Liver mets: resection, ablation, SBRT, Y-90, anything else?
Comments
-
I will have my PET scan next Tuesday, I had to reschedule it because of flu. It will be interesting to see if my liver mets that were " bombed" by y90, are still showing no uptake. Also interesting, and scary, to see if there are any new mets in other areas of my liver ( that were not bombed). 😨 The crazy making life of MBC patients.
This PET is almost six months out from my last one. Here's to five more days of scanxiety, I'll get results on Thursday. Plus, the dreaded prep for PET on Monday. But, even if I do have progression, I know that there is something else out there for me to try.
0 -
Grannax - There's a plan if you find progression. Praying you don't progress. Waiting with you. I hate scans. Know that there is a crowd who know scanxiety by your side.
>Z<
0 -
Just got home from my Y90 mapping. All went well The only hard part was getting an IV going. After the third try they went through my leg. Y90 is on 2/20 and 3/22. Boy I’m tired of being at Mskcc! Thank God I live 2 blocks away from their Breast center! And 6 from main center
Babs
0 -
Glad phase one is done Babs. Praying for 2-20.
0 -
Glad phase one is done Babs. Praying for 2-20.
0 -
What a pain. Go babs. We want to know everything!
>Z<
0 -
I just wanted to pop in to say that I did not miss a dose of Herceptin or Perjeta during my SBRT. That likely is different type of immunotherapy but I was imagining the antibodies attaching to the weakened cancer cells and my T cells eating them up. I looked at the pictures of my liver 9 months out and with targeted radiation (unlike RFA) the liver regenerates and there are no holes at all. I was amazed. With RFA there are perminate holes (who cares as long as the cancer is gone. I imagine withy90 the liver regenerates too...
0 -
Herceptin is a monoclonal antibody. This class of drugs is highly immune modulating. When Herceptin is very effective, it's most likely because it stimulated an immune response. Herceptin s highly synergistic with radiation and anyone on it should not miss a dose during and after radiation. Particularly in the few months after. My immunologist would have me on it if I were HER2+. But you need a target or doesn't have that effect ... I have to resort to other tricks.
Heading off to the Mayo Clinic this week for SBRT to my sternum and my liver. It did not occur to me, for some reason, that I was getting local treatment of my liver that would fall within this discussion. Will get back with details and outcomes as I learn them.
>Z<
0 -
Z- Can you explain to me SBRT to the liver? Is it just basically getting radiation to the liver? Does it damage the liver? this may be something I might need to pursue.
0 -
SBRT is basically just a few high dose treatments of radiation ... 1-5 treatments rather than 5 weeks of low dose radiation. It might be considered as way to get rid of lesions if you had one or two mets, or maybe 5. The problem is that, when you give a dose that is sufficient to kill off a tumor, SBRT is highly irritating to the healthy liver. You can't take out a lot of liver mets with SBRT.
In my case SBRT to kill all liver mets is entirely off the table. I have 30-40 mets on a good day. One radiologist threw out the number 50. I do not have the stomach to get a definitive lesion count. If I were to attempt to annihilate all my liver mets with SBRT, I'd barbecue my liver.
In my case, we're going to tickle 3-4 lesions that look like they might be alive (most of mine are not active) with a high dose of radiation (that's what makes it SBRT). I am expecting 1 or 2 treatments. This alone is not going to get rid of the target lesions. There will be 10's of lesions remaining. The hope is that these irritated lesions will express proteins that trigger an immune response in combination with an elaborate immunotherapy protocol that I follow ... if I get a positive outcome on the liver piece it will be due to an immune response. The radiation will contribute to the larger protocol but it is not, in itself, a treatment.
I will mention that my local RO is ready to do TACE even with the number of lesions I have. Local treatment of liver mets with intent to treat is not off the table, it just won't be SBRT. If my immunotherapy strategy fails entirely TACE or Y90 is likely plan B. So I hang out here. However, TACE is not likely to be synergistic with immunotherapy. It could wipe out the immune system along with the cancer. I have higher hopes for Y90 and immunotherapy, but that combination is not currently a topic of much research. The safer bet for me now is a light touch of SBRT.
The short answer is that I am doing SBRT as part of a treatment strategy that few people follow. SBRT is not the go to local treatment for liver mets unless the mets are very limited. With limited mets, it's an interesting option, especially if you can bring in an immunotherapy piece.
>Z<
0 -
Z, thanks, good to know, since I got news of the extent of my liver lesions I thought all bets were off as far as local treatment goes. Thanks for your research and pioneering
0 -
Z- Thank for explaining that. I have many lesions but I have one big stubborn one. I tried to get my IR to ablate it and he wouldn't do it because it wasn't going to do anything to the rest. But my thinking was get rid of the stubborn one, because the other mets were shrinking last fall big time with carbo, but that one damn tumor, barely moved.
Also I am getting a second opinion at a major cancer hospital and would like your advice on which hospital do you think is the best with MBC.
Anyone please feel free to give your opinion.
Thanks,
Robin
0 -
rpoole - As usual your thinking makes eminent sense to me. A second and third opinion is the way to go, but of course you are already on it. If you can beat back the other liver mets to the point where they are all dead or even not appearing in scans, then you will find more doctors willing to knock out the big one. Have you done a PET or an MRI that would indicate that thing is actually alive. Maybe it is just necrotic tissue?
As far as RO's, all i can say for sure at the moment is steer clear of new mexico. I am finally getting my own posterior to a major NCI center. I'll let you know what i think of Mayo, Rochester once I have an opinion.
>Z<
0 -
Z- thanks and I can't wait to hear what you think of mayo. I just had a PET/CT with contrast on Jan 4th, and with my rising TM's and pain, unfortunately think its live tumor. I had all my liver mets and tumors beat back right before the trial I was on. And now its all back to before I went on Carbo last fall. Well its actually worst. I guess I will keep moving forward with Carbo and try to the results I had last October.
Robin
0 -
Babs did you have your first y90 today? I was reading an older post. I hope I haven't missed something.
0 -
I just realized that your y90 is March 2 not today. Ooops
0 -
Grannax. Yesterday was pet/ct scan. Yes Y90 is 3/2. Nervous about my scan results due to crazy TM jump. We’ll see hopefully before the weekend!
Thanks for asking
Bab
0 -
I'm praying that nothing will keep you from having y90. I would be nervous, too. Results sooner the better. I vote for less waiting. 💞
0 -
I'm praying that nothing will keep you from having y90. I would be nervous, too. Results sooner the better. I vote for less waiting. 💞
0 -
Praying things go well on all fronts for the Babinator. You got this!
>Z<
0 -
Thinking you Babs! best of luck with the Y90!
0 -
Babs, good luck with Y90! Hoping to be shortly behind you. Keep us posted on your experience
0 -
Thanks so much ladies for your support. I got the preliminary scan results. A mixed bag. Liver mets are smaller. Lymph nodes, bone mets have slight increases in size. Lung has more nodules and the lining of my lung is thicker. Plan is to have the y 90 on 3/2 as planned. Not sure what chemo I’ll go on. I’m hoping to see the actual scan results on Monday so I can thoroughly analyze the results and ask appropriate questions. My MO wants to present my case to her team to help figure out what’s next for me plus she wants to sw the radiologist as she has some questions. She’s not sure for the first time since I’ve been seeing her. Will keep you posted as I know more
Bab
0 -
Babs - I am going to call that awesome. Nothing prevents the Y90 from proceeding. At MSK you have a remarkable number of options. Things are moving quickly and MSK is at the leading edge. I think it is good that you doctor is consulting with the team.
I am interested in whether they expect to have any oncolytics trials for breast cancer. These are viruses engineered to attack cancer.
Thinking of you. Keep us posted.
>Z<
0 -
YAY Answered prayer for Babs. It seems like you have a great team of docs who let you be involved. I'm sure they will come up with something for the lung mets.
First things first, in less than a week y90 is gonna blast those tumors to H.... just like it did for me. You go girl!💞
0 -
Babs, mixed results can be baffling. But it is excellent news Y90 is going forward. Your MO is thoughtful to take your case to the tumor board. It means your MO cares. I get so happy when my MO tells me he is going to discuss my case at the weekly tumor board at my center. It means more experts will be giving input on the case.
I have appointment with IR for Y90 consult on Monday. I have been the friendly, annoying patient calling his assistant every day last week. He usually only sees patients once a week on Wednesdays but is willing to see me on Monday.
0 -
JFL. Evidently, being the friendly, annoying lady works. I'll be thinking of you on Monday. It seems so long ago that I first had my consult with IR. I knew nothing! What a learning curve I've had since one year ago. Now I write as if I'm the PRO of y90, throwing out advice every chance I get, I'm the cheerleader for all liver mets ladies who even hint they might be interested. 👏😷 Too funny, I must sound like I've had ten years of education on y90 instead of one year of personal experience. Ha I do hope it will work as well for you and babs as it did for me.💞
0 -
Grannax, you a pioneer leading the Y90 charge in breast cancer
0 -
Babs - good news on the Y90. Mixed bag results aren't so bad. Following you and supporting you here! When do you see that new grandchild again?
Grannax2 - we are so lucky to have someone who's actually experienced Y90. Sometimes these treatments are so scary in the abstract that it is a relief to hear from those who have travelled those roads.
0 -
Grannax - We are very lucky that you are willing to share your experience and so articulate. Keep it coming. You will never know how many people you have helped.
>Z<
0
