Liver mets: resection, ablation, SBRT, Y-90, anything else?
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I can't speak to SBRT but my IR who did the Y90 and has a lot of experience in both had told me that he is just not seeing the same success levels as he is seeing in Y90. He said TACE is good but Y90 is better.
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Thanks for that JFL!!!
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Wish I could help Nicole. I don’t know if there is any published data for breast cancer to the liver. Maybe you could ask your IR and RO for some studies/articles to read. Your IR may be more comfortable doing one over the other. I hope you get a peace about which way to go.
Dee
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Thanks Dee.
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Hello! My name is Pamela and I was just dx last week for liver mets. I used BC.org a ton with my regular breast cancer 4 yrs ago but feeling lost on which forum is right for me this time around. Is this forum where I the best for liver mets? Thank you!
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Hi Pamela,
Local treatment to the liver is a great option. If you only have a couple mets in one lobe of the liver you could qualify for surgery(always the gold standard) plus the liver regenerates.
If not, there are other local treatments used to knock out the tumors. I had y-90 and bland embolization. I had to get a referral to an interventional radiologist to see if the vascular nature of my liver would qualify me for the procedure. It worked to shrink/treat my 3 large tumors to reduce the total tumor burden. I still need a systemic treatment and I am still looking for one that will get me control.
Others here have had ablation/ chemo embolization and more. SBRT is getting some traction for liver tumors. I know they do that at MD Anderson because it was offered to me. That is done with a radiation oncologist.
Sometimes you have to push your MO to get a consult for local therapy. I assume you had a biopsy and they did genomic testing like foundation 1 to see what mutations you have. It helps in knowing which meds to start on.This is a great place to share concerns and ask how others manage their way through the journey.
Blessings
Dee
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HI Pamela,
There is another stage 4 Forum that you will be interested in called, How are people with liver Mets doing?
Almost everyone on there has had various types of treatments and there is a ton of experience and support. I'm so sorry you are joining us, but you have come to the right place.
Ka
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hi Pamela sorry about your diagnosis did you have any symptoms or usual scan check revealed it
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Thanks for the warm welcome. I've had shortness of breath this summer which landed me in the hospital twice in August. The first time I went in because I had pain in my shoulder blade and it was extremely painful to take a deep breath. Spent 3 days in the cardiac unit doing test that all came back fine.
Two weeks later the shortness of breath was so severe that I couldn't even get dressed or brush my teeth without sitting down to pant. I was on the pulmonary floor and the last test was a high image CT of my lungs. It happened to capture a small part of my liver & my oncologist who saw me everyday said it didn't "look right" to her so had liver ultrasound and biopsy which came back positive. Thank goodness she caught it. So the shortness of breath came from the liver inflammation. My breathing has really improved since first round of chemo. Hoping the second round will clear it up as I've been hooked to a big oxygen machine with a 50' chord for weeks.
I am getting a second opinion for treatment this week. Fighting with the insurance company to approve a PET scan. Thanks Dee for all the information!
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Pamela23
You have been through a lot! Being tied to a machine is no fun! I'm glad it's getting easier to manage and the chemo is helping. Which one are you taking?
Do they consider this metastatic breast cancer to the liver? Getting a genomic test on that biopsy is an important step- many people here use Foundation 1
PET will show if there are active tumors throughout the body. It's good to get one for peace of mind. Prayers that insurance will cover.
I found in my case that an abdominal MRI with/wo contrast is really good to monitor my liver over time. It catches things that are too small for the PET or CT.
Let us know how your consults go and how you are doing.
Dee
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Pamela,
I will second what Dee said about MRI of the abdomen/liver. I have had local treatment to my liver -- a microwave ablation of the largest lesion I had in 2019 when liver metastases were discovered. I follow up every three months with my interventional radiologist,, and he has told me that the MRI scanning is the most reliable to get a pic of the liver lesions. I have not had a PET for a while. My MO uses CT scans on the abdomen and pelvis. However, these do not clearly show the liver lesions.
Good luck in getting your testing approved. And get that second opinion! Many of us do that on a regular basis.
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Maybe I'm an outlier but my mets are all monitored by CT with contrast. Maybe it depends how big they are? Mine are easy to see - I've seen them on the scans myself.
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moth
I’m glad your ct catches everything and you don’t have to go through multiple testing.
In my case the radiologist saw something suspect on the CT but wanted verification with an MRI. the MRI showed many more tiny lesions that they could then measure whereas the CT was not clear enough for measuring. I think it depends on the “slices”
So every 3 months it has been CT chest, MRI abdomen with every year a PET, brain MRI and bone scan.
I’m just grateful for the scans. It is what we depend on for next steps.
Dee
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Moth, yes glad CT does catch everything for you and it actually may have for me, too. A CT in December was read possible liver mets; on to a liver MRI which was the muddy one. It was read probably not liver mets; onto a PET/CT and liver biopsy confirmation.
Pamela23, hope you get that PET approval from insurance. It got me the liver biopsy which was the definitive answer for me.
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Dee--I'm on Xeloda. They do consider it metastatic breast cancer. We sent the biopsy to Tempus for Genomic Testing. What is the benefit of that?
Thanks for the MRI tip, right now she plays to do CT of liver in 4 weeks. I have an appointment on Friday with the leading cancer hospital in Chicago to hear a 2nd opinion on plan of action.
Bliss, I had a biopsy which confirmed liver mets, the PET would tell us where else it may be. Praying it's no where else.
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Pamela23,
Genomic testing on your tumor (or a blood biopsy, another method used) will tell your docs a lot about your tumor, including if you have any mutations. Cancer can mutate over time. Targeted therapies have been developed and are being developed that can be used with certain tumor mutations. The one that most easily comes to mind if if you have the PIK3 mutation, you are eligible for Piqray, which is a drug that was just released last summer. It helps your doc have a plan of attack.
Which hospital in Chicago? I have a consulting interventional radiologist and a consulting MO at Northwestern. Both are very well known and respected in their fields. And I've found Northwestern to be a great source of info.
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Not directly on point (and I'm cross posting on breaking research news not from breastcancer.org)
Interesting article out today about treating some metastatic lesions locally, and how the landscape may be changing as to whether this should be considered, in addition to systemic therapy. The article focuses a lot on oligometastatic patients (but also tries to re-define what that term means) and also talks quite a bit about SBRT. But it's worth a read.
https://www.cancer.gov/news-events/cancer-currents...
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Thanks for the article Bev. I hope to see the day when these combinations can really control cancer so that people can live longer and better lives even if hey cannot be cured. There won’t be a magic bullet, but some combinations just may have some magic. It seems to me in MBC, we have made some progress overall, but not the great strides that we need in the different areas. I still hope and pray!
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thanks BevGen for this interesting article
My case falls in line with this. I had 2 tumors around 2cm in the right lobe of my liver. My home MO wanted to do surgery which would involve removing the whole right lobe due to tumor location. 😳
MDACC was concerned with micrometastisis and said systemic first to see if I would respond and shrink tumors. OR a facility sponsored SBRT trial that was a coin flip for SBRT only or systemic.
Had I known what I do now, I may have done that trial. Because if I got SBRT to the liver, I could always leave the trial to continue with systemic.
As you all know, the liver tumors spread and surgery is out. SBRT was ruled out due to the number of tumors and amount of radiation required. At least the Y-90 worked on those big buggers.
I would suggest SBRT at a very experienced center. My local RO who did my lung SBRT said she is not a fan of SBRT to the liver for reasons I don’t remember.
BTW- Back in June, the RO considered me oligometastatic in the lung and qualified me even though I had tumors in my liver. (At that time the liver did not light up on the pet scan, big tumors were treated with y-90 and little tumors were too little to register)
I hope SBRT becomes a real option to knock down oligometastatic! I found it to be easy, just a little fatigue that resolved quickly. Reducing tumor burden is one goal, but the team at MDACC was really hoping for curative without the risks of surgery.
Dee
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so microwave ablation is done by an interventional radiologist not and RO right?
Does anyone know how much damage to liver microwave ablation causes vs. Y90?
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Nicole,
Microwave ablation is basically the same as cryo ablation except it's done with heat rather than cold. I assume that you've ha scans since your cryo, and my guess is that things appear pretty much the same as they do after microwave. When I have a scan, there is an area that is larger than the original tumor (because of the area of the ablation). The top of the "crater" left from the ablation still lights up -- I've been told that will be forever -- but the center is trashed and they always comment "necrotic material." I don't know that that area (and now the new one) will ever completely heal over, but that's the story on that.
I would ask Grannax the question about the Y90. I do think that Y90 closes off one of the veins into the liver? I don't know if that is reversible and if that makes it so useful?
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Thank you Bev...HRMMMM I didn't know about the closing off as in Permanently of the vein to the liver.
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Nicole,
if you google Y90, you'll come up with a wealth of info. Just verify what I said -- again, I haven't had that treatment; Grannax has.
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I don't think any of my veins were closed off during my y90s. Look up SIR Spheres Microspheres. The tiny beads of yittrum 90 go into the blood supply of the liver into each tumor. Then the tumor starts to die. You can also look up Dr Van Meter in Dallas. He has lots of videos on his website that are very explanatory.
Maybe during the mapping part they close off other veins that go to other organs. They don't want any beads to get into like gallbladder, etc.
I was only given one choice......y90. Both times. So I don't know which one is more risky. I had a lot of liver monsters both time so that's probably why.💞
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Grann...I think I remember the IR saying at my consult ..what you just described about during the mapping they close it.
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Cross posting for thoughts
OK ladies...we just got done with the telemedicine appt with the IR...WOW A LOT OF INFO!!!!! and I certainly do not remember even half..LOL
So it turns out that newest tumor...the one that went from 1.1 to 1.3 has NO uptake what so ever...she feels when she gets in there its gonna be totally dead (she did offer for my sake, bc I want her to, to blast it with Y90 anyway) lol
If she biopsies anything it would be the biggest tumor the one that went from 4.0 to 2.7...it is also the only one out of the 3 that even has any uptake.
I am not gonna lie I was disappointed not to be able to biopsy the newest..but she said if they are all responding to this treatment (and they are) that, that usually means the tumors are still the same NOT 100% but most likely. She is going to talk to my MO today..and see if she wants me to have 1 more cycle of Halaven which would be on Nov 9th and the 16th... if my MO doesn't care then we will get me in next week for mapping then I will do chemo on the 9th then go back on the 20th for procedure.
I did ask about her using saline to separate the colon from the tumor to blast it...she doesn't prefer to do that based on where my tumor is placed plus the Y90 is better (in her opinion) all the way around especially for the liver itself.
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great news Nicolerod,
Sounds like you had a good talk and your IR is ready to Whack-a-mole. You must be feeling so great to have good response and long term TX plans.
BTW I had my y-90 in the middle of 2 Doxil infusions.
Dee
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Wow Dee really?
Unfortunately I wouldn't say long term treatment as...even my MO said the longest anyone of her patients got on Halaven is 1 year...and I believe JFL got like 8 months...that seems to be the max...its not endocrine therapy where you can get years and years
. But we are gonna go back to Endocrine anyway and hope it works this time around... (maybe thats what you were referring to by years??). lol I may have misunderstood 0 -
Nicole - It sounds like you had a very thorough discussion with your IR. It's fantastic news that only one of your three liver tumors is showing uptake! It's nice that your IR will confer directly with your MO to decide on whether to do another cycle of Halaven before the Y90. Either approach seems reasonable to me. I suspect that my MO would be so excited about your Halaven response that she would want to do another round. Very best wishes!!
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Aww thanks Theresa..it was such a good consult she put up the disc of my PET and MRI...and we spent an hour talking with her.
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