Liver mets: resection, ablation, SBRT, Y-90, anything else?
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Robin, now that they have changed their approach based on that genetic mutation, things may very well take a turn for the better. Waiting and hoping with you. I take to heart your warning not to miss the window. I had been thinking of trying to work around my summer plans, but your experience confirms that I should simply go for it as soon as the docs say it's a good time.
Grannax, my docs may indeed be planning to keep me on Xeloda during radioembolization in order to continue addressing systemic disease. The fact that you stayed on Ibrance and Femara makes me think they will keep me on X. I'm good with that. Leftfoot, Y90 is the radioactive isotope yttrium 90 that they use to zap tumors during radioembolization therapy, so not a chemo, although it sure sounds like one. (My favorite chemo name is 5-FU. It's just so appropriate.)
Letmywifelive, things are getting complicated. Are you at an NCCN center or can you get a second opinion at one? No local resection is in line with what my onc has told me. Are they saying that because of the multifocal nature of the liver disease? I suspect this multifocality is an ILC thing. Is the onc saying that she thinks the other tumors responded to Xeloda, but the bigger one and the new one have not, thus a change of treatment is recommended? By all means get the opinion of a liver treatment specialist about local treatment. You have added another reason for me to go for radioembolization (Y90) if I can, because of the idea of tumors with different characteristics. My last CT showed one lesion gone and two lesions bigger. I think radio will be a more generalized attack than a particular chemo or hormone therapy which may work on some tumors but not others.
As for scans, the radiologist I spoke with said that after radioembolization I would need a PET scan to check my status because a CT would not distinguish between active tumors and successfully treated tumors. This was in the context of radioembolization (Y90) not radiofrequency ablation (RFA) or stereotactic body radiation therapy (SBRT). The scan I am wondering about is the next one, before I do radio. Should it be CT with contrast to compare to previous one that was done to evaluate appropriateness of radio, or PET to check effectiveness of current Xeloda? Maybe if my TMs are dramatically lower next week (please, please) that will be good enough for my onc, as they are so accurate for me.
I have to say I am afraid of this treatment in way I have not been before. Radiating an essential organ with un-removable beads in my arteries, yikes! And yet, if cancer takes over that organ, I'll be in bad shape. If this treatment could extend my survival without being too risky, I'll have to do due diligence and then just trust my doctors and my excellent cancer center. It's always a risk vs. benefit question and very individualized.
It's a deal, bstein. Let's meet in ten years and compare notes. I'll go to Canada and we'll have tea.
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Shetland- thanks for clarifying fir me. Sorry if I confused everyone
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Shetland, Thanks and yes timing is everything with this unpredictable disease. I pray you get a procedure nailed down soon.
Robin
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Me to Shetland, I hope they nail down which will be right for you. I appreciate how much information you impart to us always. That is pretty scary about the permanence of those little beads in the arteries,but like you said, risk vs benefit. It's a mind bender...
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I did the Y90 after I had completed 6 rounds of taxotere and my scans showed no improvement of the 2 lesions in my liver. My MO was really concerned as this was my third recurrence. I remember us in her office discussing different options for treatment. She was first leaning toward recommending ablation and then she switched to the Y90. She felt that I was healthy enough to handle it and at the time she would only recommend patients who did not have mets anywhere other than the liver. That may have changed since this was in the fall of 2015. I had an appointment with the interventional radiologist the next week and the mapping set up 2 weeks after that. Everything was mapped off of a CT scan for me and I was not currently on any chemo at the time. I I had another CT scan 6 weeks after the procedure and one of the liver tumors was completely gone and the other had shrunk. At 6 months I had another CT scan(my insurance will not pay for a PET) and I now had 2 smaller spots. My MO at that point felt that the remaining tumor had broken up and 2 small inactive spots were now showing on the CT scan. It was not until I had a gall bladder attack and had an MRI that showed she was correct. I now have no active tumors in my liver. I lost an organ( my gallbladder) but I also got rid of 2 tumors. The pathology report from my gallbladder referenced the beads. Looking back on the procedure is a little scary. There are risks there for sure. But it has given me more time and that is what I believe we are all looking for.
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I just got the results of my first CT scan almost 3 months post SBRT to three 0.5cm liver lesions. I have only ever had these three pesky critters and the rest of me has been clean. Well the IR said it's a favourable response, no tumours are visible there or anywhere else. There is liver inflammation only. I'm so greatful! Can I relax for the first time in two years?? Can we ever really put this behind us? I'm not going to worry until the days before my next scan! The life of a cancer patient. I have less cancer now then I ever have. I'll continue with Herceptin and perjeta!
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That is wonderful news bstein! So glad to hear it. Enjoy, enjoy!
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Wow, great news indeed. And babyruth you are right,anything that can extend our time is worth a good look.
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Exciting news bstein! Tumors are now not visible! Love it.
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woo hoo Bstein. Happy dance
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wonderful news. thanks for the report.
SBRT triggers an immune response which is system and can take care of lots of stuff you don't see ... and well as stuff that did not get zapped, to tell the truth. It's on my shortlist of treatments. I think you can exhale.
>Z<
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Bstein, congratulations. Yes, enjoy this and put worry on the shelf as much as you can.
So on my last appointment day the lab results were late. My onc and the interventional radiologist said if my TMs are up, we go to Y90 radioembolization immediately. If they are down, we keep Y90 in our pocket and let Xeloda do its thing. I had already said goodbye to doctor #2 when he came back into the room to log back in to the computer and show me the 30-point drop that had just been posted.
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Shetland I put off radiation for over a year until I was sure I needed it. You only get to do Y90 once so it makes sense to not change anything if Xeloda is working...yeah it's working!!
Z- I had treatment (Herceptin and Perjeta) on Thursday and I had so much discomfort in my liver area up into my right shoulder I couldn't even sleep. I feel no pain at all today, I kept thinking of what you said and imagining an immune response knocking out any stray hidden cells. Maybe it was my gallbladder Babyruth! I'm going to try to keep track when this occurs to rule it out...this discomfort has happened a few times since SBRT and I haven't really tracked what I ate or if it was after treatment...maybe just constipation haha!
Heading to the Calgary Stampede tomorrow. Roasting 31 degrees C here in Canada!
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SP - There is someone doing the happy dance for you in New Mexico.
bstein - glad to read that you are in good humor and not in pain. yes, definitely give the scene going on in your liver some sounds zap, pow, zing. or go on youtube and watch some videos of how your immune cells attack foreign cells. puts comic books to shame.
>Z<
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Bstein, it's good to hear that you and your docs saw it the same way mine do.
Thanks, Z. It's a slow, careful dance with no laughing, I hope.
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Has anyone heard of TACE? It's a local treatment for liver mets. My friend had y90 and then found out it failed. Now her doc is planning to do the chemoembolization. I didn't realize that there could be another local treatment after y90. This is my friend who has ocular melanoma mets to liver. I'm wondering if this same TX could be used on me sometime in the future if needed.
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I've read this meta-analysis that show that Y90 is more effective than TACE. They are similar and I know doctors that swear by TACE. This research came out of china, which can be inconsistent in the quality of it science.
But I do believe TACE can be done multiple times. I also believe strongly that these treatments are only as good as the practitioner, which makes studies like the one I reference very very hard to interpret.
>Z<
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I've posted my good news on two other threads but not here. My liver tumors showed a complete response to the y90 procedures I had in April and May. I was so surprised by how quickly the results could be seen. Overjoyed with this good news.
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Grannax2-that is great news! So very happy for you! Enjoy your time with your grandchildren.
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Hello Grannax2,
Great to hear you had so much success with Y90!
I have mapping Tuesday and the surgery the following Tuesday, any info you can give me would be appreciated!
I have a 6cm, 2cm tumour and 8 x 1cm, did you have many?
Look forward to hearing from you!
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Emily-Louise - I want to wish you the best. Many people are following this thread to learn about this important treatment option. We're very interested in your experience. The brave and eloquent Grannax has done exceptionally well and I expect the same for you.
>Z<
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Emily Louise. I think I had 8. They were in both lobes. Some were in clusters where the lobes join. Those were the hardest ones to get to for the IR. I don't have my report handy to tell you the size. Are yours in both lobes? If they are all in one, then you will be done next Tuesday.
I guess you've read all my posts on this thread. If so, you have my whole experience. Of course, it's never the same for every one. I assume you are not allergic the iodine contrast. I had a lot of problems from that.
Ill be thinking a bout you tonight and tomorrow. I'm sure you'll do great, but let me know how it was for you.
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Emily Louise I keep checking here, hoping to see a post from you. Hope you're doing well after the mapping.
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me too
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I had a liver wedge resection, then almost 5 yrs later half liver removed been three yrs no return of cancer. My sugeon said by removing it with rfa or surgically there is a slim chance it will not come back. I'll take it
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Emily Louise, I hope mapping and any subsequent actions went well. Looking forward to hearing your update!
Moppit, were your liver mets minimal or focused in one area of the liver? I don't hear many people being good candidates for having portions of the liver removed. Congrats on your success with that!
Where are the preeminent centers/doctors in the US that do liver Y90 procedures? My MO bluntly told me he wouldn't trust anyone at my center to do it. Does anyone have for a good Florida recommendation? I don't mind traveling to have the procedure performed but am assuming I would have difficulty getting my insurance to cover it if I went out of state. I am ready to start getting this lined up for the next 6 months or so.
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JFL - I would not assume that you can't go out of state... please check on that. you want a place with a long track record of successful Y90's. it would be worth traveling for. this is a procedure that takes skill.
>Z<
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JFL. My IR, Travis Van Meter, MD. is not in the Cancer Center but my MO did refer me to him. His skill seems to be exceptional. Unfortunately, a specialty hospital where he did my procedures had to close down. But, I know he's still working in Dallas area. I think he might be at Methodist Hospital. It's an out patient procedure so you wouldn't have to stay long.
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Thanks, Grannax! You certainly had success with him.
Z, you are right about out of state. I am going to call my insurance provider. I am currently looking at large interventional radiology programs that that perform radioembolization for liver mets all the time - so far, I have University of Washington in Seattle or MSSK in New York.
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JFL. My IR, Travis Van Meter, MD. is not in the Cancer Center but my MO did refer me to him. His skill seems to be exceptional. Unfortunately, a specialty hospital where he did my procedures had to close down. But, I know he's still working in Dallas area. I think he might be at Methodist Hospital. It's an out patient procedure so you wouldn't have to stay long.
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