Liver mets: resection, ablation, SBRT, Y-90, anything else?
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I was able to get everything. done for Christmas party two and three. In fact, my appetite came back for Christmas Birthday dinner. I ate two helpings of everything. It tasted sooo good. Except for having a post y90 swelling ( or could it be that I ate too much?), I've done really well with left lobe SE, no pain.
I hope everyone else had a wonderful day, too.
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glad to hear the good news about local treatments. Question for those with y-90 (grannax)Are there any conditions that would stop the y-90 from proceeding?
my HFS from doxil is horrible right now (day 15) such pain even holding a fork or walking. It should let up by the time I fly to Houston for y-90 mapping, but if it doesn’t I wonder if they will postpone. I am scheduled for Jan 6
My labs are good for being on chemo. i can ask for a dose reduction on the next doxil. But hoping I can keep the y-90 on schedule.
My liver mets are stubborn and doxil is my 3rd line in 7 months since I started treatment. Local treatment of y-90 is all they will offer until they see shrinkage of liver tumors from systemic treatment. May still have surgery in my future since mets are only in right lobe right now. But my hope for success withy-90 is my plan for now
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Alabama Dee. That's a good question. My IR did tell me that they had to use less yttrium this time than with my first round in 2017. He said there is a lifetime maximum dose that they cannot exceed. I know the stats are very good for first y90s, although I cannot quote them. The tricky part is for how long. It's a guessing game on how long till the mets they could not visualize will start being visible. Mine started showing up at 18 months. Will I get that long this time? I don't know. Does my IR know? I doubt it.I think it depends on how aggressive and stubborn my mets are. And if they might respond to systemic TX, they have not so far. But i will try a new chemo in January.
I would love to hear stats on y90's both first and second ones. I did listen to one famous IR who said the tumors they treat with y90 stay dead!!! They've proven that. Such encouraging news. And, my IR said he was able to treat all he could see, large and small in my right lobe. So I think they will die and stay dead.
When you get to Houston maybe you can ask your IR about stats. What is his name? Is he at MDA? Keep us posted.💞
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Dee, I'd be interested in the name of your IR at MD Anderson, too. I've had liver biopsies there, but no one ever responded to an online inquiry as to who they recommended for a y-90 procedure. It's not something I'm ready for but I'd like to keep it in my pocket as going to Dallas for treatment with Grannax''s IR wouldn't be an option.
Thanks, and best of luck!
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Katty Smith
I took who MDA gave me in IR for the y-90 and I decided I really like him after the consult. -dr aveitscher. I get mapping on Monday so prayers I am a candidate.
grannax
They said the mapping does not have any “hold” for issues like my doxil SEs, but the liver numbers need to be good for the actual procedure I will ask about the stats on the y-90 treated tumors staying dead I have 3 large ones and multiple very small ones that the MRI picked up last time. They told me today it takes at least one month to see any results in the tumors. If I qualify it will be end of Jan to get the procedure. Next scans with MO is end of Febgood news is the doxil SEs are beginning to lessen I can actually close my hands (so swollen and painful since Christmas) and I can walk with out the gel socks inside my crocs. I am getting a dose reduction for the next infusion thankfully.
I had my molecular profile done on the biopsy. I have a few mutations. Waiting to get a copy of the full report when I get there. I asked MO to put me into their IMPACT Umbrella trial https://clinicaltrials.gov/ct2/show/NCT00851032
which puts my info in the database for any targeted therapies in clinical trials at MDA.I am running through lines pretty fast- on my 3rd in 7 months. Hoping the 2 prong approach helps (doxil & y-90) kill the stubborn liver tumors but at least my info will be in their system for the future. my consult is Tuesday then I head home and get doxil #2 on Friday
Between treatments, appointments, recovering and dealing with SE, research to be my own best advocate-fighting MBC is a full time job!
Happy New Year All. Thanks for the support and exchange of ideas/info.Dee
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Thank you, Dee! Best wishes at MDA!
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Alabama Dee girl you have a plan. While you are having your mapping on Monday, I'll be at my MO discussing what chemo is next. Probably order scans, too but they won't be definitive for y90 results. Just to see how my lung and chest mets look. I've only been on Fazlodex for the past three months. Although, since I have ESR1, Fazlodex was mentioned in my genomic testing results as one I might respond to. I wonder if my MO could put me in the Impact to see if there are any trials for me. Do you know what your mutations are?
I'll be thinking about you on Monday. The mapping didn't have any SE for me. I hope they go through your wrist. It's easier.💞
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Grannax,
Re your question about how long it takes liver mets to die off -- I had a scan on Dec. 12th re my microwave ablation of a single liver lesion on July 5th -- scan report says that area of ablation is active with necrosis and blood products (no new cancer there) and although the area is shrinking, it's still not back to normal. If that's the situation with microwave ablation, I'm sure it takes longer for the Y90 stuff to "heal." Just a point of reference for you.
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grannax2
They told me they are going through my groin probably because of the Lymphadema. I don’t know my mutations for sure because they can’t put those up on the my chart app. So I am going to request print outs when I get there on Monday.
Hoping for good results on Monday but won’t get the answer until Friday.
Dee
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THat does make sense Bev Jen. Alabama. Surprised that it will take so long to get the go-ahead at MDA. My IR told me immediately. Curious, do you live in the Houston area or do you have to travel?💞
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Grannax2
I live in Huntsville, Alabama the “other” Rocket City, I was told by a Houston native. 😉We have a direct 2 hour flight to Bush airport.
The PA told me they need to look at the nuclear imaging afterwards to be sure but the doctor may tell me at the procedure if I am awake to ask. I think they should know with just the procedure dye if I am a candidate. I told hubby to ask him in his consult afterwards.
I hate versed sedation because I wake up agitated. I do most simple procedures (port, biopsy, angioplasty, digital repair, lumbar injections,colonoscopy etc) without versed and ask for pain meds if it hurts. I dont know if they will let me this time. It is always a hassle to arrange because it is so rare to go unsedatedPrayers that I am a candidate and that I can get on the schedule quickly(trying to work around doxil)
Dee
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Dee I prefer when they use propopal. I know that's not how it's spelled. I do ok with a combo with versed. But, this time with the right lobe y90 he wanted me to not be able to move. The anesthesiologist used a combo and gas. I had no trouble waking up at all. With versed and P I woke up before they were finished. I didn't like that. I'm amazed that you can plan to do this with no sedation. I hope you get an anesthesiologist that will work with you to give you what you want and need.💞
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Alabama Dee. Waiting to hear from you about your y90 mapping yesterday.
My MO visit went well. I was surprised to learn that she wants me to stay on Fazlodex for another two months, my next appointment. Also, she is waiting to scan because my insurance company won't pay for two PETs so close together. The IR wants to wait three months for my post y90 scan. I'm OK with all of this because my lung mets are not giving me any trouble and her exam of my liver was good. She said it felt smaller/ better than it did in October.
I hope everything went well for you yesterday and that you will get to have your y90.💞
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Good news, I am a candidate for y-90. will set up for end of the month. Glad I get something that should treat Most of these stubborn liver tumors.
Bad news my team did not make clear at my dec appointment that I had a left lobe tumor not seen on previous ctFound out yesterday it has grown while on doxil. Bit of a shock. Waiting to hear from MO if I should try doxil #2 on Friday which is a dose reduction due to severe HFS.
Will keep posted.
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going ahead with doxil #2 but my liver enzymes are high so MO said that after the second one I will return for official scans ( the y-90 mapping scan showed some growth but need the MRI) and potentially get a new plan at the same week before getting my Y 90.
Don’t know what is next in line. I’m thinking envirolimus or maybe a platinum. My cancer has not seen either of these classes
Crazy stupid cancer.
Dee
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That's a bummer. Did they map your left lobe too? Maybe you'll get to have y90 on both lobes.
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grannax
I believeIR said that they would embolise the whole left IVb quadrant because it has many tiny tumors also. They could not tell me if I will have that at the same time as the y-90 or go back with another procedure. Hoping it can be done at the same time but they are concerned about damaging too much liver.
Bloodwork tomorrow with local MO. Last time he made me feel guilty for not going straight to surgery with his team. Grrr. Hoping to hold my own with him. I like his PA but I may not have her.
Dee
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My IR will only do one lobe at a time. But maybe it depends on how much yittrium they need to use in each lobe. I've read it can be way too toxic to do both at once.
I'm going to have my AVF repair next week. My IR says they will just embolize it. He says sometimes the liver forms an AVF after a y90 or even a liver BX. Apparently it's not a big deal to fix it.💞
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My IR will only do one side at a time as well. I think it is rare to do both sides with breast cancer.
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In my talks with my IR about various liver procedures, including chemoembolization, ablation, etc., he also is very cautious about the amount of liver treatments at one time. I think the concern is liver failure, so although it's a pain to do separate procedures, it seems to be the most cautious and accepted approach.
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At one point there was a lady here who had both lobes done at once. She was incredibly sick. I don't remember her name but I do remember she was from Australia. Then she disappeared. I often wonder what happened to her.💞
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IR doc said they won’t do y-90 to the IVB quadrant liver lobe, but embolization to that whole quadrant which has the diffuse tiny tumors and one larger.
So the right lobe gets the Y-90. IR said it’s possible to do both sides at one time but they are concerned about enoughhealthy remnant liver. I guess I will find out in 2 weeks.
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THat makes sense. Embolization without yittrium on the left, right? And y90 on the right lobe.
On Wednesday I will have my liver AVF embolized to repair it. I guess that's like burning it, sort of. It's supposed to be an easy procedure. No SE.💞
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Grannax,
When I talked with my IR about embolization, it was through injection. Don't know if that's what they will do with you, but that's what he talked about.
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GRANNAX
best wishes on a great our come and no SE.
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Best wishes, Grannax2!
I had two good appointments, with a liver/biliary specialist and an interventional radiologist, and thought I would share here in case it would be helpful to others. The IR said that he does Y90 in bc patients with liver only disease or whose other mets are well-controlled. I have liver only. He will treat the largest, most stubborn tumor, which has ignored three chemos in a row. I have stents to keep my common bile duct functioning*, so he would rather not treat the other four or five smaller lesions right now, because every treated met can become a nest for bacteria. Indeed, I have already had one liver abscess. The stents are highways for bacteria from the intestines to the liver. So that is why we prefer Y90 to microwave or other ablation — which one doc referred to as “burning" — since Y90 is slower and less likely to leave problematic scars. That and the size of the lesion. We need to get my stent exchanged (it's every three months) first, again to reduce chance of infection. That brings in a third doctor, whom I call the Endoscopy Guru. The liver/biliary doc said that yes, the bile duct stuff may indeed be the cause of my unexplained fevers, and I just had a two-day episode. And risk of infection is why nobody wants me on chemo for all this stuff. They will try to expedite. I am very thankful that I am at a major cancer center where the docs coordinate. I ran into my onc as I was walking to my car, and she said, “We've been talking about you behind your back." Good!
* Scar tissue from treated mets too close to the bile duct caused a stricture.
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Shetland,
Sounds like a plan. Very interesting how they plan to treat this -- but a great explanation from the docs as to why they wouldn't do one spot via ablation. I can tell you that my single microwave ablation is still healing, per my scans, so this all makes a lot of sense. Wow, you are definitely getting the full treatment at your center, and I'm glad that they are all coordinating.
When will this all take place?
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Shetland WOW you have a team. Awesome I'm so hoping they can expedite you and get you on the healing road with no fevers! Our liver mets are twins, mine have ignored three chemo, too. Die liver monsters, die!
Bev Nope, my IR is going in the same way as he does for y90. Actually, he said it will be more like the mapping for y90. No SE but same restrictions for me in regard to use of my arm. He uses the brachial artery as access to the liver so for 24 hours I have to wear a wrist brace and not lift more than four pounds for five days post op. I don't even know exactly where the AVF is in my liver. But, my IR does. Lol. I do know that my liver just randomly decided to make this new blood flow between lobes. It's not needed and not supposed to be there. He says the whole procedure will take about an hour. I'll let you know the scoop on Thursday.💞
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Good luck on this procedure, Grannax. It sounds like your IR is a terrific doctor and is on top of the whole thing.
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Grannax2, has your IR ever said there was a cap for Y90 procedures? The IR where I live knows that I am interested in this procedure when the time is right. He said he has had great success.
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