SBRT vs. Histrotripsy for Liver Mets
Hello,
I am weighing the options of treating my liver mets with either histotripsy or SBRT. I am in communication with 2 different physicians, one who treats with histotripsy and the other with SBRT.
The physician that uses histotripsy is still in the process of reviewing my images, and is expected to contact me soon as to whether I am a candidate for the procedure. So far, I have only communicated with the liaison that collects records and gathers info for the doctor.
The physician that treats using SBRT is eager to get things rolling with the tumors on my liver. She did my breast cancer radiation after the lumpectomy. She does not have much knowledge on histotripsy, so she couldn't tell me the benefits/downsides of doing SBRT over histotripsy. She seems certain that removing the tumors on my liver with SBRT will improve my chances of survival and may limit further metastatic spread.
I've been doing my own research, and it sounds as though histotripsy has less risks for damaging the liver vs. SBRT.
Does anyone have any information on these treatments? Is there one you would recommend over the other? Have you had either done before and what has been your experience, both short-term and long-term?
Thank you all in advance.
Comments
-
@choosinghope - I don't have answers for you - my liver mets were too large and too many for local treatment. Fortunately, systemic treatment has taken care of them for now.
I'm going to follow this thread, because I'm interested in any responses you get. If/when I have a recurrence in the liver, I want to be able to consider local treatments, and i only recently ran across histotripsy. .
Here is another thread for local liver treatmets, including SBRT, y90, ablation, etc. In don't think I've seen histotripsy discussed, but it may be fairly new for liver mets.
4 -
I follow as well because I was looking in to local treatment as well.
What I undestood of histotripsy is that you can stay on your medication while you are treated. But they can only treat metastasis up to 2,5 cm o 3.
And thank you Seeq for posting the link
2 -
Hi all,
So I just had an ultrasound on my liver at the facility that does the histotripsy this past Friday. They got a picture of two of the three tumors (I think I have three?). There is one that is in a location that they couldn't see very well (top of liver, near the heart). The physician thinks he can do histotripsy on the two. The third, he isn't sure— said something about trying to find it again when I go in for the procedure. I will have to decide soon if I want to proceed with the procedure, or if I want to try something else.
According to him, histotripsy is more effective than SBRT at preventing recurrence of tumors on the liver. He didn't say why? I can only presume, from my own research, that SBRT has a tendency of leaving some parts of the margins of the tumor behind.
The report from the ultrasound scan: Lesion 1 measures 2.9 x 2.2 x 1.9 cm. Lesion 2 measures 0.8 x 0.8 x 0.6 cm.
As of right now, I am leaning towards getting the histotripsy treatment. If I get it done, it will happen sometime at the beginning of December.
I will update as things move forward.
3 -
Update-
I had the histotripsy procedure completed in December. The doctor was able to treat all 3 locations. I was in more pain than what was expected. So much so, that I could hardly move without grimacing, and I kind of hobbled around, babying my right side. I found that applying heat really helped, and made sure to mention this to the doctor in the follow up visit. He said that some are experiencing more pain than others, and that they are learning that pain is more common with histotripsy than originally thought.
Anyway, the latest CT showed shrinking of the tumors. The doctor thinks that they are all liquified, and my body is just slowly absolving them. I had a PET scan in June after the CT scan, and I was excited to learn that nothing lit up on the liver, nor the breasts. We are monitoring two very small nodules that were seen on the CT scan. The PET scan report says they are too small to take up radioactive tracer. Hopefully, the next CT scan in November shows that those too are shrinking or completely gone!
1 -
@choosinghope - Very sorry to hear about the pain. I hope you get past that real soon! I'm also surprised to hear about it. I too am trying to decide about what to do about liver mets. My oncologist and the interventional radiologist are talking about things like Y-90 and other forms of ablation. No one has mentioned SBRT to me. Both have also told me about histotripsy, but have said that it's still very new and there is much unknown (like your pain?). I have been in touch with the local hospital here that does histotripsy (not my regular hospital) and they looked at my scans and said that I could be helped, but what they can do would be "palliative not curative". I held off on all of this for the last month or so, as I was scheduled to get a liver biopsy. That biopsy did show that as expected and presumed, the spots on my liver are indeed breast cancer and that I have an AKT1 E17 mutation (not good). I'm getting scans today, so will see what the liver situation looks like currently and then go from there. My oncologist and interventional radiologist seem to lean toward local therapies like Y-90 first, and probably over histotripsy due to it's new nature. My oncologist told me he'd had a patient who did the histotripsy and wound up with a disaster. He didn't go into detail of course, but it sounded like the person needed some sort of major invasive surgery after the histotripsy debacle. He told me this after I told him I was leaning toward it because they really tout how "non-invasive" it is. He says, not so fast! Also, like you, I had a consultation with a nurse at the location that does the histotripsy so that she could gather info first, before I see their doctor. She also said that histotripsy is just another tool in the tool box and it isn't some sort of panacea for liver tumors. She also said that I could do Y-90 first and then they could still probably do something for me along the histotripsy line. The IR also told me that you can do a variety of these various treatments and that doing one does not preclude the ability to do others also. My oncologist seconded that notion. I was told that none of these procedures are perfect and that some of them work better on different tumors than others depending on size, location, etc. of the tumor.
I saw my oncologist a few days ago and he would prefer to try these local therapies (Y-90, thermal ablation, etc. ) first over systemic therapy if possible, and I think the IR was of that same persuasion. They want to see the results of the scans I will get later today, and then we will talk some more. I'm hoping to have that consultation with the doctor who does histotripsy also, after getting more information. I would sure like to put off systemic therapy as long as possible, because it will mean stopping the Verzenio that I am now on and have had a pretty good run with (2.5 years).
Again, I am sorry about the pain you have and hope it passes soon. I also am very grateful to you for posting about your experience, because I have been finding it very difficult to hear about people's experiences with histotripsy, due to it's newness, I believe. I've been wanting to hear about all of the experiences that I can, and I think yours has been the first, so thank you so much for posting!
0 -
Thank you for your sympathy regarding my pain, but I think I’ve mislead you- I was only in pain for about 1-2 days, immediately following the procedure. The doctor said that the one lesion was near the edge of my diaphragm, and he suspected that was why it was painful. The other two spots they worked on did not hurt at all.
Sorry for the diagnosis on your biopsy. I remember when I received the report and how disheartening it was to learn the news. Prayers for you and all that are going through this crud.
I would’ve tried (and still might) Y-90, I think, if I didn’t go with histotripsy . Y-90 seems to be very targeted. But I don’t know… maybe my radiologist would’ve talked me out of it… she was a huge proponent of SBRT… even would go to seminars and talk about the effectiveness of it. We all must choose the path we are most comfortable with because it is us who have to deal with the aftermath!
We shall see what happens with me in the future. I just received a follow up tumor marker blood test and I have trace numbers in my blood (from previously having none). Ugh.
1 -
@choosinghope - Very sorry to read about your blood test, but it does sound like a minimal complication right now and I'd like to think it will improve as you move forward. Thank you too for some of the clarification re your pain, etc. It's good to know that it didn't last too long. Y-90 seems to be what my oncologist and IR are talking about the most, but I do want to consult with the histotripsy doctor at some point, just to get more information. Like you say, we all must choose the most comfortable path, and I need lots of information from lots of different sources, before making any serious decisions about what might be comfortable for me. Thanks again for sharing your experience, as I think it is the only one I've seen/read about so far.
1
