Chemoembolization vs Ablation therapy for large liver metastases - 1257241

I wanted to sympathise as I have been in a position simiilar to your mother's for the last few weeks. I take this to be "capsule pain" in the liver, and I could not agree more that it is indeed excruciating, so I send all my best wishes and fellow-feeling to her.
I am in the UK so approaches may be different. In general my oncologist (like Dr West on this site) has discouraged "local" liver treatments on the grounds that a) the tumour is too big; b) these treatments can make you feel worse; c) they carry some risk of radiation "leak" or spread into other areas like the bowel. I found this (British) link to be quite helpful on the "Sirt" or chemo-embolization (with radioactive beads) approach:
http://www.macmillan.org.uk/Cancerinformation/Cancertreatment/Treatment…
We've also talked about a regular blast of external radiotherapy, but again there have been suggestions that it could make me feel very sick. So we haven't got anywhere really, which is frightening as the tumour is growing very fast. We have however finally made some progress on pain relief, so I'd be happy to share more if that would be of any use. All best to you and your mother.

Hi Dan,

Here's what Dr. West has written about chemoembolization for liver mets:

"It's hard to assess without being there to see the extent of disease in the liver, but I've never requested embolization in a palliative effort to reduce the challenge to the liver. The embolization procedure tends to be very challenging and toxic to the liver itself, at least in the acute setting, which is arguably justifiable in a curable situation, but I think pretty dubious if you're trying to prevent future liver damage in an incurable situation (which, I'm sorry to say, sounds like a realistic interpretation). You can definitely see the liver functioning less well in the event of very extensive liver involvement with cancer, but it's often surprisingly resilient. I've rarely seen patients actually decline rapidly because of liver failure far before we would have expected to see a decline from other causes, and I would certainly be wary about potentially making things worse in the short term from the risks of the embolization procedure." - http://cancergrace.org/forums/index.php?topic=10158.msg81025#msg81025

In the same thread, Dr. Weiss adds:

"I have some experience with chemoembolization from my training. As a resident, I did some oncology under one of the procedure's inventors. It is mostly used for GI cancers. It can help control disease in the liver, but also can be physically painful and can harm normal liver function. It's one of those tools that I consider from time to time and have rarely pulled out of the toolbox--for lung cancer, I can only remember doing it once. If it is considered, I recommend that the doctor at least informally consult with someone who does this procedure all the time (typically a GI oncologist who treats liver and colon cancer) to ensure that the patient is a good candidate. If this procedure ever has a role in lung cancer, it should be rare."

JimC
Forum moderator

(Continued from previous post)

There was a previous discussion of chemoembolization in this context here: http://cancergrace.org/forums/index.php/topic,2828.msg16714.html#msg167… In that discussion, Dr. West posted the following comment:

"To me, one important reason why I've never been tempted to pursue chemo-embolization or radiofrequency ablation for lung cancer metastatic to the liver is that it's so rare that this is a solitary metastatic focus: lung cancer that travels to the liver tends to be so likely to have other micrometastatic disease, or areas of readily visible metastatic spread, that pursuing a treatment with added side effects that is going to be effective at most for just one area of a multi-focal process just doesn't seem to add clear value. Colon cancer is a different situation, because it's more common to have one or two metastatic foci of cancer in the liver but nothing else appearing anywhere else for a long time, so it's not as likely to be a disseminated process. And that's part of while I consider it to still be a compelling idea in colon cancer but not really in lung cancer. This isn't to say that I'd never consider it, but I think it would make the most sense if a patient was followed over time and had just a single growing area in the liver with long enough follow-up to feel assured that new disease isn't likely to pop up within weeks or a few months after undergoing that local treatment."

On the other hand, Dr. Pennell has said:

"In situations where patients have a dominant liver lesion that is causing pain, and the systemic chemotherapy is either not effective (or not enough) to help, then chemoembolization can be very helpful to shrink the single tumor and relieve pain. In my experience this tends to be better for large tumors while RFA is better for small tumors (although small tumors rarely cause pain in the liver)." - http://cancergrace.org/forums/index.php?topic=8278.msg62414#msg62414

JimC
Forum moderator

(Continued from two previous posts)

Regarding RFA, Dr. West also stated:

"In truth, the situations in which RFA for liver lesions or any other metastases in lung cancer would be a tempting consideration would really be very, very limited (and by that, I mean it's in the range between rare for NSCLC and pretty close to never in SCLC)." - http://cancergrace.org/forums/index.php?topic=9725.msg77130#msg77130

So it appears that this is a situation in which your mother's doctors would need to make a careful assessment of her overall situation before considering either procedure.

I hope that they can find a way to alleviate her pain very soon.

JimC
Forum moderator

Hello shinbo, I'm very sorry your mother is having such pain. I hope she finds relief soon.

Hi certain spring, I'm very glad to hear you are having success with pain control and even if shinbo doesn't ask for specifics I'd like to ask for it is likely to help others who read this thread.

With much love, know that I keep you, and the rest of our Grace family, including our doctors in my thoughts and meditations.

Janine

Jim has ferreted out a huge amount of relevant information here. As he conveyed with input from several of us on the GRACE faculty, there's a range of approaches that could be used, but it really depends on the underlying diagnosis. Some causes of liver metastases, such as small cell lung cancer, may respond very well to chemotherapy. Others, such as a primary liver cancer (hepatocellular carcinoma), is usually big and solitary and is very appropriately considered for chemoembolization. The key point is that there isn't a "one size fits all" approach, so I think it'll be very helpful to get input from a doctor directly involved in her care once more is known about the underlying cause and other important details.

Good luck.

-Dr. West

Shinbo - - I too am sorry to hear of the pain your Mom is experiencing. . .and wish her a speedy relief from it.

cs - - yes, please do share. xoxo

Laya