Liver mets: resection, ablation, SBRT, Y-90, anything else?
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I was just reading an article in a newsletter on Nanoknife and thought it would be of interest here. Sorry the article, a case study, is in German. Long story short a woman achieved NED after CT-guided Nanoknife treatment of her liver metastasis. Also called irreversible electroporation, it uses electric currents to kill tumors and is noninvasive.
Some info in English
http://www.theprincessgracehospital.com/hospital-services/services/nanoknife/
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Shetland Pony-I returned to work full time the following week. I worked those 2 weeks and then had 2 weeks off for Christmas. I was very fatigued during the 2 weeks that I worked and looking back I should have taken some more time off. I just thought I could handle it until Christmas break. I had no pain but I did have nausea for about 3 days. I literally got nauseous on the table when the procedure started. They gave me some medication which seemed to control it until later that night after I got home. It is hard to tell you how to plan for it because I was certainly not expecting the reaction that I had and neither were my MO and Interventional Radiologist. Our bodies all react differently as demonstrated by how great Grannax2 has done with her procedure.
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Thank you for sharing. It sounds like after a week or two I could probably handle rehearsal and performance commitments if I took time off from other things. Yes? But not good if I look like I've just been through, oh I don't know, cancer treatment or something...
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Hi all. This thread is very valuable. I know this has been brought up more than once, but could someone clarify which of these treatments (if any) works for extensive liver mets? Seriously considering one of these, if I qualify.
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JFL, I think it depends on what you mean by extensive -- many locations vs. compromising liver function and health. I was told that while most local liver treatments are not for multi-focal mets, radioembolization is one that is appropriate for multi-focal. Rather than aiming at a one or two discrete tumors, this treatment is more like whole-liver radiation. (But since the radioactive beads are introduced into the bloodstream, tumors end up getting more since they are so vascular.) The radiologist also said that there is a window of opportunity. I believe the liver has to be functioning well and the patient should be otherwise healthy, for it to be safe. I'm not an expert, but that is what I gathered from our discussion. So maybe you can meet with an interventional radiologist who does the procedure and ask if you are a candidate. Have your onc talk to the radiologist.
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Thanks for the reply, Shetland My liver function is normal with no issues. I will look into radioembolization.
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The countdown has begun for my next y 90. It's 9 days and counting. I still don't have my questions answered. I go to my MO tomorrow maybe I will ask her, although I think I'm her first patient to have a y90.
Meanwhile, I'll be busy this week getting ready for my trip to see my grandchildren....more T Ball and dance recital this weekend.
I hope everyone had a great Mother's Day, I did. My daughter and her husband took me and his mom out to dinner. My son had to work nights, but I'll see him this weekend.
I don't have time to be anxious this week, that will have to wait till next week. Ha
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Hi all! I was just diagnosed stage IV off the bat in March with 2 liver mets. Are these procedures something you do as a first line of treatment or further down the road? I'm currently doing chemo and was just wondering when this is usually an option... This is my first course of treatment and although we haven't done scans yet, it appears to be working on the breast tumor. TIA
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Eicats I'm not sure.in my case I was DX in November and started on Ibrance and Femara on January 5. After my first PET scan at 3 months of treatment, there was one tumor (of about 8) in my liver that was getting worse. My MO suggested Y90. I had a consultation with an interventional radiologist who specializes in this procedure.
So I think your MO would want to see your first scans before recommending for you. Although I'm sure you could have a consultation with IR on your own.
What chemo are you on? After you finish it, then you'll probably have hercepton. Sometimes chemo has to be stopped before you can have y90. That might not be good if your tumors are responding.
I also have an extensive 25 years of BC and MBC. This time it's in lung chest and liver.
Hope you can find a more definitive answer.
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Eicats - Typically you do a systemic therapy first. In fact this approach is generally not considered a "line of treatment"/ For a long time local treatment of mets was only done to relieve symptoms or if they impaired organ function. It is really only recently that local treatment of the liver was done to hold the cancer back like any other line of therapy.
t was considered a "line of therapy". If you are interested, look up the biggest baddest specialist you can find nearby, make an appointment and ask them what they think the right time is. Your MO is unlikely to know or believe this is the way to go. That is not how they are trained .... and using this as a treatment is very cutting edge.
>Z<
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Eicats- My MO recommended the y90 for me in 2015 after I finished chemo and we did not get the results that we wanted. I am glad it is becoming more of an option for breast cancer patients.
Grannax2-enjoy your week. I do not remember the questions you were trying to get answers for. I hope your MO was able to help you.
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I saw my MO yesterday. She was surprised at how well I'm doing this month so that was good. I asked her if she knew why IR said it might be harder on me this time than last time. She said probably because I have a cluster of tumors where the two lobes join and some other ones so he is going to try to get to all of them. She says we'll plan for it to take longer for me to recover but still hope it won't. Some of the SE's I'll know to expect so this time they won't frighten me. As long as the yitrium gets to all the tumors I'll be grateful. Seven days and counting.
She is going to postpone my 3 month PET to 4months. I was not surprised because if scans are done too soon after y90 tumors sometimes appear to be larger. It may take even longer to see an accurate picture of the liver tumors response to y90.
I'm just glad I'm a candidate for this TX, it makes me feel like I'm doing all that can be done to reduce the size of my tumors. Hopefully, in July, they will see more response of the tumors in my lung and chest from Ibrance and femara.
I'll post all details of my next big adventure next week. I dread going through it again but I'm eager to have it done. Conflicting emotions seem to be a big part of coping with TX for MBC. I can see by the comments here, I'm not alone in these feelings. That helps.
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Thank you for the update. Your courage is an inspiration to me.
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Grannax, I hope the next round goes well!
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hugs grannax. keep us posted. appreciate your posts. reading with interest.
>Z<
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Yes go Grannax, best wishes and speedy recovery. I appreciate the info we are getting from you1
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Thanks friends for all the encouragement. I never anticipated, when I was DX in November, that I would have new friends from all over the USA and many other countries as a result of MBC. Grateful
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Thank you ladies! I am on THP (docetaxol, herceptin and projeta) and was initially supposed to have 6 rounds before doing surgery and switching to just Herceptin. However, when they found the 2 liver mets, they said we'd do this treatment until it stops working or I can't handle it anymore. I've had 3 treatments and handling it fairly well so far. The tumor has shrunk some from just feeling it but haven't had a scan yet. I was just curious if and when this might be an option and if I'd need to be my biggest advocate which is what it sounds like in most cases. I'll ask at my next MO appointment just to see what she says..
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24 hours and counting. I won't post every hour but I will keep you updated on my last y90.
I had a fun weekend with family watching T ball and dance recital. Next big event will be 13 days after my y90. Aubrie will be in the play Jungle Book. My goal is to feel well enough to drive down and enjoy the show.
Pray for me that I can put up with my talented but not so charming doctor one last time.
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Grannax2- Wishing you a fast and easy recovery tomorrow from your Y90 procedure. I sure hope you get to go to your family events! I am sure you will meet your goal!
I just got some great news today! My scans came back clear for the first time since I was diagnosed stage IV with liver mets almost 2 years ago! My MO and I talked about it today and we both think the turning point was the Y90 procedure I had in December of 2015. It completely got rid of one of my tumors and shrank the other one. I am so thankful that my MO recommended this procedure for me!
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Great news BabyRuth! Congrats!
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I want you had, I clean scan! If it takes two years after y90, I'll be fine with that. Such encouraging news for me to dwell on. I hope you are having a celebration, BabyRuth.
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Babyruth, what good news. The encouragement is timely for me, as I have about a week before my next appointment, where I may find out it is time for me to move forward with radioembolization. I hope not yet; I have plans for this summer. Then again, it hasn't done much to stop Grannax2!
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Chearing you all on, watching closely.
>Z<
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I'm watching closely too. Great news Baby Ruth and Grannax. Keep on moving!
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I survived! I haven't had any SE, yet. It was a much better experience than last time. I also found out some interesting, actually a little terrifying, about what really happened during my y90 on April 17.
As i was wheeled up to the surgery suite ( I think it's actually the cath lab floor) I was awake and talking to all the nurses up there. They all remembered me. I was surprised until they told me why. They said you're the one who turned red, we're not likely to forget you! I said What?!? Yes we were fanning you and trying to figure out what was happening. We think it was a reaction to the iodine/ contrast. I said but you premedicated with 125mg of steroids and benadryl? They said this time you will have more steroids because we don't want you to turn red again. I said me either. They really listened to me and asked me a lot of questions. Yes I was still awake as they were prepping me. They asked about benadryl and did not give it to me when I told them it works opposite on me. I said it does not make me sleepy, it makes me hyper and my legs jerk around uncontrollably. I guess that would not be a good thing during this type of procedure. I remember a lot of things but they didn't seem to bother me. They told me they were changing the draping to expose the area of access (if I was seriously awake I would have been embarrassed, so I must have had the I don't care medicine). Then Dr. VanMeter came in to start the cath. I remember there was a lot of pressure. He explained there had to be to control the bleeding. Then I guess I was more out for awhile. I remember I asked them at one point if they had forgotten about me. They all got a good laugh out of that and said No we're still here. Then I remember being in the scanner for a long time. It was like the bone scan machine, not a CT.
So that is my long winded, detailed story of yesterday's adventure. Quite different than last time when I remembered nothing. I guess to summarize I have to say that each of my three adventures have been completely different experiences.?!? I don't know how that is going to help any of you get prepared for your y 90, except that I survived all three.
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Ok, Grannax. You did it! What a strange experience. I think your post does help us get prepared as it reminds us to get details about what drugs will be given and what will happen. That way we can tell the medical people details they need to know, as you did when you told them how benadryl affects you. And I know I am more calm when I know what to expect and what is going on. It will be interesting to see if your medical records give any details about your episode of turning red. That could be important in the future, but based on my experience and I think Zarovka's, I am getting the idea that they don't want to write these things up. Thank you for posting. Rest well!
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Grannax2- I am glad you are done and home resting now. What a crazy experience to hear about what happened at the prior one.
ShetlandPony- I was awake during my procedure and the IR talked to me during the whole procedure about what was going on. I checked my electronic medical records to verify and I was given fentanyl and versed for sedation. I have copied and pasted the summary of my procedure so that you all can read about it. it is a lot of medical terminology but my be informative for you.
MEDICATIONS: Fentanyl and Versed titrated to sedation. Moderate sedation
was performed under my supervision for 28 minutes.
TECHNIQUE AND PROCEDURE: The risks, benefits, complications and
alternatives to the procedure were explained to the patient and
understood. The patient was brought to the interventional radiology suite
and placed on the table in supine position. The patient's left wrist was
prepped and draped in normal sterile fashion. A time-out was performed.
Utilizing a 22-gauge single-wall access kit, the left radial artery was
accessed. Using a 0.018-glidewire, the proximal left radial artery was
accessed. The needle was subsequently removed and a 4-5 French Glide
Slender Sheath was advanced into the artery. The inner dilator and wire
were removed. The bag was subsequently connected to a Flush catheter.
The mixture of heparin 3000 units, verapamil 2.5 mg, and nitroglycerin 300
mcg were infused via a 20 mL syringe mixed with normal saline.
Subsequently the 5-French Jacky catheter with a Bentson wire was used to
access the superior mesenteric artery. Superior mesenteric entering was
performed. Subsequently the Jacky catheter was used to access the celiac
artery. Digital subtraction angiogram was performed. Subsequently a
2.8-French Renegade High-Flow catheter plus 0.014-glidewire were used to
access the common hepatic artery. Digital subtraction angiogram was
performed. Subsequently the combination was used to access the right
hepatic artery and digital subtraction angiogram was performed.
Subsequently radio-embolization was performed at the level of the right
hepatic artery. The microcatheter was withdrawn into the 5-French Jacky
catheter and subsequently in a systematic manner the catheter withdrawn
and the catheter discarded.
A TR band was placed at the left wrist site and the sheath was removed and
the TR band was left in place for hemostasis.
The patient tolerated the procedure well and left the Interventional
Radiology suite in stable condition.0 -
Thank you very much, BabyRuth. So the versed did not make you "sleep"? Did you feel pain? I "woke up" during port placement using those same drugs and groaned to tell them I was feeling it. I heard a brief exchange between the doctor and nurse then went out again as they gave me more drugs. It wasn't traumatic, but I wish I knew more about it. It may be that my dizziness at the beginning made them think I had enough drugs, when actually the dizziness was from the strong whiff of alcohol. Nothing about that incident appeared in the report. So I will need to talk to the anesthesiologist beforehand. I think they would need to use my thigh as it appears they did for Grannax as my right arm is at risk for lymphedema.
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No. I did not "sleep" at all. I was awake during all 3 of my port placements also. I have been very lucky and never had any issues with major pain. The only pain that I remember is just a very slight pain and a lot of pressure as they accessed and put the catheter in my left forearm. I did get nauseous when the radio-embolization started and they had to give me something which I just realized is not noted in the report so I do not know what that was.
Most of these procedures do go through the groin. My IR likes to offer the option of the forearm because you do not have to lay flat for the 3 to 4 hours after the procedure. I was willing to give it a try and it worked for me. I also am at risk for lymphedema on my right side due to having 14 nodes removed. Did not have a problem with the left side at all.
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