Liver metastasis

[Easey]

Hi all, wondering if there's anyone out there who can help with suggestions on treatment for liver Mets.

The cancer seems to be confined to a couple of spots (65 mm total) on the right lobe of the liver. I've had stereotactic radiotherapy to the area before and looking at :

RF ablation

Chryotherapy

SIRT

BAT

Starting cabazitaxel next week

Any suggestions

[GP24]

Here is some information about SIRT:

cancerresearchuk.org/about-...

[Easey in reply to GP24]

There is a relative contraindication for previous radiation to the liver , which I have had. Which in my mind means it can be done but there is possible risks. When I speak to the IR specialist I'll know further regarding my "risk profile' .

[GP24 in reply to Easey]

TACE is another treatment for metastases in the liver:

cancer.ca/en/cancer-informa...

cancerresearchuk.org/about-...

[Easey in reply to GP24]

Thanks Ive' just had a quick read before I do a bit more research. The article refers to liver cancer primarily, but that will be a question I will be asking when I meet with the IR. "Can this work with prostate tumours in the liver"

Thanks for the reply , terrific

[GP24 in reply to Easey]

As far as I know, this will work with liver mets from any solid tumor, e.g. PCa.

radiologie-uni-frankfurt.de...

[Easey in reply to GP24]

This TACE sounds like it could be the GO , . I will explore this with the specialist but looking at the linked article they do it pretty well in Germany. I'm in Australia ( willing to travel !)

The biggest issue I am finding with all of the cancer regimes is "the order" - In that you have to have had this chemo or this hormone drug before you move on to the next course , or if I had known that having the stereotactic radiation to the liver previously would rule me out of SIRT then I would have looked at SIRT first maybe. I"m feeling very encouraged with your replies thus far and wish I had of joined this forum earlier , Alas ?

thank you very much

John

[GP24 in reply to Easey]

John,

I just thought of it: SBRT can be repeated. They can radiate very small areas, so if you were radiated at one side of your liver and now have a met at the other side this can be radiated too. Also one SBRT RO told me: "I can radiate dead tissue as often as I wish". So she would even radiate overlapping areas.

So the most straightforward way would be to talk about this with your SBRT RO. You could even combine this radiation with a chemo to hit it hard.

[Easey in reply to GP24]

That is very interesting thanks mate . I know my bloke knocked another hit to the liver straight up. His issue is what I've heard described as the Pokemon effect ! that's a pretty apt description of what happened after my SBRT : you knock them down and they pop up again next door . Taking everything into account the liver must be an extraordinary organ - !!!

[GP24 in reply to Easey]

John,

this is a general problem with metastasis directed therapy. You destroy what you see but usually there are more tiny mets you do not see and which pop up later. On the other hand, you will probably(!) gain some time when destroying the biggest mets.

Therefore I recommended to combine this with chemo. This will also attack the mets you cannot see yet.

I have radiated my lymph node mets in the pelvis three times now and I am sure there will be new ones again. On the other hand I am happy that the PSA value is currently so low I do not have to do ADT.

[kidclutch]

hello! my dad has liver mets, and is in the third cycle of docetaxel. liver mets are fading as of this week's scans.

[Easey in reply to kidclutch]

Good News

[Tall_Allen]

Radioembolization works well if it is highly localized. Cabazitaxel+carboplatin may get at the mets you can't see.

[Easey in reply to Tall_Allen]

I will be talking to a Interventional Radioligist on Monday and I'm scheduled for the cabazitaxel starting Wednesday and maybe leave the carboplatin for later. Hoping the tumors haven't mutated to the neuroendecrine type especially after the xtandi resistance. Not too sure how the nets react with chemo either taxane or platinum or both. I also hope the IR specialist is not of the conservative type and is willing to have a bit of a go , as of tolerated all treatments thus far pretty well.

[vandy69]

I was diagnosed with 20+ lesions in liver in September 2017. Immediately had CT guided biopsy to determine what kind of cancer—liver cancer vs. prostate cancer mets in liver. It was the latter. Had infusion port implanted in right chest and began 6 cycles of Docetaxel/Carboplatin chemo combo. Used Xtandi as rechallenge after chemo and got 4-5 months before next 6 cycles of same chemo. Again used Xtandi as rechallenge.

Just completed cycle 4 of my 3rd round of chemo but this time am taking Xtandi throughout the chemo process. PSA has dropped from 48 to .2, liver lesions 50% smaller, lymph nodes normal size, and no need for last 2 cycles of chemo.

My response has been outstanding, but SEs do increase with frequency of chemo.

Best Wishes. Never Give In.

Mark, Atlanta

[Easey in reply to vandy69]

That's brilliant Mark and keep it going mate. I think I will start on cabazitaxel and look at the TACE / SIRT / RF for a direct hit. Xtandi worked initially and I used it to great effect with SABR to the liver but I very quickly developed resistance. Anyway good luck and thanks.

John

[Easey in reply to Easey]

This probably goes with out saying but .. be vigilant ! The result I had with Xtandi and SABR dropped my psa to .06 and I was hoping ,... you know ... and then the old psa started to double every month etc. I guess what I'm trying to say is "don't relax" and kick it while its down. You've already done bloody well