Caryn next step - might be option for others

eric · 09-22-2008, 04:24 AM

Caryn has a single 7cm tumor on her liver. Since she's been ejected from 2 trials recently her Onc has finally agreed to have an RFA (radio frequency ablation) done to remove this stubborn spot. The spot is larger than the 5cm max preferred for an RFA and one end is resting on the portal vein. This is important since the RFA generates heat to kill the cancer cells and the portal vein will attract the heat and therefore limit the impact on the cancer cells. As a result, prior to the RFA, they are planning to surgically drop radioactive seeds in the tumor section by the vein. This should eliminate the section by the vein and hopefully shrink the tumor to the preferred size. Apparently, this "seed" step is used often for primary liver cancer but is new for bc liver mets. I'm not sure if it's considered a trial but I'm happy to have it as an option.

Eric

WomanofSteel · 09-22-2008, 05:37 AM

Eric, I hope your wife does well with this. I will keep my eyes open for your updates as I have multiple liver lesions the largest which was 10 cm that at last scan had gone down to a little over 7. Maybe it will be an option for many of us with these stubborn mets. Meanwhile I will pray that this is the magic she needs.

chrisy · 09-22-2008, 10:44 AM

Eric,that is very good to hear that they are willing to try this. It's so refreshing to see that people, when they put their minds to it, can get very creative. It sounds like a good plan. Please let us know how it goes. This has been an approach I've been keeping on the back burner, I'll be interested to hear how Caryn does.

Much love
Chris

Kim in DC · 09-22-2008, 11:05 AM

Eric,
That sounds like a very good plan. Thank you for sharing it with us. Where is this proceedure being done?

Kim

Mary Anne in TX · 09-22-2008, 11:17 AM

Eric, I send my prayers and good wishes for this to be super successful for Caryn. ma

Mary Jo · 09-22-2008, 11:45 AM

Hi Eric and Caryn,

I,too, send my prayers and ask God to please let this be a successful procedure for your wife.

Surrounding you both in prayer,

Mary Jo

Jean · 09-22-2008, 02:19 PM

Eric,
I too am happy to hear that this approach is open for Caryn....please do let us know how it goes...sending you
and Caryn my prayers.

Jean

juanita · 09-22-2008, 03:59 PM

i hope that everything goes okay for your wife. i'll add my prayers to the others.

Esther · 09-26-2008, 01:31 PM

Eric:

I had a lesion that was stubborn and resisted to chemo also, it was 4 cm. It was also by the hepatic artery so the cooling would make RFA innefective.

I ended up going to Stanford and had Cyberknife done on it, and that took care of the lesion.

So perhaps you might look into Cyberknife as well as an option.

JustwannaBE · 09-26-2008, 01:41 PM

Hi Eric. Since it is just one tumor, why can't they do a liver resection ? Also you may want to investigate another technology called SIRT's. Go to Aboutlivertumors.com and check out either the theraspheres or sir-spheres technology. I met with an interventional radiologist this week about it, however, I am going to go on a clinical trial right now, and can't be on any other treatment. If the clinical trial doesn't work, then I am going to have the sir-spheres radiation procedure done.

Esther · 09-26-2008, 01:51 PM

When the liver lesion is so close to a major blood source, surgery is not an option because the risk of bleeding is too great.

It is a trickier situation with less options when it is close to a major blood supply. The blood flow makes RFA ineffective due to the cooling effects, unless a combo of treatments is possible and re-section is too risky.

eric · 09-26-2008, 06:14 PM

Honestly, I don't know why cyberknife wasn't suggested. I didn't bring it up since I was concerned about the vein proximity but obviously that doesn't have to be an issue.

Lani · 09-26-2008, 06:31 PM

I think that Stanford is the only institution in the country using the cyberknife for prostate cancer. I believe it is the only institution in the country utilizing it for a number of new indications ie, things other than primary and metastatic tumors of the brain. I was happy to hear when Esther went there for treatment of her liver metastasis and was even happier to hear how well it went.

Perhaps you can find out more from Esther about how she arranged a consultation and if they know of anyone else doing something similar near you so you know all your options.

DanaRT · 09-26-2008, 06:50 PM

This sounds like a good plan. I am hopeful for your wife and will include her in my prayers.

eric · 09-27-2008, 08:06 AM

Lani - that's a good recommendation but since Caryn has already had the embolization and mapping and is scheduled on Thursday for the seeds, we're going to proceed as planned.
I'm happy that Stanford is pioneering this approach. The more strong options the better!
Thanks all,
Eric

Rich66 · 09-27-2008, 09:41 AM

Is this considered theraspheres or SIR Spheres

Rich66 · 09-27-2008, 11:32 AM

Looks like cyberknife is at UPM:
http://www.upmc.com/Services/liver-c...s/default.aspx

Esther · 09-27-2008, 10:45 PM

Very few Cyberknife facilities are certified to treat liver lesions. It requires specialized software, equipment and training. So while they may offer Cyberknife for other body locations, they aren't likely to offer it for liver lesions.

Because the liver fluctuates constantly due to blood flow it requires fiducials to be inserted around the lesion and the cyberknife uses them to calibrate constantly during the treatment to target only the lesion and spare healthy tissue.

I found it awesome that cyberknife was constantly adjusting to compensate for the movements of the liver due to blood flow.

Cyberknife is completely different from theraspheres or SIR spheres. It is a form of targeted SRS the same as what is used to treat brain lesions.

jones7676 · 09-28-2008, 06:48 AM

It sounds like a wise decision to me...please keep us posted.

eric · 10-12-2008, 03:18 PM

The "sirt" went very well as the dr was extremely pleased with how the seeds settled in the most active part of the tumor. She had to deal with nausea, fatigue and some pain but the drugs have helped (even though she hates taking them since they come with their own side effects). Happily she's starting to feel like herself again and we met with the Onc last week who suggested that we let her body recover more before going onto another step. The plan is to do markers and then discuss chemo or the RFA. He (the Onc) feels like he's gotten a pretty good understanding of how her cancer acts and feels comfortable taking a little more time away from a systemic approach. I'll keep you advised.

Eric