Liver Mets - Cryo vs Radiation vs Surgery

[Lori R]

Hi my liver mets friends. My PET/CT in mid-February revealed a return appearance of my nemesis the liver met. Same time, same place. (but he is getting bigger 4+ cm in just 4 months....he is going on a diet) Seriously though, I do have a single liver met that presents itself in the same location. To date, I have no other known disease.

So...we've had many a debate as to an ablation technique vs targeted radiation vs surgery. I thought I would fill you in on 2 very, very busy weeks of Dr. appointments trying to determine the next step.

Short answer - Surgery - Liver resection of the left lobe.

Long answer below:

Cryoablation - as many of you know, I was so hopeful this technique would get rid of the bugger. I tried 2 times and when it returned a 3rd, the interventional radiologist very much encouraged me to consider a different alternative. I am not certain he would have tried again even if I had pressed him.

Targeted Radiation - This was very seriously considered as it is a very non-invasive procedure. We ultimately ruled this out because the tumor is high in the left lobe and is close enough to the heart that the dose would need to be reduced. Thus, making the procedure less effective. Also, the chubby tumor was a little large for radiation. However, I was quoted progression free rates of 90% for 1 year and 80% for 2 years. I will be keeping this on my list as a back up procedure.

Surgery: All involved called this the "gold standard". The surgeon that will ultimately perform the resection jokingly said that I must have "proved myself" to finally get the OK for a resection. So....I am getting one more 2nd opinion to make sure I choose the best possible combination of surgeon +hospital and then will get this met removed within a couple of weeks. (at least that is what I am hoping for) Due to the small amount of BC patients with liver resections there weren't a lot of stats that he could quote. So he gave me the more common colon cancer stat which is 60% without progression in 5 years. WOW!!! I'd be thrilled. Not banking on it. I would love another 4 years to get my daughter out of college. (she graduates from high school in 3 months!!)

In other posts I had detailed the cryoablation procedure (freeky but manageable). When I am done with the liver resection, I'll give the gory details of that procedure as well.

I am disappointed to not have the chance to be a cryo cheerleader. I was so hoping that would put the end to this nonsense. So....OK....I will be a liver resection cheerleader. That will be OK too.

Lots of love to all, hope this info is of some value to anyone pondering the various liver met treatment options.

Lori

[Ellie F]

Hi Lori
Glad to hear from you but sorry the pesky met keeps coming back.
It sounds like resection would be a good option as the whole met would be 'out'.
A women at my onc centre had a resection for a liver met 5 years ago and is still NED.Also a friend with bowel cancer has been NED for a long time.

Would you have any chemo post surgery? I wondered if this would 'catch' any little bc cells that might escape during the procedure.

Hugs
Ellie

[Missyw]

Hi Lori,

We've talked before as liver met sisters. Wanted to wish you all the best and remind you I am a liver resection veteran and after two years (so far) NED, I'm a big fan. I've recounted my story before, not sure if you remember it. Let me know if I can help you with any information re: the surgery or recovery. It may be a little rough in the short run, but maybe this little bugger needs the big guns to be gone for good! Let me know how you are doing.

[schoolteacher]

Lori,

I don't have any suggestions just glad to hear from you.

Amelia

[leez]

Lori, I wonder what kind of Targeted Radiation you refer to. One of my friends was treated using Microspheres technique and the result was not good. Good luck with your resection. I am rooting and praying for you. I always thought surgery should be our first line of defense in most cases.

[Laurel]

Lori,

I have nothing to offer except to say that I thoroughly enjoyed your rye humor, and admire your courage. Your post was also very informative. I sure hope your resection goes well and that you see your daughter's daughter graduate high school!

[michka]

Hi Lori
First thank you for sharing. I am thinking of you.I am so sorry cryo did not work enough. Have you found the right hospital/surgeon now?
On my side I am still fighting to get my mets removed. But things changed: I had 2 appointments this week I had made a month ago. The first in the most experimented Cyberknife center in North of France, and the second with a surgeon in the biggest cancer center in France called Institut Gustave Roussy.
In the Cyberknife center they started by a MRI. And then they informed me that I didn't have 2 mets but four. They explained that the 2 "new ones" were in fact very small and that they believed they were always there. But they have a more powerful MRI 3T when most of the MRIs in France are 1,5T. I discovered this! So since November I first thought I had one met, then 2 and now 4, all there since the beginning. The biggest one is 17mm. The only "good" news is that the 2 already identified tumors lost 2 or 3 mm. The fact that there were 4 tumors did not seem to bother the doctor and he said he would operate but he had to go through the process of the center and consult with the team. That may take 10 days. I was very worried about my second appointment but the surgeon said that she would operate even if there were 4 tumors and maybe use RFA for the smallest one during the operation. But she also had to submit my case to the staff. I will have an answer end of next week.
So please hope for me that these teams will say yes.
I am afraid of Cyberknife because we do not have many stats about the outcome and the side effects of radiation in the liver for breast mets. I am also afraid of resection not only because of the risks and the pain but because Lani posted several times that operations lower our immune system and that could make other mets pop up in other parts of the body. Did you ask that question?
How many mets do you have, one? I read you took Navelbine. Are you still on it and if not, how long did you take it?
I hope you have a plan by now. I sure understand what you are going through. Sending tons of hugs.
Michka

[Lori R]

Hi team,
First of all, thank you for all the support!! Missy, it is so encouraging that the stats some of the Surgeons are sharing might not be too optimistic. I'll pm you as I think of those scarry surgery thoughts in the middle of the night.

Michka, I was on Navelbine following my 2nd chryo and honestly it didn't seem to do anything. The Drs. are thinking that for some reason the chemo is not getting to the part of my liver with a tumor. My onc is thinking that since I have remained NED in other parts of my body that throwing more chemo at my system might not be beneficial. I do worry about just destroying my system with all these non-targeted drugs. Yet, I do like the idea of a follow up for escaping cancer cells.

Michka, are the little mets all in the same lobe of the liver? If so, that would be a good thing for surgery. It is also good that the mets are very small. The Sterotatic radiation is good for very small mets. The radiologist quoted the 90% recurrance free after 1 year.

Leez, the Sterotatic readiation is a targeted beam of radiation. I don't know if the microspheres procedure you are referring to involves implanting radioactive particles in the liver. The stereotatic option is extremely sophisticated and precise. I understand the planning for the treatment takes the radiologist 2 weeks to develop. One of our wonderful, wonderful sisters Lily used Sir - Spheres and I don't believe it worked for her either.

One final consult with one of the best liver surgeons in Denver on Monday. (but has a notoriously unfriendly bedside manner) I've decided that if he will take my case, I will use him. (we call him Dr. grouchy) Then....just need to get on his schedule.

Thank you again for all of your warm thoughts...lots of hugs.

Lori

[Joan M]

Lori,

Damn those pesky liver mets, again! But I'm glad that you continue not to have mets anywhere else.

I would agree that if you now lose that section of the liver the mets can't come back in the same place. And you've given cryo, or a minimally invasive procedure, a good shot.

Joan

[schoolteacher]

Lori and Micka,

Thinking of you.

Amelia

[michka]

Thank you Amelia. It helps me a lot to have your support. Michka

[schoolteacher]

Michka,

I hope I have helped. On a cold, gray day in February 2008, you helped me to have courage and continue on this journey. You are one of my heroes.

Amelia