Liver mets: resection, ablation, SBRT, Y-90, anything else?
Comments
-
NicoleRod —Here is my situation
I had multiple liver mets before I had chemo( taxol+carboplatin), after 4 cycles, only 2 left (1.2 cm and 0.6 cm), I then have another 5 cycles of Carboplatin only, the 2 old ones are stable, no SUV uptake, but 2 new ones popped up (2.5 cm and 0.8 cm). I keep postponing the chemo due to the low platelet side effects from carboplatin . Up until today I am already off carboplatin for 4weeks, the platelets are growing up slowly(67), but still not enough for me to get another cycle of Carboplatin. It’s time for new treatment regimen.
My next regimen is olarparib, not chemo. My MO just prescribe the drug yesterday so I am still waiting to get the new drug.
I also have multiple bone Mets, they are continue healing. I had double mastectomy 10 years ago so I don’t have any mets in my breast.
All my other liver numbers AST/ALT/….are good.
Hope I explained everything clearly, yesterday I was so frustrated, but today I feel better. I should have ask my MO what data she is taking about. She is so busy every day, I feel I don’t have enough time taking science with her. Maybe I asked too much.
0 -
Sandi...when I had Y90 (as you know I wound up being off all meds for 4 months) but the standard is usually a week or 2 prior to Y90 and 2 weeks off after. I was told you absolutely cannot be on chemo and get Y90 you must take a break like I just mentioned....and Yes I progressed elsewhere in spine mets...
0 -
Thanks NicoleRod. Your input matched my research. Since cancer masses are in both lobes, will ask if I can do worst lobe 1st, then chemo, then 2nd lobe. Probably too risky.
I don't have solid lesions, they are heterogenous masses. That is why they had to take multiple cores as some might not show cancer.
Just want to eek out more life like the rest of us.
How are you, by the way? When is next scan to see if A/F is working?
0 -
I'm ok. Scans in July fairly positive Afinitor/faslodex not working bc my spine mets still hurt....but I wonder if they would still hurt if I was stable? I've *never* been stable so I don't know.
0 -
Yes, they can still hurt if you are stable Nicole.
0 -
Thanks Sadie...heres to hoping thats it!
0 -
I will assume microwave ablation is the same as RFA, Radio Frequency Ablation? I know when I was considering this 20 years ago they had been training surgeons at the Cleveland Clinic but very little research was being done into this approach, especially for MBC. The surgeons that were trained in RFA recommended it, the surgeons who did liver surgery recommended the surgery (one immediately made an appointment for me). The RFA doc had me wait a while to see if systemics would work, and it did and then I didn't need the RFA . I finally had surgery 15 years later, a blend of RFA and surgery, whatever it took to get ride of the two mets, and 2 cysts along the way. 4 years later mets came back to the liver but disappeared with Xeloda for the past year.
0 -
Mapping for Y90 completed. The IR did not see any areas that would need a coil placement during mapping to prevent Y90 leakage,eg, lung gastrointestinal. So that is good.
My MO, RO, IR will meet to determine the next best step that is specific to my cancer. The IR thought I could handle both lobes at same time. Still waiting for Path and F1 reports.
While healing from SBRT for a single lingering lesion, my cancer became resistant to chemo and liver exploded with mets. The concern is if I do Y90 to treat these mets, what prevents a new crop of livers at same time like before. I have been off effective tx for 4 months.
The IR said the mapping is good for several months if I wanted to go systemic first, then circle back when needed with just updated nuclear scans.
0 -
SandiBeach
I understand your concern. So glad you are approved for y90. My questions would be
- how soon can I get y90
- a how soon after can I start systemic
- If I try systemic first and the tumors grow larger am I still eligible for y90- what is the cut off criteria
I was already having some diffuse micro mets when we did y-90. But the goal was to whack a mole and kill the 3 fast growing larger ones to give me time to find the next systemic.
It is great that your team is getting together. Love the communication. I would want to be on that call asking questions!!😉
Dee
0 -
Thanks Dee..great input.
0 -
I decided on weekly Taxol. I have not been on a working tx since March. While I was healing from successful SBRT for a 2cm liver met, my liver grew a new crop of diffuse lesions. So although the mapping for Y90 went smoothly (no coils needed for potential leakage to gastro/entero, lung), I can't afford to hold off chemo for another 8 weeks. If I need Y90 in near future, I do not need to redo the mapping part.
0 -
SandiBeach - great choice. Hoping Taxol can really knock down those tumors! Ice up to avoid neuropathyand keep us in the loop.
Dee
1 -
Sandibesch- weekly taxol took care of my liver Mets. May it do the same for you.
0 -
crossposting from breaking news thread
great article about oligometastes and local treatmenthttps://ascopubs.org/doi/full/10.1200/JCO.21.00445
Oligometastases (<=5 lesions in one location) is getting more attention and guidelines.
The treatment of patients with oligometastatic disease is and must remain individualized and based on multidisciplinary decisions.
size could become part of the definition: metastatic lesions should be considered oligometastatic (ie, potentially eligible for local treatment) only when the size of the smallest lesion has reached a certain threshold, which could be proposed around 8-10 mm in diameter
Dee
0 -
Very interesting, Dee. Thx for posting!
0 -
cross posting with liver mets...
Has anyone had local liver treatments to liver mets at Memorial Sloan Kettering? If so, what kind of treatment(s) have you had?
After my hyper explosion of mets from my short period on immunotherapy, my interventional radiologist at Hopkins said he wouldn't do anything else local with my liver. I am currently on xeloda and neratinib. Bone mets are stable but the issue is the liver mets.
I have watched for about two years the expansion of material on the MSK site about liver treatments, especially mets, and it seems that they are talking about a lot of options in a lot of situations. On a short video that I watched, they were talking about how many procedures they do in a year, and how it may be best to go to a high volume center for these types of treatments.
Thanks for any info you can provide. I've had 3 microwave ablations.
0 -
Is there a tumor size limit for Y90.
0 -
Im going for my 2nd Y90 on Friday I was hoping yall might say a prayer for no side effects this time..
0 -
Nicole
🙏🏻🙏🏻🙏🏻
Dee
0 -
you got it nicol
0 -
Nicole, wishing you a smooth procedure and super fast easy recovery! This time will be golden!
0 -
In your pocket for Friday, Nicole. Hoping all goes well and your recovery goes even better.
0 -
Nicole,
Hope that your procedure goes smoothly tomorrow. We will all be thinking of you and hoping it is a successful procedure with quick healing!
0 -
Thank you all so much!!!!!
0 -
Nicolerod, I will be with you in my heart during the Y90 and your recovery.
0 -
Nicole - in your pocket for tomorrow. Hoping for easy peasy.
0 -
Nicole
Thinking of you tonight. I hope all went well and you are home resting.
Dee
0 -
me too. In your pocket Nicol
0 -
Thanks ladies!!!! That means so much. So far so good side effects from Y90 should kick in for 3 -5 days they said...but the Esphogitis from the rads to spine kicked in yesterday...(which was the exact day my RO said they would)...it hurts to swollow even water..feels like swallowing glass...but I am using throat coat tea and cough drops and this pink stuff that numbs the esphogus (I take that before eating).
0 -
I had my Y90 on right lobe yesterday, targeting a 10 and 3 cm lesions. No coils needed and I started prilosec 5 days ago. If all goes well, Left lobe with 7 cm lesion in 6 weeks.
I will continue to stay on weekly Taxol as it is keeping lesions stable (no progression, but also no recession).
My IR, RO and MO all met in same room and discussed the safest Y90 dose so I could continue weekly Taxol. IR will monitor TBil levels.
The morning of the ptocedure my INR was slightly elevated and my white blood cell count was 2.0 and hemoglobin 8. After discussion with MO, decided to proceed.
So..do not know what to expect in the next few days. Company coming on Day 4. Ha.
0
