Liver mets: resection, ablation, SBRT, Y-90, anything else?
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Doing much better BevJen, thanks
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Hi. Y90 on both lobes are done and I will have MRI and CT 12 weeks post the 1st Y90 on Nov 15.
To alleviate radiation fibrosis (SBRT caused radiation recall on back), I have been in a hyperbaric oxygen chamber. So far, 11 out of 30 treatments. I see improvement, but will always have the fibrotic tissue, which adheres to rib lining and surrounding tissue. Just an inconvenience.
I am still on Taxol, although reduced amount and on a week on/ week off schedule. If progression is noted (mets in my liver grow fast), I have no idea the next treatment, possibly Afinitor/Aromasin. Always looking for trials that don't exclude me!
Meanwhile, I am deconditioned and will start back my walking and biking.
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Sandibeach
I missed that you were getting y-90. It really gave me good PFS for 6 mo along with afinitor and faslodex. (
my y-90 tumors died but unfortunately others grew.
The A/A Combo is now the ESMO recommended next step if you fail cdk4/6 and don't have the pik3ca)FYI- I heard somewhere that ARV471 is at UCFS and recruiting. I can’t remember where you live.
Dee
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Hi AlabamaDee. I live on the east coast. I looked at ARV471, but I haven't had a 2nd antiestrogen in a metastatic setting. I think you had to have failed on two..
I am negative for PCK3, ESRI, PDL1 and androgen receptor. My last 2 liver biopsies showed ATM and FGFR1amp mutations. Not sure if mutation(s) caused the progression while I was on Ibrance/Letrozole. My cancer has not seen a mTOR inhibitor yet.
Taxol is holding me steady, but I have a gut feeling that there is new liver met growth while healing from the two Y90s. That happened with the SBRT..killed the tumor, but had new lesions grow before the 3 month MRI. Grrr.
Not only do we have to worry when treatment fails, but have to plan ahead for the next treatment. Then you have to be mindful you are not excluded from clinical trials with the new treatments after progression.
It is so very tiring.
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The Y90 with Taxol caused a side effect which I do not think I will recover from the damage.
I developed cirrhosis on parts of my liver, causing enough irritation to have ascites fluid. I get drained once/week. There was hope the ascites would clear, but doubt it now.
The extra fluid is painful and hard to find clothes to mask it.
I am sad and sleep a lot. Have not been on treatment for 2 months. I am starting afinitor and aromasin next week. MRI this Sunday and CT scan on Wednesday. It will be interesting to see if I have cancer growth.
P.S. I have 4 more weeks of hyperbaric chamber to help the healing of radiation recall wound. This was caused by SBRT.
I guess radiation and me do not get along.
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SandiBeach,
Good to see you posting, but I am so sorry about these developments. I think you are correct when you say that radiation and you do not get along.
I am hopeful for you that the A/A treatment will work for you, and that you have no new cancer growth.
We are pulling for you.
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Sandi..I am so sorry about this...What do you mean the Y90 and Taxol?? When I did Y90 I had to be off all chemo for 2 weeks prior and 2 weeks post.... If you were off for the 2 weeks prior and post in what say do you feel the Taxol effected the Y90 and your developing ascites? Just because it was too much stress on the liver? How many leisions did you have Y90'd? Also were any located near colon? Also when did you have the Y90 done and then when did you develop the ascites?
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Nicole, I was on Taxol concurrently with Y90.
1st was 8/25/21 R, 2nd was 10/6/21 L. I had several liver lesions.
I developed Ascites 2 months ago..thought was severe constipation -approx 11/6/21
It was not near colon, but did take a PPI every morning, starting 2 weeks prior to 1st Y90.
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Sandi...so your IR never told you to stop the Taxol 2 weeks prior to the Y90 and 2 weeks post??? That is NOT good. Also...why did the IR agree to do Y90 only 2 months after Rads to your liver??? That is A LOT of stress on the liver....
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Nicole, the SBRT killed my liver met , but while waiting for scans, I grew more and then later developed radiation recall. While I was healing, Y90 was discussed. Taxol was to address the growing mets as I was taken off Xeloda.
Seems like everything happened at once. I hope my liver heals. I start A/A next week. My cancer has not seen mTOR inhibitor. Just want more time.
Thanks for the interest as it may help others to ask the right questions before proceeding.
S
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Sorry Sandi..I have to say I definitely think your IR should NOT have given you Y90 and an RO should not have given radiation while on chemo..(they should have taken you off all treatment 2 weeks prior and 2 weeks after).... Im pretty sure my IR would not have touched my liver if I had just had rads and /or was on treatment continuously.
I defintely think all that over loaded your poor liver. I hope the issue clears up for you...look into TUDCA....its very good for the liver.
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I will soon be meeting doc to talk about the y90 treatment. Any advice about this procedure would be appreciated.
My first BC dx was in May 2002. Second dx : October 2008 / still stage 1 & 3rd dx:. Liver Mets in March 2018.
I've been on Ibrance 125 mg & Falsodex since 2018. Recently received CT scan November 2021/ which was stable. Tumor Markers started rising December 2021 / Out of Normal range / Went and did another CT Scan January 13, 2022 & have 3 more liver Mets measuring 1cm, 0.8 cm, and 0.6 cm & Oncologist is wanting me to do another liver biopsy (last one 2018) & Y90 treatment.
I think it's important to note that in 2018 CT showed 3 liver Mets and scattered lesions throughout the liver. Liver functions great always. Also, my TM's started trending upwards 2021 but staying in normal range until November 2021(which was 38.1) & December jumped to 52.8.
Any advice would be nice! Success stories! Please help & Thanks in advance.😞
Kelly
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Are you very very thin and is the tumor near your colon wall?
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No I’m not very thin & I’m not sure of location of tumors.
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Then I wouldn't worry about it.
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Kell, I did it Aug/Oct and it was successful. I just had scans last week for the first time and many had shrunk and the smaller ones were dying/dead.
Its a process, and it can be very uncomfortable. There isn't much you can do to prepare, just follow the IR's instructions.
Good luck! I hope it goes fantastic for you!!
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Terri-c
Thank you so much for your reply. I’m getting nervous about this procedure. I haven’t went for my consultation as of yet. I’m waiting for my oncologist office to set my appointment up for me. You mentioned it’s uncomfortable. Can you give me more details about your experience? I’m very happy to hear that you had success! That is great news & I wish you all the best!
Trying to stay 💪,
K
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Thank you for the information.
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Kell...I had a very horrible experience and a very good one. Which is why I asked if you were very skinny...bc if you were and your tumors were close to the colon wall...I would warn you to ask your IR specifically about the 3% that leaks out.... but since you said you are not....it should most likely be a breeze. I had some pain after the 2nd one (the one that went ok with no side effects) but nothing that required pain meds. Good luck.
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Kelly - since the liver is next to your stomach you could have some nausea afterwards. I didn't have any problems with the left side except a couple of days of nausea, but the right side had a lot more tumors in it (I probably had a lot more than you have) so the radiation dose was bigger. I had some pain for a few days (pain meds helped), and my stomach got randomly upset for a couple of weeks.
All in all, it wasn't bad, and I would definitely do it again.
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Thanks for your replies. I appreciate the information so much
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Hi
I’m curious to know how long does it take to resume your daily routine? I’m not working now but things like house cleaning , grocery store, etc…
I met with the IR yesterday & he is recommending Y90 for both lobes. Starting with my right lobe. My tumors are not close to the colon wall. He wants me to get a Petscan since my last one was done in 2018. Also, I had my liver biopsy last Thursday and my cancer is the same. Breast cancer, Er+Pr+Her2neg, Ki67=High. The largest tumor about 2cm. The others appear smaller.
I’m so dreading this.😭
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Hi Kelli! I was thinking about you yesterday! When I had the left lobe done, I really had no downtime, I was functioning as normal the next day. When I had the right lobe done I had a few days of downtime. The right lobe is bigger than the left, and mine had more tumor burden in the right lobe, so the amount of radiation was higher.
The thing you need to keep in mind is that this is a highly successful procedure, and it will buy you more time. A few days off and a bit of nausea (I had, you might not) are worth it.
(gentle hugs) you are in my prayers hun. The procedure itself is super easy, you'll pretty much sleep through it
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Good moring Terri-c
It's so good to see your reply. It's helps to overcome my fear hearing from someone that has experienced it. I'm at my oncologist office now so I'm going to ask if I have more tumors in my right. I think I do.
I have an only daughter so I definitely will go through it. She is 24 now but no marriage or children yet.
My concern is liver damage. Very scary. 😨
Hope things are going good with you.
Hugs & prayers sent to you too!
Kelly 💪
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Stereotactic Radiofrequency Ablation of Breast Cancer Liver Metastases: Short- and Long-Term Results with Predicting Factors for Survival
https://link.springer.com/article/10.1007/s00270-0...
"Overall survival (OS) rates of all patients at 1, 3, and 5 years from the date of the first SRFA were 84.1%, 49.3%, and 20.8% with a median OS of 32.3 months. Univariable cox regression analyses revealed age > 60 years and extrahepatic disease (without bone only metastases) as significant predictors of worse OS (p = 0.013 and 0.025, respectively). Size and number of metastases, hormone receptor status and time onset did not significantly affect OS after initial SRFA."
Full text free at link above
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Hello Ladies
I need some advice. I now have my Y90 procedure set up for:
Mapping / March 24
1st Lobe/Right- Dose - March 30
Follow-up: April 19th
My dilemma now is I’m currently taken Ibrance/Falsodex shots. (was so looking forward to my 7 days off/ as my dosage is almost completed I have an appointment for March 16th for my shots. I knew my oncologist was changing my meds to Piqray but thought that would be after Y90 treatments. I got a call this week & my Piqray is ready for pick up. I was so concerned so I called my oncologist office and the IR’s office to see if I should change NOW(Yikes) to the Piqray & the answer I received is Yes. Also was informed that I can take Piqray while going through Y90. I’m very concerned about the side effects from both treatments but also concerned about progression of the liver Mets.
Any thoughts or advice?
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Hi All,
Does anyone has elevated AST and ALT after 4-6 weeks of liver SBRT ?
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I have a liver tumor that had a 1/2 dose of Y90 and keeps growing. MY MO spoke to my IR and said the IR thinks I should do ablation to it instead of Y90 again...I have an appt on the 28th to talk to IR and find out why she feels this way. I have never had ablation to a liver met can anyone tell me what kinds there are and what usually works best and what are the side effects? I feel like I want the Y90 ....
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Nicole, I had microwave ablation for residual liver mets after good response to Ibrance. It was a pretty easy procedure with just some occasional twinges of soreness. It kept me at NEAD for about 10 months, but then I developed new liver mets and flipped to TNMBC in my liver. I can’t answer your other questions, sorry. I hope someone comes along with more info for you.
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Nicole. I had a liver microwave ablation in January of 2018 on a 1cm tumor in my liver. I remained cancer free in my liver for 3 years. I still had cancer in my lungs tho. The ablation was easy. I was in lots of pain for 2-3 days and then it quickly resolved.
question for the group. Unfortunately, my liver tumor came back last year. It was small at firstbut then my last scan was bad and it is now 4cm. My liver markers are good and low but my tummy hurts by my liver and I worry it’s inflamed. What local therapy am I suited for now? It is too big for an ablation? Maybe SBrt is more suitable? Thanks0
