scan on Monday and your doc's visit on Friday. Hope the SBRT did its thing! Interested to see how it all plays out.
Bev
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I got my scan esults this morning, and the SBRT part is very good. The SBRT worked completely on the liver tumor & lymph nodes radiated. Unfortunately, Xeloda has definitely failed me and a new small area of uptake in the liver (not a defined lesion) and 3 lymph nodes on the left side near(ish) heart are now lighting up. The radiation oncologist wants to do SBRT on those and then I will start gemcitabine to hopefully keep anything new from growing. I am frustrated about the new growth but very thankful that the SBRT did its job!
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RBnotes. What a mixed bag. But, I am very glad SBRT has been successful.💞
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Hey y’all
I am a candidate for resection if the Xeloda does it’s thing and reduces the 3 tumors in the right lobe. (FYI-My first line of faslodex and verzenio did not cause shrinkage only a little necrosis but the tumors grew a little.)
The surgeon explained that we need to have the tumors respond because micro metastasis could be hiding in the left lobe(and other places) and when the liver regenerates the growth factor could cause those micros to grow in the left lobe. (Not good). Scan in November to learn next step
I tried to search this topic for info on those who experienced resection but did not find much.
Anyone out there have liver resection? Can you tell me what to expect? I know I will need the portal vein embolization procedure first
MO wants me to consider SBRT so I am following that too
TIA
Dee
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TIA. I know that micmel had a resection a few years ago. Seems like there are others, but I don't remember their name. Several have had SBRT. I'm sure they will chime in. I've only had Y90's. But, I had multiple liver mets. Then I had progression, now on Gem/Carb.
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Yes, Micmel and also Leftfootforward had resections, I believe. There are a few more but I cannot think of the names right now.
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you remember correctly. I did have a resection in 2015.
I was on Xeloda, convinced my MO to stay in it, and had a solitary tumor resected.
My surgery was later in the day do I spent 2 nights in the hospital ( day of and the next) but I was home by myself and parenting 4 kids by myself on day 3. Probably not normal but I managed. I dong like pain killers so stick to ice and Tylenol and did ok. I used a tool to help put in my socks for the first few days as bending over hurt too much. Worst part was giving myself the shots of blood thinners. I was able to do that myself as well, but you might want to have someone to that for you.
It was a while ago, but I found the recovery not bad at all. I feel like resection is a good option when available. I got a great sample to confirm that my cancer was still the same.
I’m happy to answer any questions to the best of my ability.
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thanks Leftfootforward
I have 3 months to ponder SBRT vs resection if all goes well on Xeloda. I am working on a list pros and cons of both. Will post later and would like input from those who have experienced resection and those who have experienced SBRT.
Dee
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Info for anyone thinking about an interventional radiology procedure -- I had a microwave ablation of my largest liver lesion on July 5th. Saw my interventional radiologist today preceded by an abdominal MRI with contrast, so he could see how well it's all healing. He said that the healing is going well (the lesion was a bit over 2 cm). My other liver lesions are stable -- no better, no worse. He would prefer to let my meds take a hit at those first (I'm doing Ibrance/faslodex) and then he said that all of the IR procedures that we had previously discussed -- chemoembolization, more microwave ablations, Y 90, etc. -- would still be on the table.
For me, the microwave ablation worked out pretty well. For two weeks, I had some pain on my side and low energy. After 2 weeks, I started resuming my usual schedule, including exercising.
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Happy Dance Bev Jen. Glad it's working and that other mets are stable.💞
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Thanks for your good thoughts, Grannax! And best of luck on your current treatment.
I really have no idea what's going on in the rest of my body since I'm only in the middle of cycle 2 on Ibrance and won't be scanned full body for a bit yet. But I'll take the stable on the other liver mets, the destruction of the largest one, and I'm relieved that the interventional radiologist said that all options are still preserved with respect to the remaining liver lesions.
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