Liver mets: resection, ablation, SBRT, Y-90, anything else?
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S3K5 Yes... Eribulin chemo...was the easiest drug and it's particularly good for liver mets.
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S3K3- I am so sorry your stable mets were too diffuse to use y-90. I'm glad the IR did not close the door.
I understand the frustration and anxiety over this. Breathe!! Process!! and Let Go!! of what you can’t do so you can Focus!! on what you can. I care
If you truly do not have a peace about the anti-androgen then please have a hard talk with your MO ASAP. There are reports on the PFS in trials of your drug- read and learn and decide.
I can’t remember- have you looked at any TNBC trials? There are so many out there. since you are mostly stable then maybe now is a good time to try a trial before going on another chemo.
I have heard a lot of good things about Erubulin and Nicole had good response.
Hoping you get a peace and find the right next step!!
Dee
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I am 3 months out from the Y90 and most of you know my liver still has pain...every single day....a friend mentioned to me that maybe they hit a nerve when they did the Y90?? I sent an email to the Secretary of my IR asking.... I wonder if that is even possible and if that could be why I still have pain and then would that be forever??? OH MY WORD i hope not. Any thoughts or anyone know if this is possible?
Thanks,
Nicole
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S3K5,
I did not have the same situation as you, but when I started talking to my IR about treatments, He was very emphatic about liver failure in the case that he tried to take out all of my mets at one time by any treatment. He always said that if I wanted all of them removed he would have to do them sequentially.
I'm not sure if I posted this before, but if you want some activity, you could ask the IR if there is a size differential in the lesions and, if so, is there some sort of plan that could take out several at a time -- I'd start with the largest first.
Good luck. I feel for you.
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Alabama Dee -
Thanks for the reply. I started off with lymph node mets, now liver, I've had two brain lesions recently that we just zapped; follow-up MRI the end of April.
My previous treatments include:
Taxol - quit working January 2020
Ibrance - did nothing for me
Erubilin - this one did work ... until it didn't in November 2020
Gemzar - another one that showed promise but we moved on after two months
Abraxane - not sure if this one is working on not. One tumor marker going up, one going down. Just finished my third cycle; PET on 4/7. I don't have high expectations on the PET
For the record, I feel fine. I am dubbed the chemo queen as I tolerate everything they've thrown at me with little or no side effects so far. I am not interested in a clinical trial yet. We still have several options open to us. I did get genetically tested and Piqray (sp?) is an option for me down the road.
Since this journey, I know I have witnessed a minimum of two miracles, possibly three. So ... I do have some divine intervention at play, no question (my blog talks about it if anyone is interested .... its a place where I go to tell it like it is, mainly for me and my family but open to all). The least I can do is my part, hence the diet change. I have already realized some health benefits ... blood pressure being one. I typically have great blood pressure but it has been all over the map since I started chemo 18 months ago. It's back to 118/68 two weeks in a row. Plus ... my wrinkles are going away! I don't expect to see any diet related results in my PET this go around, but I am expecting improvement in the next one in two to three months (PET has proven to be the best way to monitor my cancer - elusive little suckers.).
Regardless, I told myself I would give it at least 6 months before I revert back to eating Blue Bell Ice Cream for breakfast ... just kidding; that was not a common practice but it did happen occassionally
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Those that have had Y90 please read/help....
I just read my MRI.... it says all my liver tumors are like HUGE now... is that normal???
Also it did say something about "mild postobstructive biliary duct dialation identified in segment 8".... didn't someone say that the duct can cause high ALK PHOS?? Im so sorry I cant remember who told me that???
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IR called liver has no active disease it was radiation fibrosis from the Y90...also
Ref Y90... Grannax I know you mentioned that your IR said Y90 can only be done 3 times in Liver...did he mean for you? I asked my IR about that and she said she can do it as many times as the liver can tolerate it...and it show to be having good re-growth of liver and liver numbers are healthy and good. Obviously if a persons liver is in bad shape then no they cannot keep doing it. Just thought you all might want to know that... btw I was paraphrasing a bit from her exact words..lol
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Nicole - I met with radiologist today prior to the Y90 on Thursday for me and he said the same thing. No limit to how many times they can do Y90 as long as you have a healthy liver. I think the issue with some people is that they have diffuse mets throughout their liver and Y90 would lead to too much exposure of the entire liver to the radioactivity.
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yes hope thats probably it. I just remember Grannax saying Y90 can only be done 3 times...bc i remember replying back saying "really, I did not know that"...
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HopeandGratitude - Very best wishes for your Y90 procedure tomorrow! I will be praying for excellent results and a relatively easy recovery!
Nicole - Congrats on the awesome results! No active disease in your liver is excellent news!!!!
Theresa
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cross posting from liver mets thread:
Hello everyone. Thank you all for being in my pocket and for offering good wishes and kind prayers. It's Friday and my Y90 treatment is done!! The mapping/prep 10 days ago was a little more intensive than the actual treatment, because they had to embolize a few blood vessels and put in a coil to prevent anything from getting into my stomach. So the actual procedure yesterday was fairly short. And as I had mentioned before, they restricted it to segments five and eight, the anterior portion of the right lobe. So high exposure there but the rest of the liver should be well protected. I'm not sure what the side effects will really be since it's only day one, I'm assuming there will be fatigue and I hope not too much else from the list! Now it's just remembering to keep distance from my husband and the pups and just being careful for the next three days intently and for another four days with caution. I'll have a check up with the doctor in four weeks and an MRI in 10 weeks. Just posting a lot of detail, because this is all very new to me. Praying this procedure takes care of the two active tumors while the Verzenio keeps the remaining eight asleep. I did not have to stop taking Verzenio/exemestane in preparation for the treatment. I will find out in another 10 weeks if the verzenio is still working.
Prayers and well wishes to all my sisters and brothers on this thread. Will take me a couple days to catch up
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HopeandGratitude - I'm so happy to hear that your Y90 procedure is done and that you are feeling well overall!! Thanks for posting your detailed experience! It is so helpful for those of us who will undergo Y90 in the future! I will be praying that the combination of Y90 and Verzenio/Exemestane will be very effective against your liver mets. Prayers and very best wishes! Theresa
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European study on surgical resection of liver mets for MBC
Association between the histopathological growth patterns of liver metastases and survival after hepatic surgery in breast cancer patients
https://www.nature.com/articles/s41523-020-00209-1
"in patients with liver-only or liver-dominant metastases, surgical resection of liver metastases (LM) is associated with survival between 22 and 61 months and long-term progression-free survival (PFS) in selected cases4, serving as a proof of concept for an oligometastatic status in a subgroup of patients. "
BUT they said that it seems to depend what type of liver mets you have, specifically their growth pattern, which unfortunately appears like it can only be assessed at surgery, not from a biopsy. One type of met has a little covering around it and it grows its own blood vessels. The other doesn't have the little covering and tends to just steal the livers blood supply. The type with the covering had better outcomes as far as PFS and OS.
But again, seems right now you can't tell which you have until after surgery. They're hoping we can test for this somehow or learn to tell from imaging because it would identify pts for whom surgery would be appropriate.
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MOTH thank you for your commentary its so easy to understand!!
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MOTH
This is an interesting article. Thanks for sharing. I hope there is a test soon, it would help in making that very big decision of liver surgery.
I wonder if the type of liver tumor growth pattern also has impact on the efficacy of Y-90. It’s all about the blood vessels getting the med to the tumor.
FYI- I was lined up for liver surgery (they would have to remove the whole right lobe for the 2 tumors) but MDACC said no until I had proven shrinkage on systemic treatment. So no surgery
Looking at those survival numbers in the paper makes me glad I did not have that very major surgery. I already have 2 years survival and finally have some PFS! I don’t think I had the better growth pattern because of the rapid progression and great y-90 response.
Dee
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ok all I heard from Bev. She is feeling pretty bad..she is still in hospital ..may go to short term rehab later. So let's just keep her in our prayers for quick recovery. I will cross post.
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I am posting this photo to help others.
I had SBRT to my 2cm liver met 5 weeks ago. I am also on Xeloda.
Today I found out that my recent
angry red rash on my right flank back is latent SE radiation burn.."Radiation Recall". My rad onc is treating me with pentoxifylline, silver sulfadiazine cream, lidocaine-prilocaine cream and vitamin E.
So just be aware. I am posting a photo.
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sandi- omigiosh!!! That looks scary. How painful is it? I hope it heals quickly. Will remember that!!
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sandi- 😳 what a shock I hope you heal quickly and completely I care that you are going through this rare SE Thanks for sharing your experience. Did you have to go off xeloda?
Dee
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Sandi that looks really bad and scary...glad they know what is wrong and they are treating it.
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Hi to all.
From what I understand, Radiation Recall is not understood on why it occurs. The chemo triggers it..weeks, months, years from radiation tx.
Apparently it can happen also when undergoing palliative care tx to bone mets while being on chemo.
I have not heard what to do about Xeloda. My RO and MO are in discussion as this news is only 1 day old. I have started tx for the radiation burn.
My questions to RO are (1) will I be able to have future radiologic procedures (2) will I be able to take future chemos that tend to cause this, like taxanes.
This is rare, but I felt my met friends should know it can happen. My "rash" went undiagnosed by internist, MO and two dermatologists for 11 painful days. The RO knew exactly what is was when seen as it matched the SBRT mapping.
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Wow SandiBeach, thanks for showing us so we can learn!
I don't have anything like that but I have an area with more minor rash & phantom itching. It's a spot on my back which was part of the lung met treatment. It just constantly feels like something like a tag or something is irritiating it or I have a bug walking on it etc but other than once having an actual minor rash there, most of the time it's just a phantom feeling.
I hope yours clear up soon - that looks so painful.
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Nicole - Thanks for the update on BevJen. I'm so sorry that the news isn't better. I've been worrying about her and praying for her...
Sandi - I'm glad the cause of the rash is now known. I hope that t will clear up soon with appropriate treatment! Thanks for sharing your experience.
HopeandGratitude - Are you still feeling ok after the Y90? I hope that your first post Y90 scan will show that the treated tumors are dead!
Grannax - How is Halaven going?
Hugs to everyone!
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theresa45 - thanks for checking in! I’m just over a week out from the procedure and I’m doing OK. First two days no issues at all and then on day three I got hit with fatigue, loss of appetite for a few days, and low grade fever, which they say is normal. Then I seemed to shake that fog and I think I’m moving to recovery mode. Doing normal every day activities, but taking it easy as I am a bit tired overall and appetite is not the best. They told me at least 2 to 4 weeks for recovery and there could be fatigue a little after that. Looking forward to positive results 10 weeks from procedure with an abdominal MRI. I have a thoracic CT (regular scan timing) probably a month or so before then. And of course will start monitoring tumors markers. We did send samples from the tumor biopsy off to foundation one so hopefully will get results from that in a few weeks. It’s kind of hard waiting, but I’m also praying very hard that it was successful.
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HopeandGratitude – Thanks for the update! I'm glad that you've been doing ok and hope that you will feel a little bit better with every passing day. I will be praying and watching for your positive results from your liver MRI in 10 weeks! I truly believe that there is every reason to be very optimistic that the Y90 will have been very effective. I'm glad that you sent your biopsy off to Foundation1. I didn't have a tumor biopsy with either or my microwave ablation procedures late last year, and am regretting that decision. I actually wanted to biopsy, but I was on the DESTINY04 trial and I was already pushing it by asking for microwave ablations while on the trial. Hugs and prayers! Theresa
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cross posting from breaking news thread
SBRT Safe for Cancer Patients With Multiple Metastases
Given the critical need, NRG Oncology NRG-BR001 trial sought to determine the safety of delivering curative-intent SBRT to patients with 3 to 4 metastases or 2 metastases within close proximity to each other.
https://www.medpagetoday.com/radiology/therapeutic...
Love the phrase curative-intent!!
Dee
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Dee - this is exciting news!!!!
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Dee
Does that mean only 3 to 4 spots in your body? Or if you have 2 spots in your liver and 10 in your bones will they do sbrt on liver?
Thanks
Julie
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jjzn
I think this study is for oligometastic which means active mets in only one area or organ. 3 or 4 tumors (depending on the size and location) in the liver can be treated with SBRT with the goal to destroy the tumors and expectation that they don’t return. It is an alternative to major surgery with curative intent. If you have tumors in multiple organs/ places they don’t use SBRT for curative, but can use it for control, like they use cyber knife on the brain, or to reduce the pain of bone mets.
My example is a little different, last year I had a PET scan and the only mets that lit up were in the lung. My large liver tumors were already treated with y90 and considered dead. The tiny liver mets did not light up. So I had SBRT to the lung met. It was not curative intent, but an effort to stop the lung met from growing/multiplying while I find a systemic Med that works. SBRT worked for me- no new lung mets.
At the beginning of my journey, I was offered an SBRT trial on my 2 liver mets ( oligometastatic) but I did not really understand the benefits and was hoping to get surgery at that time. The MDACC surgeon said no until I found a systemic that worked. Meanwhile the tumors grew bigger and I no longer qualified for SBRT- too many fractions of radiation to kill the tumors. And then they spread to the other liver lobe so I no longer qualified for the surgery.
I am interested in that article because of my experience and hope to see more people benefit from SBRT. It is high focused radiation and has its side effects, but seems to be a good tool for the right situation.
Dee
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Thank you Dee for the explanation. That makes sense!
Julie
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