Histotripsy for Liver Mets. Experiences, Thoughts, Knowledge, Suggestions?

Seeq - So glad to hear that this subject is of great interest to someone else also. I haven't seen anybody talking about it on here previously, so I thought I'd start something. I actually only heard about it a few months ago when my oncologist mentioned it along with other treatment methods like Y-90 and other forms of ablation. My clinic doesn't do it at this time, but another hospital in my city does. I looked up the info on the hospital's website:

https://www.swedish.org/news/uf/686449730?streamid=7723912

I've also googled and found other articles over the last couple of weeks from other places like MD Anderson:

https://www.mdanderson.org/treatment-options/histotripsy.html

And University of Chicago:

https://www.uchicagomedicine.org/forefront/cancer-articles/histotripsy-for-liver-tumors

That's all I've really done, is just google around. I haven't looked for anything super scholarly yet though, but I'm sure there are things out there.

After reading, I suggested to my oncologist that I might be interested in pursuing the idea further, especially because of the supposedly "non-invasive" nature of the treatment and he seemed a little hesitant. I was kind of like, "Why wouldn't someone want to try this first since it's non-invasive and supposedly just sort of 'liquifies" the tumors and they disappear." Well, he said that is not the real true picture. He said that it can become an extremely invasive procedure and that if something goes wrong during the initial procedure, it can take a big major and very invasive surgery to fix it. There's also the part where the sound waves don't necessarily "just liquify" everything and it disappears. There are areas they can't reach, such as behind bone, and those cannot be treated with histotripsy, as sound waves don't penetrate, and there are also other times when only partial success can be achieved. I'm becoming rather taken aback at all of the hype on these websites, etc. that tout what a great breakthrough and non-invasive technique this is. It looks like it is all that for some people, some of the time, but there are apparently things that aren't well advertised about what can go wrong and more. It looks like a bit of an ethical thing to me, how they really talk these treatments up in only a general way, without giving the full picture.

I also had a consult with an interventional radiologist about my liver mets and I mentioned the histotripsy option to him too. Like my oncologist, he cautioned that it is still considered experimental generally and that there is much they don't know. He's the one who told me about the sound wave issue with bones. They don't have lots and lots of data yet, like they do with some other treatments. To your question about who might qualify for this treatment, I think they have some ideas, but the IR told me that most of the current research being done now is looking at that very question, i.e. they don't really have a good handle yet on just who it will work for. My oncologist told me he had a patient who tried it and it didn't work. He of course didn't go into detail about that patient, but his demeanor suggested that it had turned into a nightmare for that person.

My oncologist did make a referral to my local hospital here that does histotripsy for a consultation and they have viewed my scans. I'm in the process of doing some absolutely crazy phone tag right now with a nurse there for some commentary re the scans. All I've heard from her so far is that they could do something for me in the way of "de-bulking" the lesions, i.e. palliative, not curative intent. She says I can still consult with their surgeon if I'd like, and I am still considering it, because I do have a lot of questions, like you, and do want to hear more just for general knowledge before making any decisions. My sense has been that both my oncologist and the IR would rather have me go with a tried and true method like Y-90, but I am terrified of all that insertion of things into that groin vein like they do with heart patients.

I'd also like to know if you could try histotripsy first and then later go to these other ablation techniques if it doesn't work out, or could you do it the other way around, or a mix of treatments? Do getting any one of these treatments then preclude your ability to get any of the others? I just have so many questions.

Sorry this is so long, but this is a new process and I'm learning as I go here.

Seeq, edited to add that if you are anywhere near a hospital that offers histotripsy, you might want to just get a consultation.

Thanks, Seeq. I think my onc told me about it for ethical reasons, i.e. they want you to be informed of all possibilities. Interesting, I got a MyChart message from his office late yesterday asking how the referral was going. He and the IR though seem more "solid" about the old tried and true things. I did finally catch up with the NP I'd been phone tagging with and she too said that while it's a great new thing, it is "just one more tool in the toolbox" and not necessarily better than the other available treatments. It's all on an individual basis. She said that yes, there are the soundwaves not being able to travel through bone problem like the IR said, but she also said that if the lesions are near certain organs or major blood vessels, etc., it can also not work. That's the same with the other treatment methods too. She said that you can get the other treatments and then they can review new scans and then usually still do something more to help, so it looks like a person can get quite a mix of all these different treatments for liver lesions. The IR had suggested a slight mix also (e.g. Y-90 and ablation). I see my onc tomorrow, so will run this by him for further input before scheduling a consult with the histotripsy surgeon (he's also a liver surgeon, I was told). My needing to speak with the NP first was apparently a "pre-screening" before being allowed a consultation with the doctor - sheesh! Hopefully, you will never need any of this!!

@AJ - I decided to wait and see what this upcoming liver biopsy shows before scheduling a consult with the histotripsy surgeon or proceeding with any other treatment option, e.g. Y-90. I just want to see that absolute confirmation that it is indeed cancer metastases first. All these doctors are absolutely convinced that this is indeed cancer, and I have no reason not to believe them, but want that official confirmation. I will get that consultation with the histotripsy doctor then at some point. I'm really interested in how it can complement these other treatments. So far I've been OK with the Verzenio and Faslodex and the onc doesn't want to change treatments. He thinks a localized treatment for the liver lesions and continuation of Verzenio/Faslodex would be best for now. AJ, you are fortunate to have your liver lesions stay so stable with the Xeloda - good for you!