[Joan M]

Ann,

Hang tight. I'm praying that your news will be good.

RFA procedures produce a lot of inflammation up to 6 months later (and it's been argued that this is a good immune response reaction). I had this in the lung when I had a 1 cm nodule ablated in 2008. As it turned out, a fungus had grown in the RFA cavity and it was eventually taken care of in 2009, but you don't need to worry about that for the liver. Also, if there is a small recurrence, it can be ablated again, which is one of the benefits of that procedure.

Local procedures followed by chemotherapy are going to start becoming more common for survivors with oliogometastases. At ASCO, these procedures were mentioned several times at different sessions, even though there are still many holdouts. These procedures were clearly listed in all the slides shown and discussed in the presentations.

Dr. Perez, whose video I posted a few days ago, spoke at a small group meeting at ASCO. She supports local procedures, "absolutely," she said, when I thanked her for that.

Dr. Perez is planning a trial where survivors will be randomized between getting systemic treatment alone versus getting a local procedure followed my systemic treatment.

I've been on Herceptin alone since January 2007 when my cancer advanced from stage II to stage IV (and took Herceptin off-label when I had early stage, deciding not to enroll in an adjuvant clinical trial). So, I'm still taking systemic treatment, even though it has never included chemo in the metastatic stage. I often wish that I had followed up the local procedures with chemo, but I didn't and now that's water over the dam. Also, anyway, who knows. I think in the final equation, there is no right answer: different procedures either work or don't work for different people.

I understand how you feel about leaving work, which I did almost 3 years ago. At first, it's a shock, but afterward you'll see how new opportunities will present that you never dreamed of. You seem to have a very good spirit.

Joan