Cryosurgery Procedure

[Lori R]

Hi all,
Below are some details of the cryosurgery procedure I had in May of this year (2009) and the short term results. (which were good)

BACKGROUND:
Upon my initial diagnosis in Oct 2007, I had a single liver met. Unfortunately, approximately 1 year after completing Taxotere the met returned. The "new" met was measured at 2.8 CM.

PROCESS - DETERMINATION TO USE CRYOSURGERY
Upon discovery of the Met , my Oncologist referred me to an interventional radiologist. I was thrilled with the interventional radiologist as he answered EVERY question I had. As always, make sure that you are comfortable with any Dr. performing a procedure. He explained that a couple of years ago he used Radio Frequency Ablation (RFA - heating) to destory liver mets but has been using cryosurgery much more frequently. He informed me that the healing time was shorter with the cryo (freezing) and during the procedure it was much easier for him to see where he had treated. He felt this visibility allowed him to be more precise and feel more confident about an appropriate margin.

Unfortunately there are some limitations to the procedure that I am not 100% certain I have the facts, so I encourage you to investigate this procedure with a Dr. My radiologist informed me that he felt the effectiveness diminished at anything over 3 CM. So...I felt lucky to have just made it under the wire at 2.8 CM. He did not indicate that he would not perform the procedure if over 3 CM but he was expressing some caution. I also understand there are locations next to critical veins (?) that limit the use of this procedure. I am not certain about using the procedure on multiple mets.

PROCEDURE DESCRIPTION
Short answer - very manageable. Long answer - see below
First of all, the procedure is performed laproscopically so the time in the hospital is minimal - outpatient. The recovery was amazingly quick.
I checked in at 8 a.m. (the usual pre-hospital blood draw, insurance paperwork etc. etc.)
The procedure was performed in a room containing a CT machine, ultrasound equipment and the cryo equipment which involves a big tank of gas (nitrogen?) and the rods that are inserted into your liver to freeze the tumor. These rods are about the size of your small finger.
This is the amazing and encouraging part.....I was given "twlight" gas so I remained fully awake. They numbed my stomach which I don't even remember them doing. The radiologist made 2 small slits and inserted the freezing rods. He would freeze and then move me about a foot into the CT machine, check the margins, pull me out and then freeze some more. I only felt pressure on a couple of occasions. OK....a little freeky...kind of like going to the dentist and being numb but when they push on your tooth you sort of feel like it hurts but doesn't really.

The procedure with lots of back and forth into the CT machine was complete in 2 hours. I was rolled into recovery and walked about with my husband at 5 p.m. (ok...the anesthesia made me sick..that was THE worst part) Only "stitches were little tape like tabs over 1/8 inch slits.

Thursday (day after procedure) I felt crummy, again a result of the anesthesia but showered by noon and felt much better. No need for any pain medication. (I think I was provided some but didn't need it)

Friday - Drove to the grocery store, picked up a few items for dinner and made dinner.

Saturday - cleaned out my garage.

Monday - back at work

I respect both my oncologist and interventional radiologist as they did not want me to assume I was "cured". As we all know, those pesky tumors can have long tenticals that exceed a reasonable margin. So, to be on the safe side the cryosurgery is usually followed up with a round of Chemo. We let the liver recover for about 3 weeks and then I started on Abraxane for 6 cycles.

THE SHORT TERM RESULTS:
After 3 cycles of Abraxane my PET/CT showed no evidence of disease!!!

LONG TERM RESULTS:
I will continue to add to this thread as time marches on. It is my understanding that this procedure can be used on multiple occasions.

For now....I'll take the victory provided by this minimally invasive procedure.

My sincere hugs and best wishes for anyone considering this treatment approach.

[tricia keegan]

Lori,

Thank you for your pm and also for posting this info which I'll pass on to my friend. It may not help her as she has many liver mets but I know she'll be glad to at least discuss with her onc as chemo is not working and she's ready to try anything.
Once again, many congratulations to you on NED and I wish you many more years of good health

[chrisy]

Lori,
Thank you for the detailed report on this process. It is indeed very encouraging, especially for those of us dealing with liver mets, to hear that new approaches for local control are being pursued. And it's always wonderful to read about successful results AND quick recovery. I'll keep this one in my back pocket (I hope the garage cleaning part is optional)

[Joan M]

When it's possible to perform them, minimally invasive procedures like cryoablation and radiofrequency ablation can work well sometimes. RFA is also used a lot for primary liver tumors and mets, and the IR doc's take on using cryo rather than RFA is interesting.

Joan

[Lori R]

Cryosurgery Round #2

I am back with an update on Cryosurgery round #2.

Unfortunately, this pesky liver met insists on returning. Per my signature he showed up on a 7/10 PET Scan.

Same location.....Single met....So...back to cryo again.

I reread the procedure from the first time and just wanted to say...."Ditto".

The interventional radiologist decided to be as aggressive as possible with creating a significant margin, in the hopes of sending my unwanted house guest packing.

Round #2 - encouraging that it could be performed again, was similar to Round #1. Outpatient on Thursday, up and about on Friday, pretty active with the family on Saturday.

Plan is another insurance round of chemo (UGH!) of Navelbine.

In waiting to heal mode and will start in a few weeks.

While disappointing that the met popped back up, I am hopeful that beating it back quickly will somehow pay off in terms of just wearing this cancer down.

[Joan M]

Lori,

Sorry to hear that the liver met returned, but I'm glad the result lasted over a year (May 2009-July 2010) with having only short-term chemotherapy. And what's really good is that the PET showed no other nodules.

I'm praying that round #2 of cryoablation works to knock out that pesky met.

Thanks for continuing to update us on this interventional radiology procedure. I'm for such procedures when appropriate. Yet, medical oncologists rarely mention them: I had a lung radiofrequency ablation in August 2008 on the sneak, for a lung nodule recurrence after a lung wedge resection about 16 months prior.

My local onc knew about the RFA, but I did not tell until the 11th hour an onc I was consulting at a major cancer center where I had the procedure. He actually called the IR guy the night before the procedure and asked him, "What are you doing? An RFA is not standard of care for metastatic breast cancer." They "agreed" that this is what the patient -- me -- wanted. Your onc is A-1 in my book.

Unfortunately, I developed a fungal infection in the cavity created by the RFA, a rare occurence, from inhaling a fungas commonly found in soil, probably from gardening in the summer right after the procedure (like your cleaning out the garage), which lead to coughing up blood in February 2009 and a thoracotomy in July 2009. I was admitted from the ER. To stop the bleeding, a thoracic surgeon had to perform another wedge resection to get rid of the fungus. But the path report showed no cancer, only the fungal ball, or mycetoma (or aspergilloma, after the fungus, aspergillus).

In the fight against cancer, I believe that every stone should be turned over, even though in some instances local procedures are not possible, as you mentioned, due to proximity to major arteries, nerves, etc. Thankfully, yours is possible.

Good luck with round #2, and let us know what happens.

Joan

[Rich66]

Been collecting info on lung mets, including cryo..here

The bit about using Cytoxan/Cyclophosphamide to modulate immune response to cryo is intriguing.


Info on liver mets tx here: