RFA Anyone?

[jessica]

Hi All~
Jessica here...the fog of benadryl & chemo #3 has finally cleared, despite cutting the benadryl dose in half!I feel co-herent enough to post a question...please excuse typos...
For those of you who have had RFA, can you share your circumstances w/me?I'm having a difficult time finding anyone to RFAblate this single, 11mm spot in my liver. One surgeon says "Continue on the chemo, let it do its work.If it doesn't work, them biopsy the lesion and try a new chemo." My onc says,"8 weeks chemo, scan to see response, if it's working do MORE chemo, scan again, THEN if anything is left, RFA." I told her I wouldn't wait that long to see if the chemo is working, so she agreed to scan after my 4th tx.But,she still believes that even if the chemo is working, I should continue with MORE, then RFA only if there's disease left.
Isn't that backwards? If I'm back on chemo & we find out that it IS working, then doesn't that mean we have 2 good options for tx-chemo or RFA?And wouldn't it make more sense to do the more effecient of the two- RFA?
Help!I'm off to see a 3rd surgeon for a consult-tomorrow.Would love to know what the circumstances were for those of you who have had successful RFA.
Thanks so much for your help.
Keep the Faith!
Jessica

[Brian]

Just to let you know my wife, Lisa, had RFA on liver mets. When we discovered that she had liver mets our Doc told us that we needed to get control of the cancer with Chemo and then we could consider RFA. Our first round of chemo resolved the initial set of mets (three 1cm tumors) but oddly three new tumors began to grow that were refractory to the drugs. Lisa went on Herceptin/Gemzar at that point. After 8 weeks the tumors were dissolving. Our Dr. wanted to do the RFA before the tumors completely disappeared.

Lisa went through the RFA on two of the three tumors, the third was actually excised from her liver. That tumor biopsy showed no living cancer.

Just a note, if you do RFA permanent spots are left on your liver that show up on subsequent scans. So each time you have a scan your radiologist will have to compare the location of the spots on each scan to ensure that nothing new has appeared.

[anonymous]

Hi Jessica. It is such a confusing thing about this RFA. When my liver mets were discovered
2 1/2 years ago, I searched around the country. Most places would not consider RFA for me because I had bone mets. However, I was able to find a surgeon who disagreed and had the RFA. His name is Stan Rogers and he is at UCSF.

A few things you should consider. Even though you only have one lesion on your scan, lesions smaller than 1 cm usually do not show up. In my case, there were 3 small lesions on scan but when the RFA was done 5 more lesions were found and ablated.

Also how you do the ablation is very important. If the ablation is done by a radiologist, they do it with a needle through the skin, called percutaneous. The problem with this is they don't directly visualize the liver to look for more lesions. If you are going to do an RFA you should have it done laparscopically with someone who has done ALOT of ablations. If it is done this way they will use an ultrasound done directly in the abdomen not through the skin to look for more lesions. I think a percutaneous RFA is not as thorough and will miss small lesions because of this.

Another argument for RFA is why wait. What if the chemo doesn't work and this lesions sheds cells and other lesions grow?

There are times though when one might not be a candidate for an RFA. If the lesion is near a major blood vessel, near the bile ducts or too large ( not your case ) then RFA cannot be done.

I am very glad I had my RFA. It wasn't as easy as I was led to believe. It was a 5 1/2 hour surgery because so many lesions were found and there was more pain than I had been told after surgery. But I would do it again in a minute. My liver has remained clear now for 2 1/2 years.

One thing to remeber as one other person said, your liver will look different on subsequent scans so you have to have a good radiologist who can follow this and figure out the difference between scars and new mets. I have holes left in liver as a result of my RFA but they are stable and now the radiologist knows they are just remnants.

Wish you the best of luck