Liver mets: resection, ablation, SBRT, Y-90, anything else?
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"Curative intent"... most oncologists always run away from these words. It is great there are brave people who at least try. Thank you Dee... Saulius
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I have a question for those that got a radiation burn (radiation recall) at the site of SBRT. I have the moist desquamation on right flank and use silver sulfa cream mixed with lidicaine/prilocaine with nonadhesive dressing. Granulation is starting to begin in the open wound.
Has anyone had this side effect and what did you do?
For us stage IV folks, who have both low white blood and platelet counts and also on forever chemo/targeted tx, I would like to get peer input.
P.S I did not stop Xeloda while I heal.
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Sandi
I wish I could help answer your question, but I have not experienced radiation recall with my SBRT. How are you doing? Is the area healing?
Dee
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Dee..thanks for responding. I was hearing "crickets"..haha.
I am still in the "moist desquamation phase of this radiation recall. I am using sulfa silver cream with nonadhesive bandage.
it is an unusual phenomenom, that is why I posted. I had SBRT to liver met and 6 weeks later I developed an initial rash where radiation was super targeted. Apparently being on chemo can trigger this. At 16 days, the center ulcerated..but now healing. My MO said she has seen this with breast rad, but not SBRT where the burn appeared on right back flank.
I have attached a photo.
** I decided to delete the photo of radiation recall. It was a little too graphic, even for me! Basically it is a radiation burn and treated like other radiation burns, that silver cream and nonadhesive bandages.
I will know with June PETCT if liver met was killed and if others are growing..hope not!! Had to wait 12 weeks for everything to calm down.
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Sandibeach
oooh does it hurt? What is the timeline for healing?
It reminds me a little of my double mastectomy skin necrosis(mine was black and not pink) it healed from the outside in. I used the silvidine cream and mepalex bandaging.
Dee
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Yes, it hurts and I have no idea when it will heal.
Do not feel sorry for me as I am still training for a long distance bike trip. Keeps my miind off scans.
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SandiBeach
You are amazing to stay so active! My next scan is in June too. Let’s hope for great reports.
Dee
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OMGOSH Sandi!!!! I am sending you HUGE (((((HUGS)))))
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wow Sandi! You are handling that in stride. It looks very painful and I am sorry you have to go through it!! 🙏 the liver met is taken car of to make this worth it
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Hi to all..you are so kind, especially with your own challenges.
I am healing, but anxious already with June PTCT scan.
I will have questions for my IR at followup..like how is this internal beam SBRT burn different from external beam radiation burn? Both can occur as "radiation recall".
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Sandi - I had an oozy, open wound from a particularly aggressive radiation treatment of a skin met (quarter sized bump) on my chest. My radiation oncologist had me use Domeboro soaks to help speed healing and dry the wound. Here's a description: https://www.beaumont.org/treatments/moist-skin#:~:text=Domeboro%20soaks%3A,for%2015%20to%2020%20minutes.
You can buy Domeboro without a prescription at many (not all) pharmacies. I was also told to keep it open to the air as much as possible. Finally I was instructed to use a diluted chlorine bleach solution called Dakin's solution to prevent infection.
Once the wound was completely closed, I read that lotions containing calendula are most effective for healing the skin after radiation. I used Weleda Calendula baby face lotion.
Of course, I would ask your radiation oncologist before trying anything new.
Best wishes! My wound healed up nicely and the cancer thankfully never returned in that area.
Theresa
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Hi Theresa45! Amazing what we undergo to heal from rad burns. I had chest wall external beam rad 15 years ago and do not remember how that blistered skin was treated..
I had SBRT (internal beam) to a liver met. Six weeks later, while on Xeloda, I developed a severe radiation burn at the site.
I cannot find in my literature search other folks like me who experienced this with SBRT, especially weeks after completion.
Just hoping there were peers out there in BCOland that had similar experience.
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SandiBeach, I had a look last week because I was super curious about the patch I have on my back - the itchy/I have a spider walking on me area, which looks just like it's been tanned in a 10 cm circle.
I did find literature, primarily a few case studies, that radiation recall dermatitis RRD can be from SBRT and can occur months after treatment.
This mBC pt had traditional rads to breast & lymph nodes + SBRT to bone mets. RRD to all areas after starting a CDK4/6 inhibitor! so not just chemo can trigger it.& it was a *year* after finishing rads.
https://www.sciencedirect.com/science/article/pii/...
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Moth..fascinating case study. Thank you
My IR said he sees RRD in external beam rad with mainly the taxanes. So he has never seen in his patients the RRD in SBRT with Xeloda. I did not stop Xeloda while healing. Feel fine..no further skin damage.
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Well My husband and I met with the RO today and he feels it is now time to radiate my sacrum. He also feels that my Glute pain could be from the Sacrum as well. So they will do the molds this Thursday.
My RO mentioned he wont be there Thrusday but his colleague would be there but that he will be there for the actual Radiation, and that will be everyday for 10 days. So my question to you all is ....Is this like Y90 where its like getting mapped out this Thursday bc I feel upset and worried that hes not there for that??? I am going to cross post.
TIA for your replies
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nouvelle- I think you will be ok. I did not see my RO the day of my mapping for my current chest radiation, just the techs. I don’t know if he reviewed them that day or not. He called me the next day after reviewing the scans and talking with his co- worker. That being said, you can call them and ask how it works if he isn’t there the day of mapping and request that he is. Never hurts to ask. Worst case is that you do your mapping as planned on the day he isn’t present; best case is they change the appointment to A day he is.
I wish you all the best. I just finished day 8 of 10 today.
A side note: I had to get my mapping done the next day as their special CT machine was down for 2 weeks after that. Had to take work off. Nothing ever goes as planned.
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nicole- I have no idea why it autocorrected your name to nouvelle. Sorr
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LFF no worries
. Glad you are almost done.On a side note...I guess the Affinitor is not working yet....now my C7 and T3 are hurting again....
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For those who had Y90 treatments and also track TMs, how long after the Y90 treatment before the TMs started to decrease? I just had the Y90 treatment on April 22, not quite 3 weeks ago. Had bloodwork done at MO appointment yesterday and all my markers were the highest they have ever been. Really shot up in one months time. I am not sure if the Y90 treatment has any impact on TMs that would cause them to go higher before dropping, but I was really startled that they were not at least stable compared to 1 month ago. Of course it has me concerned that there is something else going on. Scheduled for thoracic CT and bone scan in early June an abdominal MRI around Jul 1 (10 weeks after treatment).
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So I have spots on my liver, and a tumor on breast tissue in my armpit. It's not a lymph node, it's actual breast tissue that was left over after my bilateral MX in 2014. Is that oligometastatic, because there are only mets in one place, in addition to the primary tumor?
It still feels really weird to me that there's no plan to get this lump out of my armpit. Does anybody get breast surgery after a stage 4 diagnosis?
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Hope sorry I do not track TM's they have never worked for me....but you and I will be scanning same time frame...my MO just scheduled C & T spine MRI and Boney Pelvis MRI June 2nd
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Nola, That sounds like oligometastatic to me. I think part of the definition includes 5 or fewer lesions. Some people do get breast surgery after stage 4 diagnosis. I am one who did. I had a lumpectomy after about 10 months on Ibrance/Letrozole shrunk the primary and liver tumors quite a bit. I believe many MOs look for response to systemic treatment before recommending a surgical consult. And mine wouldn’t have done it all if I hadn’t asked about it more than once. My new MO seems more aggressive and may have initiated it herself, but I had already had the lumpectomy when I started with her. She did suggest ablation to my remaining liver mets, which I had in February.
For anyone who remembers me writing about possible “residual neoplasm” in my post ablation CT, my MRI today showed “nothing suspicious for residual or recurrent disease in the ablation areas, and no other hepatic disease demonstrated’. I’m very happy about that, and also happy to get the report so quick. I know things can change at any time but for now I’ll enjoy that
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oligometastatic does not have a formal definition yet. Some of the radiation/SBRT trials were using
, some <5....now there's a trial running with <10. And some consider size and location and number of organs, while others don't. It's a really "young" concept that they're just beginning to flesh out & start to define. We also have developing definitions for "oligoprogression" Some stage 4 breast ca pts have surgery but we don't yet have super strong evidence about it. One newer study showed some OS benefit but previous ones did not. If it's an easily accessible lump that would be a small day surgery, I can see pushing for it. One thing to remember with having a metastatic cancer is that the whole system is messed up which makes all surgery more dangerous for us due to higher risk of clotting disorder, higher risk of strange immune responses, higher risk of infection etc (even though we might feel fine & our labs might look good but when you disturb the system too much it can go haywire fast). So the risk/banefit calculations have to include all that.
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Rosie- great news!!! Happy Dance for you. 💃🏻
Nola- so sorry about the breast met. are the liver mets behaving or dormant? When my liver mets were not active, I had SBRT to a lung met that was considered oligometastatic at the time. I would ask if they could treat that breast lesion locally with SBRT if not with surgery. MOTH brought up some good points to consider. Hope you get a good plan that works!
Dee
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I'm still on my first month of Kisqali and haven't had any repeat scans yet, so we don't know how I'm responding to it.
I talked to an Integrative Medicine doctor who recommended getting Thymosin Alpha 1 peptide injections to boost my immune system. He was a medical oncologist before going into integrative medicine so he's not a quack, but I don't know how my oncologist will feel about me adding supplemental treatments on top of my kisqali/femara/zolodex cocktail.
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Just a general note - not related to the above messages:
My experience about Y-90 to the liver: I should have pushed for this procedure sooner rather than wait for the 'systemic' therapies to work first.
In Oct2020, when she was asked by my MO to do a microwave ablation on one of the larger liver lesions my IR had said that I should go for Y-90. I should have heeded her advice. Six months later, I asked my IR if Y-90 is still an option for me. She said that based on the MRI, my liver is so full of tumors that Y-90 would cause liver failure and that "I'd pass very quickly".
SO IF Y-90 IS SOMETHING YOU WANT TO CONSIDER, DO IT NOW NOT LATER !
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S3k3
I hear your frustration. local therapy treatments are not as utilized, recommended, or even understood in my opinion. If it weren't for this thread, I would not have known about the Y-90 (liver) or SBRT(lung) that I pushed for.
I hope your systemic knocks out those diffuse mets. I unfortunately got diffuse mets a few months after y-90 because my systemic wasn't working. At least the y-90 reduced my tumor burden and bought me a little time to keep looking because those big tumors were growing fast and now they are dead.
I asked if I could get y-90 to my almost 3cm tumor while on my trial and they said no- it is one of 2 RECIST tumors they are watching. It is stable for the last 16 weeks and hoping it is shrinking- I will know in June
Dee
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Dee, what was your systemic that killed those big mets?
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SandiBeach
I hope I wasn't confusing. Y-90 killed the big mets last year. The only systemic that I have had stable disease is my current trial of ARV-471. I started it in Dec. 2020. My 6th line.
I got 6 months on Afinitor/Faslodex but it allowed diffuse mets. The trial for cdk 2/4/6 allowed the 2 RECIST tumors to grow. So now I have 2 measurable tumors and diffuse mets in the liver. But I am stable and hoping for shrinkage.
Dee
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I guess maybe I should have posted here...I made a new thread asking about PROTON THERAPY...has anyone done it? If so on what, bone or organ?
Does anyone know if its good for bone mets?
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