Liver mets: resection, ablation, SBRT, Y-90, anything else?
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takes a licking and keeps on kicking. Nagourney is trying metformin, letrozole and afinitor. I've been On the latter two, but not together. It's not far off from his original assay. In the meantime, brain/skull rads. It's a bit crunchy. I'm hoping for a Nagourney miracle. You don't know till you try. Better on the Pyche too.
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Sunset,
So happy to hear from you on the boards! Best of luck with this combo. Hoping it all works!
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Sunset, I know this will sound weird, but I've been begging my MO to put me back on letrazole...it's just my instinct, since nothing has worked for me since, and the last time I took it was almost three years ago and it got rid of a 2.5 cm tumor in my left breast in less than 3 months..it's never returned....
I have a good feeling about this...may it turn out to be a good and long lasting TX for you !
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Sunset, it’s good to hear from you! I hope The Nagourney triple plus rads will be miraculous!
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Sunset, it is nice to see you posting! Hoping this Nagourney cocktail will be the "Hail Mary" you need right now.
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Yay Sunset. You are a miracle. I've told my kids if it goes to my brain just shoot me. But, hearing you makes me want to rethink that. 💞
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From the Journal of Vascular and Interventional Radiology --
https://www.jvir.org/article/S1051-0443(19)30652-9/fulltext?dgcid=raven_jbs_aip_email
I hope this link works -- basically the summary of the article details a combo methodology for liver tumors (presumably would work as well for metastatic tumors?), which involves chemoembolization (aka TACE) followed by radio frequency ablation -- the article indicates that if you're going to do something like this, which I take it is a newer procedure, it's best to follow the chemoembolization with the ablation within 30 days for best survival rates, rather than waiting to go back in later to do the ablation.
One more possibility?
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I found out yesterday that my liver mets grew in spite of Gem Carb. Darn! Plus there's a new one. So, what's next? Who knows. I have contacted my IR. Four TX have failed to halt my liver mets. Only y90 helped and I don't know if I can have it again. Getting desperate.
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Grannax,
I would not discount having your IR think through if there are any other alternatives in IR for you besides the Y90, like the TACE/chemoembolization that is described in the article that I linked above, or like SBRT (which is done by a radiation oncologist, not an IR) to attack your liver mets. Of course, you will still need some kind of systemic treatment that helps to hold you stable, but I would really be talking to the IR here about potential treatments. It seems that studies are being released all the time now about potential IR treatments and how they can help. Best of luck. Thinking about you.
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Thanks for posting article, BevJen. I am going to look into this further.
Grannax, I am so sorry to hear that Gem Carbo didn't work. Sounds like a great idea to inquire about additional local treatments. My MO has already recommended I do another Y90. TACE is an interesting option as well. I am waiting at this point but may be close behind you on my #2.
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Thanks, BevJen and JFL. Yes, I'm putting all my eggs in one basket. I may be done with chemo, at least while I'm having my IR procedures. Chemoembolization or even SBRT. Whatever, it doesn't take a scientist to know that my liver mets DON'T respond to chemo or any other TX. DUH Its been three years of TX, nothing has touched them except y90.
My lung mets are basically stable, plus they don't bother me at all. We all know they are not as life threatening as liver mets. I think my IR will consider stable lung mets a plus. I do. Am I desperate? YES.
I will have a consultation with my IR next week, before I see my MO. They are not affiliated with each other. At this point, after my disastrous MO visit, I trust him way more than I trust her. He is truly on my side and has done numerous procedures for me.
I'm finally ready to see my liver monsters. For three years I have avoided seeing the images. Not anymore. I need to see and hear what I'm up against. I don't even know how large a percentage they are taking up in my liver, when will they block my bile duct, like Shetland? I don't want any sugar coating. Tell it to me straight. I'll do whatever is possible to live longer.
If my IR says I'm a candidate for y90, I may tell my MO to go fly a kite.💞
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Shetland says it's not her liver mets blocking her bile duct, sorry I misspoke.💞
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No problem Grannax2, I can barely keep up myself. My docs had assumed it was liver mets for obvious reasons. But then this week I had endoscopy for stent replacement, photos and biopsies. The biopsy from inside the duct showed only inflammatory tissue. Still waiting on the biopsy results for the thing just outside the duct. Could be a met, could be inflammation and scarring.
We only see one other lesion, way in another area, that seems to have grown and that CT-guided biopsy showed ILC. Is it true we can’t zap it if it is over one centimeter?
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Shetland,
I had a microwave ablation of a 2.1 cm lesion in my liver. I believe that Nicole told me that another IR at Hopkins told her up to 3 cm for cryotherapy. So the answer to your question is yes, most likely.
Bev
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Hi all...so I had my cryoblation yesterday. I underestimated the pain... I do not take pain meds at all. When we left the hospital my pain wasn't bad..but then a car ride home that normally takes about 1 hour and 30 min took 3 and half hours...I was in sever pain..it is what people must feel like when they break a rib I couldn't get a breath (nothing to do with lungs and I knew this, they do a chest X-ray before you leave) so the pain was so bad that my liver started having spasms...it was awful. I couldn't at that point even get a script for pain meds because they cannot be called in to Pharmacy. So when I got home I took an 800 mg Motrin and 2 tylenol and THANK YOU LORD that took the edge off. I am still very very sore today and when I try to breath in it all hurts where the liver and ribs are.
So out of the 3 tumors he cryoblated 2. 1 he had to leave because it was too close to intestine/colon and he did not want to risk perforation. He said if (what ever treatment my MO decides on) doesn't work, surgery can definitely remove it. With that said...I think cryo is awesome but now I know it doesn't just depend on your tumor size..but also about location as to whether or not they can do it.
Waiting on biopsy results I do have appt at my MO next Wednesday to discuss that and treatment method.
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Nicole, I hope and pray that your pain has continued to lessen.
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Thanks Katy I am feeling better today. I dropped the tylenol and only taking the 800mg motrin
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My IR has reviewed my PET and he said he can do another one on me. He did say that he won't be able to do as much as they did on the first ones. I'm not sure what that means. He said I have to be three weeks out from chemo, which means two more weeks. It's three procedures, mapping and both lobes separately. 💞
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Grannax,
That's great! Hoping that this is what will do the trick for you. Hope you can get a clarification on what he can do this time around.
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Thanks Beg Jen. Two of my procedures are already scheduled! Mapping November 13 and first lobe November 20. The second lobe will be about a month later, depending on how my liver is doing.
I think my IR won't be able to use as much yitrium as he did the first time. I'll ask more about the details next week. I trust him so much but I am curious. 💞
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Grannax, I could very well be following in your footsteps sooner than I would like. My tumor markers and liver enzymes have been on the rise a bit. I wanted to wait another cycle to see what was going on as I had been sick last month and seem to develop elevated liver enzymes and sometimes even elevated tumor markers when I am sick. However, I am no longer sick and my liver enzymes were a bit more elevated today. Tumor markers still not back. Glad you were able to secure those appointments so quickly!
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Gosh JFL. That's scary. I'll pave the way for you and share my recovery. 💞
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I'm scheduled for my mapping and y90's, it's in the books. Approved by insurance, etc. And, my MO. The dreaded appointment with her is over and it all went well. We are on the same page and have a plan for the next three months. Mapping November 13, first lobe November 20 and second lobe one month later.
As you know, this will be my second y90. My first ones were in May 2017. Liver mets stayed inactive for 18 months. I hope I get the same amount of time with this one.I am going to take Faslodex during the 3 months I can't do chemo. I'm not sure what I'll be on after that.💞
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Grannax,
Sounds like a plan!!! Yippee!
Have you been on faslodex before? I've found it to be a very easy drug, and I don't even mind the shots anymore.
Glad that you have a solid plan in place.
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Bev Jen. No this will be my first TX with Faslodex. Glad to know it's easy, especially compared to chemo. UGH💞
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Grannax,
Oh, NO comparison to chemo!!! Some people don't like the shots, but I only dislike shots when I can see them coming at me. Since this is in your rear, you don't exactly see the shots going in! I also was on letrozole for 13 years, and this is MUCH easier for me than the AI. So that will be a good treatment for you while you deal with the Y90 procedures and subsequent healing.
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Grannax, you are all set! Glad your MO appointment went well and that you don't need to worry about that anymore.
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I had the mapping for my y90s on November 13. They went in through my wrist this time, radial artery. Things have changed in the past two years. It was easier. My IR did see more mets than he expected to see. But, he does plan to be able to zap all of them in both lobes. It will be two more procedures of course. The first one is November 20.
He did find an unexpected abnormality. A rare post y90 complication. It's called AVF, atrial to portal vein. What?!? Never heard of it. He will have to embolize it in another procedure after my y90s are healed.
I'll try to keep you updated.💞
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Cross-posting this -
Update on my PET - I haven't received the results or radiology report yet but my DH did review the scan himself as he has access to my results. As suspected, PET lit up "a lot" in my liver and the lesions have grown a bit. Have no idea what is next, in additional to the COC protocol. Maybe Gemzar?
I also plan to set up a consult with my IR re 2nd Y90. Grannax, I am right behind you!
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We’ll get through this together.
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