Liver mets: resection, ablation, SBRT, Y-90, anything else?
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Thank you all for your responses! Much appreciated and very helpful. Especially on different ways to balance local and systemic treatments when I have to. Good questions for my MO. My tumors are all in bad locations for ablation so that won't be an option for these tumors. I have 8 across both lobes. "small" right now - 1.5 cm to less than 1 cm.
JFL - you hit the nail on the head and put in clear perspective how the Y90 treatment works and why "vascularly active" tumors are necessary. Thanks! helpful in discussions with my IR.
Happy New Year everyone!
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HopeandGrattitude,
When I had y-90 there were just 3 tumors in my liver that needed treated. (They also saw evidence of very small ones that could not be measured.) The goal for me was to stop those bigger 3 from growing and reduce my tumor burden because I could not find a systemic med to get control(still working on that). Y-90 worked fo me and can still be an option to reduce tumor burden in the future according to my IR. All 3 treated tumors (2 y-90 and 1 bland) continue to reduce in size and do not light up on the PET. I was on doxil and did not have to stop my treatment- just scheduled y-90 in between infusions.
Best wishes in local treatment decisions!
Dee
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Thanks Dee! Appreciate the information.
Thinking of you and praying this trial is working for you.
Happy New Year
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I am gonna cross post this...
So I was 16 days out yesterday from my Y90...last night to relax I took a bath with epsom salt...I used regular plain Epson salt and little of the one that had lavender smell *****NOTE: I have used both of these numerous times in the weeks prior to my Y90***. Well...last night I got out of the tub and the light was out in the bathroom so I didn't see this...but this morning there was a puple like color in the tub where my back and arms were I will attach a pic...even bleach is not taking this out????!!!! I did dry brush prior to the bath, but I have done that before and this never happened...I did not and do not wear any lotion, oils etc..nothing! Could this be from the Y90 isotope??? I googled but found nothing.in the pic we already had thr bleach on it so it looks light but it was dark purple
I do usually take a Benntonite clay bath about 3-5 days after PET scans ya know to pull out the radioactive stuff...but I didn't know epsom salt could do it too?? I am thinking thats what happened?
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Just posting here for future readers -- last Thursday, I had my first MRI after my second microwave ablation to the same spot on my liver (pages ago, probably, I described how they missed part of the tumor on the first round on Oct. 19th; second round was December 11th.) I have had an interesting time after this repeat round. Have had a lot of intermittent nausea, reactions to certain smells and texture of food, etc. Have tried to sleep a lot. Have had some intermittent pain in various places along my liver. Many days since Dec. 11th I have just sat around reading and doing literally nothing because I've felt out of sorts.
MRI seems to read like they got the remaining tumor tissue; I have a video appointment with my IR this coming Friday and will know for sure then. But the liver is still swollen, and it sounds like there may be some free fluid around the liver and that the spleen may have been nicked? or disturbed? or something else. I assume that all of these things added to my discomfort over this last month+.
I still believe in microwave ablation and other liver procedures. But this was all very different from my first procedure in July of 2019 re recovery, overall energy, etc. I just wanted to put that out there.
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BevJen - Thats for putting this out there. The accumulation of these varied responses is really important for people to understand - they can be different from person to person and within same individual. I am sure so much of it depends on where the tumor is in the liver and what is in the surrounding vicinity. Like you, I would never say "no" to local treatment, just have to go into it with eyes wide open. You did the smart thing by resting, taking care of yourself and letting your body recover. You mention that this procedure seems to have taken care of the "miss" issue and that's awesome. I hope you have a full recovery and you receive further good news.
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BevJen, Thanks for explaining your different recovery experiences with your microwave ablations. I hope your symptoms, especially the pains and nausea, will fade away before long.
I saw my MO today and she suggested I have a consult with an IR about possible ablation. She was hoping to get a clearer picture of my liver mets with a recent mri, but the report turned out to be very vague. Apparently the contrast I got was not the preferred one and that limited the info. MO thinks the consult will give me more understanding about the process and also finally get us approval for a pet scan which my insurance is refusing so far. It may be a while until I know any more but I want to tell you all that I appreciate all that you've shared here. It's a big help.
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Rosie,
That's really interesting about the MRI with contrast. I think I've posted here before that my IR swears by MRIs with contrast to get the best view of the liver. I'll be curious to see why your doctor thinks a PET would be better -- my understanding of PET is that it shows how "active" mets might be, but doesn't necessarily delineate them any more clearly.
It will also be helpful for you to talk to an IR so he/she can tell you about other options that perhaps could be used in your situation. There are several, depending upon location of your liver mets, and also the number and size of the mets.
Good luck in getting in to see an IR. And please let everyone know what information you obtain. It's helpful to all of us.
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BevJen, My MOs seem to be believers in using contrast. I've had 3 for the abdominal area,each about a year apart and all with contrast. I'd be happy to go without it. I'll be interested to hear what the IR decides he needs to see, and what can be done, if anything. Thanks for responding.
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Rosie,
I always have contrast in any of my scans. What I find confusing is that trying to compare scan results from an MRI to a CT to a PET to a nuclear bone scan -- they do all seem to display mets differently, and the write-ups are also very different -- so it's hard to figure out what's really going on.
Last summer, I asked my old radiation oncologist to go over all of my scans and to tell me what she saw -- that prompted even more testing, on her orders, and then I was more confused than ever (this mostly on bones, though). Recently, in addition to the MRI of my liver, I had a CT scan (last one May 2020) and nuclear bone scan (last one May 2020). Results on CT re bones -- everything looks the same. Results on nuclear bone scan -- lots of changes. All very upsetting bc we almost need to be doctors ourselves to figure out what's going on.
Anyway, good luck on the IR consult and hope you get some answers.
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Checking back in. I had a consult with an IR today about possible ablation. He explained a lot about the procedure of microwave ablation and answered my questions as well as he could. No one can really answer, is it worth doing this when we know cancer can reappear at any time? He answered it without answering, saying with my situation of two shrunken mets and no new ones over my time on I/L, ablation was standard of care. I wasn't aware of that. IR had booked me for ultrasound as part of the appointment so he and his colleague could try to visualize the mets. Tech ran the transducer, the docs looked on and one clicked away at saving images. DH was in the room and found it very interesting. They did see them and he said my mets were amenable for ablation, do I want to move forward? I said I did. So I’ll wait to hear from the scheduling person. IR guessed it would be mid to late February.
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Rosie,
Glad that you got to see the IR and now have this set up. I've not heard that this is standard of care, either, and I'd bet it's news to a lot of MOs. Also glad that they could visualize them on ultrasound -- that will save you some radiation during the procedure.
Make sure, when you are settling details, that you ask for some pain meds. You will most likely have a little bit of pain for the first few days. Also, though, if your system doesn't play well with things like oxy (as mine does not), ask what else they can give you.
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Rosie 24
Standard of care!! That’s fantastic. Hope it goes well and whack-a-mole the remnants of tumor hanging around.
Sounds like you have a great IR.
Dee
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Rosie, Yes! I was happy to hear standard of care. It shouldn't have to be a battle to get the right treatments.
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Thanks Bev, Dee, and SeeQ for the responses. I think the IR’s standard of care comment was specific to checking certain boxes having to do with the size and number of mets and maybe relative stability? It would sure be great to know all the particulars but he did a lot of explaining and I probably don’t have it all as he said it.
I’ll add one more thing about my situation. One of the mets to be ablated is in segment 5, near some of the bowel and possibly the kidney. He said he’d need to protect them (using fluid) which makes things more involved and would require full anesthesia rather than twilight. I’m ok with that. Just somewhat nervous in general.
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Rosie,
One of my lesions was in segment 5 -- the most recently ablated (for which I had to have two ablations bc they missed all of it the first time, as I posted before). My IR did not do anything special, but I'm all in favor of it, given that you want stuff protected. I've read about them using fluid to protect -- not done with me, but not something to be nervous about in general. I'm sure it will go well.
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Gosh, I can’t believe how long it’s been since I have posted here.
Those on the liver mets thread know all about what has been keeping me busy for the past few months.
I seriously believe in local TX for liver mets. YES it should be standard of care. It’s amazing that I still believe even after having such a horrible time with MWAs.
Rare complications happen. That should not stop us from looking at the good these TX usually give us. I got a lot of time, about 2 1/2 years from my two y90 TX ( 2017 and 2019). Even though my two MWAs ( November and December 2020) took a really long time to recover from, with several painful complications, the MRI showed they did destroy the four tumors my IR ablated. Success sometimes takes perseverance.
For me, now, I have to focus on systemic TX, Eribulin, to get my remaining diffuse ( my IR said 100 but who knows) tumors in my liver and the progression in my lung. That sounds daunting. Eribulin is the only drug I haven’t already had. My IR says I’m not a candidate for a third y90, my body responded so off the charts to MWA that my PCP hopes I will never have to have one again. So, as far as I know, I’m stuck with “Eribulin needs to work” I won’t know till April.
But, I gave local TX my best shot and I would recommend it to all with liver mets.
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Rosie, I was told that my segment 2 lesion was close to my bowel, so the IR had to use fluid to separate the bowel from the liver while doing the microwave ablation. So, you're not the only one and I did not have any damage to my bowel. Microwave ablation of colon cancer mets to the liver have been considered standard of care for awhile, so thankfully the IRs have a lot of experience with microwave ablation. I'm thrilled that your IR thought microwave ablation was standard of care for your breast cancer liver mets!
Grannax, I will be praying that eribulin is very effective for you! You ABSOLUTELY have been a pioneer and an inspiration in local liver met treatment! I'm very happy that the microwave ablations wiped out the four treated liver mets, especially after the difficult recovery!
Theresa
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It seems that microwave ablation and Y90 are the two most used targeted therapies. Is this correct?
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SandiBeach,
Re local liver treatments -- Maybe, maybe not. There are newer treatments, such as cryotherapy, too, and some IRs rely on treatments like TACE, where they actually inject any tumors with chemotherapeutic agents. The field of interventional radiology seems to me to be exploding.
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Judging from how busy my IR is, I agree, his field is exploding. Rightfully so. He has so many tricks up his sleeve, but I think he does y90 the most. Good question.
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Well..here I am searching this thread for info and advice. Seems I have a lot to read.
I have been on Xeloda succesfully for 10 months...liver was full of quick growing mets, now down to one small one that is still metabolically active. It is either dying or growing and my MO doesn't want to wait for that answer.
So I will have SABR for that one. I am actually looking forward to its demise.
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sandibeach-that sounds like a great plan. I am glad the xeloda is working for you. I was able to be on it for 5 years. Hoping the same gor you.
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Sandibeach. Great news about Lady X and local TX for that stubborn one.
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Ok so it seems I am the ONLY person on this website that I can find that has had such a harsh reaction to Y90... The first 5-6 weeks my stomach was HORRIBLE hopsitalized 2 times...Then week 7 my liver started hurting hospitalized for a week...I am now as of Feb 22nd will be exactly 2 months out from the procedure that was done on Dec 22. I still have pain in my liver...it feels exactly the way it feels when you run to much and you get a "stitch/cramp". how you are unable to take a deep breath or the pain get worse...also I (and others) if they put their hand on my ribs (where my liver is) we can sometimes feel what feel like gurgling..or almost what your chest feels like when its consgested and you can feel it in there...but in my liver. I am beginning to wonder if it's die off...I asked if my liver pain (before feeling the gurgling) 2 weeks ago could be from die off...she said she didn't think so...but a lot of the pain either is high up on my rib cage where my old cryoblation was done (Oct 2019) and also down by the bottom rid on my side which is exactly where the Y90 was done (near the colon wall).... Just wondering if anyone has heard of this or anything.
I have now stopped all MEDS and began taking Ibprophen 3 times a day. I just don't feel like the didlaudid and the patch were taking my pain away so why take them......I will cross post this for maximum exposure.
TIA
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I've posted in a couple other threads but will add here too. My doc said the microwave ablation went well. I've finally come out of the anesthesia sleepiness and fog and feeling pretty good. just a dull ache in one area and trying Advil and avoiding heavy stuff if I can. I'm hoping for no big spike in pain but I know it happened to some of you. Doc got the two mets he was planning on and couldn't find the third one that's been mentioned in one report. I see him for follow up in a month, either in person or telehealth, up to me. Glad to be done.
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Rosie,
Glad that you got through it and that you're feeling okay. Take it easy for at least a few days so you can heal some.
It's possible that the third lesion was too small to spot, or that it's receded.
Get some rest!
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Rosie 24
Glad to hear your ablation went well. I hope you have an easy recovery. Stay on top of any SE and rest well
Dee
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Rosie24, wonderful news your ablation is over and it went well. Hoping for a speedy, but restful recovery for you. Take it easy.
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Good news Rosie. Give yourself time. Rest and recuperate.
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