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Old 07-05-2012, 06:25 PM   #8
Joan M
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Re: SRS and liver met

Jackie,

I had both a wedge resection and RFA, but for my lung, not my liver. The last time I had cancer in the lung was August 2008 (I also had one brain met, and treated it with a craniotomy followed by targeted radiation, and that was in 2008, as well).

I had early stage breast cancer in 2003, which recurred in the lung in 2007. Since becoming stage 4, I have not had chemotherapy, only Herceptin.

Most breast cancer oncologists really look down on local treatments. They say that once the cancer becomes stage 4, it's systemic and should be treated systemically. I would agree, and even though I had local treatments, I'm still taking Herceptin, which is a systemic treatment. It's just not chemotherapy. Thus far, I've been NED for 44 months, but who knows when that could change. Jml was NED for 5 years.

There seems to be a movement within some breast cancer oncology circles to consider local treatments for women who have very limited disease, such as nodules in only one or two places, which is called oligometastasis (check it out online). Afterward, patients would receive an adjuvant round of chemotherapy (which is like having chemotherapy for early stage disease). If all is still well, the patient would just continue on Herceptin. I didn't go the chemotherapy route and took only Herceptin, and the nodule which had been treated with the wedge resection in 2007 recurred a year later. But since the ablation of that second nodule with RFA in 2008, the lung has been clear.

Last fall I attended a conference for women with metastatic breast cancer at Johns Hopkins Hospital, and a surgeon spoke about local procedures. Since he was a gastrointestinal guy, he mentioned liver mets a lot, and he also said that RFA, as well as cryoablation (freezing, rather than burning), and chemoembolization (arterial) is reserved for patients who are inoperable. But was I clearly operable and opted for RFA. Interventional radiology procedures have been done in the liver for both primary and secondary (mets) liver cancer for many years. RFA is radiofrequency waves (and I believe pretty harmless). SRS is radiation. RFA can be repeated, which is often not the case with radiation.

Click on the presentation by Kenzo Hirose to see and hear his session on treating mets with local procedures. It's an excellent comprehensive overview of treating metastatic breast cancer with local procedures.

http://mbcn.org/special-events/categ...sentations/P6/

The more cancer meetings I attend, the more I'm hearing about using local procedures as an option for treating metastatic breast cancer. It's another option, and I would like several options for controlling my disease.

Dr. Edith Perez who was one of the principal investigators of an adjuvant Herceptin trial thinks that local procedures should be considered. I recently saw her at the annual meeting of the American Society of Clinical Oncology in Chicago. Dr, Perez was also interviewed recently and was asked about surgical procedures and she is looking into setting up a clinical trial to give everybody chemo but first to treat patients in one arm of the trail with a local procedure. Here is a 15-minute video and the transcript, where she discusses surgery for metastatic breast cancer:

http://www.medpagetoday.com/clinical...stCancer/32835
Others at the conference were also mentioning local procedures during sessions about metastatic breast cancer.

As an aside, what's happening with your tumor markers? Are they elevated? Have they ever been elevated?

Regardless of which treatment you choose, good luck with your choice.


Joan
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Diagnosed stage 2b in July 2003 (2.3 cm, HER2+, ER-/PR-, 7+ nodes). Treated with mastectomy (with immediate DIEP flap reconstruction), AC + T/Herceptin (off label). Cancer advanced to lung in Jan. 2007 (1 cm nodule). Started Herceptin every 3 weeks. Lung wedge resection April 2007. Cancer recurred in lung April 2008. RFA of lung in August 2008. 2nd annual brain MRI in Oct. 2008 discovered 2.6 cm cystic tumor in left frontal lobe. Craniotomy Oct. 2008 (ER-/PR-/HER2-) followed by targeted radiation (IMRT). Coughing up blood Feb. 2009. Thoractomy July 2009 to cut out fungal ball of common soil fungus (aspergillus) that grew in the RFA cavity (most likely inhaled while gardening). No cancer, only fungus. Removal of tiny melanoma from upper left arm, plus sentinel lymph node biopsy in Feb. 2016. Guardant Health liquid biopsy in Feb. 2016 showed mutations in 4 subtypes of TP53. Repeat of Guardant Health biopsy in Jana. 2021 showed 3 TP53 mutations, BRCA1 mutation and CHEK2 mutation. Invitae genetic testing showed negative for all of these. Living with MBC since 2007. Stopped Herceptin Hylecta (injection) treatment in March 2020. Recent 2021 annual CT of chest, abdomen and pelvis and annual brain MRI showed NED. Praying for NED forever!!

Last edited by Joan M; 07-05-2012 at 06:33 PM..
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