Need opinions/advice/prayers on liver options
 

Was praying for good news today and God answered our prayers! Saw an interventional radiologist (IR), who thinks radiofrequency ablation on the liver would be successful and a liver surgeon who said surgery could be a back-up plan. I have to talk to the oncologist on Monday. It would mean I'd have to come off the clinical trial I'm on. I know that oncologists don't like tumor removal in stage 4 patients because it "blinds" them. They use the tumor size to gauge whether or not chemo is working on unseen, microscopic cancer cells (I'll be on chemo forever). However, the IR and surgeon pretty much feel, "well, there's this bad thing in your liver and we're pretty sure we can kill it or remove it, so why keep it"? I get both points of view. The clinical trial has been a God-send, considering the fact that it shrunk the tumor more than half, but now it's stable. So we have decisions and options, which is good! What do you all think?

Re: Need opinions/advice/prayers on liver options
 

I had Rfa done in feb,2011 and have been Ned since then. Why do you think you will be on chemo forever? I had my last chemo in jan, 2011, and have been on just herceptin and tykerb since then.

It was a very easy procedure. I would go for it.


Laurie

Re: Need opinions/advice/prayers on liver options
 

Penny,

We will be praying for you. The abstract below shows thermal ablation is effective:

Eur Radiol. 2012 Oct 13. [Epub ahead of print]
Thermal ablation therapies in patients with breast cancer liver metastases: A review.

Vogl TJ, Farshid P, Naguib NN, Zangos S.
Source

Institute for Diagnostic and Interventional Radiology, Johann Wolfgang Goethe University Hospital, Theodor-Stern-Kei 7, 60590, Frankfurt am Main, Germany, T.Vogl@em.uni-frankfurt.de.

Abstract

BACKGROUND:

The liver is involved in about half of patients with metastatic breast cancer. Unfortunately systemic chemotherapy as the treatment of choice is limited. Due to multifocality and/or insufficient remnant liver volume, the majority of liver metastases are also unresectable. Currently, thermal ablations are used in these patients with acceptable impact.
METHODS:

We reviewed studies on radiofrequency ablation (RFA), laser-induced thermotherapy (LITT) and microwave ablation (MWA) regarding local tumour response, progression and survival indexes in patients with breast cancer liver metastases (BCLM).
RESULTS:

The reviewed literature showed positive response rates of 63 % to 97 % in RF-ablated lesions, 98.2 % in LITT-treated lesions and 34.5-62.5 % in MW-ablated lesions. Median survival was 10.9-60 months using RFA, 51-54 months after LITT and 41.8 months using MWA. Five-year survival rates were 27-30 %, 35 % and 29 %, respectively. Local tumour progression ranged from 13.5 % to 58 % using RFA, 2.9 % with LITT and 9.6 % with MWA.
CONCLUSION:

The reviewed literature demonstrated that ablation therapies either as single therapy or combined with other locoregional therapies are a good alternative as an adjunction to resection in patients with resectable lesions or with positive response using chemotherapy. However, multicentre randomised studies should be conducted to obtain further evidence of the benefits of these treatments in patients with BCLM.
KEY POINTS:

• Thermal ablation is an alternative treatment for hepatic metastases from breast cancer • This review assesses thermal ablation therapies and local chemoembolisation techniques • It helps prioritise treatment options for managing hepatic metastases from breast cancer.

Re: Need opinions/advice/prayers on liver options
 

I say if you have an opportunity to blast it with a local therapy go for it. I did not have that as an option initially as the disease was too widespread in the liver, but would still push for it if/when we can get things stable again and with enough healthy stuff left there!

Sounds like you are in a good position to try this.

Re: Need opinions/advice/prayers on liver options
 

How wonderful for you to have options! Gods blessings to you.
You are in my prayers.

Re: Need opinions/advice/prayers on liver options
 

Thanks everyone. I was assuming I'd always be on chemo because: herceptin doesn't work too well with me, especially on its own; I'm severely allergic to tykerb; and I have the brca2 gene. Maybe I'm wrong? I'll know more Monday after my oncologist appt.

Re: Need opinions/advice/prayers on liver options
 

Sounds very promising Penny. I would go for the intervention if they think you are a candidate. It seems to work well for many.
All the best
Marie

Re: Need opinions/advice/prayers on liver options
 

Hi Penny,

I'm a firm believer in reducing the tumor load as much as possible to give the systemics a better chance of getting control of things.

I would think that RFA, or Cyberknife would both be appropiate options if the docs feel you are a candidate.

I had the left lobe of my liver resected in 2002 because I wasn't a candidate for RFA (tumor was too close to the portal vein). Turns out what they thought was a tumor in my liver was just scar tissue from the taxotere and Herceptin doing it's job. If Cyberknife had been available to me then, I would have pushed for that.

My liver seems to have regenerated quite a bit since then, so I'm hoping that if I have further involvement in my liver, I will indeed be a candidate for CyberKnife.

Best of luck to you on these weighty decisions,

Kim

Re: Need opinions/advice/prayers on liver options
 

You are at the best stage for ablation when things at stable. I would blast it. ablation is a easy procedure and you recover fast. That is what i did a while back.

Re: Need opinions/advice/prayers on liver options
 

Ditto, Chrisy.
I have used only chemo for my liver mets. Hoping this streak will continue, staying positive, but who knows where the times goes, who knows what our destinies are?

Karen

Re: Need opinions/advice/prayers on liver options
 

I had a liver resection (left lobe) and a microwave ablation of a spot in the right lobe. He said he got a good margin and he didn't think it would come back but he was wrong, the cancer came right back in the ablated spot and they won't do it again unless it shrinks down - it's too near vital structures.

The resection was a hard surgery but manageable. I had the ablation at the same time so can't differentiate the symptoms.

Even though I didn't get any benefit, I appreciated my Hail Mary shot and I think you should take it. Many women get many more years of life by these interventional treatments. Good luck!

Edit: Oh, and yes, I was told I would continue to do chemo after the surgery. They believe that there are still stray cells there that they would kill.

Re: Need opinions/advice/prayers on liver options
 

Than you! I see the oncologist tomorrow. Praying for guidance. I will post an update.

Re: Need opinions/advice/prayers on liver options
 

I should add that I'm BRCA2. Herceptin doesn't work too well with me and I'm allergic to tykerb. Eek.

Re: Need opinions/advice/prayers on liver options
 

Penny, I pray all goes well for you.

Ann, I'm so sorry your surgery didn't do the job. Please know that you are also in my prayers. Gods blessings to all.

Re: Need opinions/advice/prayers on liver options
 

Lorrraine had rfa on a liver met way back in 07 or 08, blasted it out , still no cancer there. at the time MGH in Boston claimed they were among the first to use it , had about 10 yrs experoence w/ it . the surgeon, Dr. Arellano, was very good , and took a wide margin. very small incision , s/e were feeling like youd been kicked in stomach , flu-like sx's . passed in afew days . we are very pleased w/ its results.
L. too couldnt handle tyk . i dont know much about velaparibs' effect on on her2 bc. could your reduction be due more to paclitaxel and carbo ? t dm-1 is coming soon , thers no way This FDA can block it past Feb.

Re: Need opinions/advice/prayers on liver options
 

As another liver mets gal, I say Go For It!!!! Get that nasty stuff out of there! I have seriously been thinking about looking into it myself, although my oncologist has discouraged it. I did initially have little birdseed tumors pretty widespread through my liver, but for the past six months have had just one 10 mm tumor visible. I would LOVE to get that out of there. It makes me cringe thinking about it sitting there waiting to spread. Best of luck to you my dear...here is to stellar results from the treatment!

Re: Need opinions/advice/prayers on liver options
 

I chime in for blasting it. There doesn't seem to be a down side other than the oncologist's point of losing his ability to monitor response to treatment. What did you oncologist say?
xoxo Kim (from CT)

Re: Need opinions/advice/prayers on liver options
 

Penny,

As many on this site know, I'm very much for local procedures to target limited disease. I did this and have been NED since October 2008.

Patients have mixed results from local procedures. At the time I wanted to try it. First a lung wedge resection, and then when the cancer recurred a year later in 2008 in the same area (even though I had clean margins), I had an RFA.

I've been on only Herceptin since my disease advanced in January 2007, and I took the drug off label for 52 weeks when I was diagnosed in 2003 with stage 2B. It's like, Go figure. (I had 7 positive lymph nodes and didn't want to risk drawing the arm without Herceptin in the adjuvant trial).

I just take a wait and see approach, and hope my LVEF holds out and I'll continue to be NED.

Good luck with whichever decision you make.

Joan