Liver Met recurrent Adcc - 1242051

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ncgatorguy
Liver Met recurrent Adcc - 1242051

I was a user on the old website and my info can be found here:
http://cancergrace.org/forums/index.php?topic=11422.msg94632#msg94632

I have since seen a surgeon that states resection is an option. The tumor is close to the rt hepatic vein. He says he can do it with only opening a "hand port" and not cutting me wide open. With that said his biggest concern is me having only one lung and getting pnemonia while in the hospital. He says that ablation won't work and that therasphere's are not used for this and also not an indicated treatment (insurance wise). He is presenting my case to the Tumor Board on the 27th. I have also spoken with the Pathologist and my cell make up was all three but more solid form and thus he states more aggressive than my lung tumor was in 05' I saw an Interventional Radiologist today just to rule out that avenue and BAM. He states he thinks that sir spheres will work on my tumor! They have been using them for other cancers other than Mets from colorectal cancers with sucess. I AM TOTALLY CONFUSED NOW. I guess my questions would be
1) has anyone had this work and if so how long and what was the experience like?
2) Any Dr.s care to weigh in on this? I would hate to go through this and then have to go through a resection also. I have done resection and traditional radiation in 05' and now this.
3) Has anyone been through any of this that can shed some light on my situation?

ANYTHING would be of help at this point.
Thanks from Charlotte NC

Dr West
Reply To: Liver Met recurrent Adcc

I think it's very hard for us to speak the applicability of a local therapy for liver metastases in the setting of a primary lung cancer. I have never pursued such an approach, and I don't know of any lung cancer specialist who has ever recommended this for lung cancer metastatic to the liver. I'm not saying it wouldn't possibly be a consideration in someone with a very unusual circumstance, but this is so unusual that I think that a doctor would really need to be directly involved in reviewing your case to speak to whether this really makes sense.

-Dr. West

+++++++++++++++++++++++++
Dr. Howard (Jack) West
Medical Oncologist
City of Hope Cancer Center
Duarte, CA

Founder & President
Global Resource for Advancing
Cancer Education

laya d.
Reply To: Liver Met recurrent Adcc

Sorry for my ignorance, but what are "sir spheres"?

Laya

ncgatorguy
Reply To: Liver Met recurrent Adcc
certain spring
Reply To: Liver Met recurrent Adcc

I don't find the website very clear, but it seems to be a method of delivering radioactive beads into the hepatic artery, via a catheter that goes into the leg. I can't see any difference between "sir spheres" and "theraspheres". I think the idea is of a radiation treatment that works from within.
I am sorry you're in this alarming and confusing situation. I think it's a good thing that your case is being presented in front of a group of specialists; as far as I can tell - and the GRACE doctors can speak to this - tumour boards are good for patients in the sense that no one person can impose their opinion or run away with their pet enthusiasm. But yours is the most important view - what you feel about the various options and what you'd like to do. If it were me I'd want a proper briefing on the risks of surgery, and I'd like to see some research on these internal radiotherapy techniques. I'd also want someone to tell me how things would be likely to develop if I did nothing. I hope you're not getting pain from the liver. Very best.

laya d.
Reply To: Liver Met recurrent Adcc

Ah! Thanks. . .I've heard of this before (in the context of prostate cancer, I believe). . .

Laya

Dr Pennell
Reply To: Liver Met recurrent Adcc

I would agree strongly with Dr. West. No one has ever shown a benefit from surgery to remove a liver metastasis from lung cancer, so this would be considered outside the normal standard of care. In one person, of course, there could be special circumstances that make this worth trying, but I would want to make sure this was well thought out beforehand. It is not hard to find doctors, especially surgeons, who are willing to do aggressive procedures without evidence supporting benefits, and it is important to make sure it is not just technically possible to do but also the wise decision. Is this something your oncologist has suggested?

ncgatorguy
Reply To: Liver Met recurrent Adcc

Thanks to Dr.s West & Pennell. I need to clarify something because I am hearing the same thing here as I do with my Dr. visits. I did NOT have LUNG CANCER. I had first round of cancer in my lung that was ADCC (never anywhere else). With that said everything I hear and read says "remove & radiate". I understand and have read many things about lung cancer mets to the liver and what happens. Now if your saying there is no difference in having adcc in the lung and mets which are also adcc in the liver now then that is new news to me and I need to approach things differently.

Is this different than what you thought I was saying? If so I would love to hear what you think if it is now different.
Thanks Again!
Lost in Charlotte NC

Dr West
Reply To: Liver Met recurrent Adcc

I think that makes for a more complex discussion, though still without a clear answer. Adenoid cystic carcinoma can follow a very slow-growing course that would make us more inclined to consider a local therapy for metastatic disease. Theoretically, we could apply this for metastatic lung cancer or AdCC or another metastatic cancer. The general principle is really that metastatic disease is a systemic process, so it doesn't make a lot of sense in most cases to pursue local treatments for advanced disease -- the disease could just grow somewhere else as fast as you can treat a local area.

It's more complex with a slowly progressing cancer. If you go a long time without seeing progression outside of one area, you can become increasingly confident that there won't be new areas of disease visible shortly after giving local therapy to the limited visible disease.

The question is that it's somewhere between hard and impossible to know whether someone doing well for a while after local therapy is doing better than they would if you didn't eradicate the localized and slow-growing disease. We don't want to just treat the scans to make all of us feel better, if we end up seeing progression elsewhere later on, especially if it's at the same time that they'd progress if they hadn't undergone local therapy. On the other hand, it has now become a standard practice to resect metastatic liver lesions in patients with metastatic colon cancer, and such patients may do so well with surgery and systemic therapies that there is reason to debate whether they might actually be cured (or just slowly progressing).

I've written some more about this question here:

http://cancergrace.org/lung/2010/09/07/local-therap-for-metastatic-disease/

Good luck.

-Dr. West

+++++++++++++++++++++++++
Dr. Howard (Jack) West
Medical Oncologist
City of Hope Cancer Center
Duarte, CA

Founder & President
Global Resource for Advancing
Cancer Education

ncgatorguy
Reply To: Liver Met recurrent Adcc

Thanks to Dr West for a great reply. I feel better now going forward. Thanks to GRACE also, what a site!
Lost in Charlotte

ncgatorguy
Reply To: Liver Met recurrent Adcc

Well as you can see my last post was 2-23-12. Since that time we have been fighting BCBS to cover the Sirspheres and took that to the NC Insuance Commission to overturn and were denied. Now my intervetional Radiologist is trying to get me to try TACE (CHEMO>>UGH).

I am wondering if anyone has heard of this and with ANY Success? I am now just leaning towards were I started and "cut it out and radiate". I have asked for a consult with my Medical Oncologist whom has always stated that chem does not work on Adcc.

Any thoughts?
Thanks!

Dr West
Reply To: Liver Met recurrent Adcc

Trans-Arterial Chemo-Embolization (TACE) can definitely be helpful for people with liver metastases from colon cancer. This is a different situation, but it's still meant to be a local therapy, and I think it could be effective. I have no experience using it, given the patient population I see.

It's true that the responsiveness of adenoid cystic carcinoma to systemic (IV or oral) is somewhere in the range of very modest to minimal, this use of chemo (TACE) is different enough that I don't think I'd make presumptions about it not being a feasible idea -- it would be given as a local therapy (to a specific area). I think it's fair to not be enthused about systemic chemotherapy in this situation. If we do it, it's often because we just want to try something. However, it's also so difficult to study because of its infrequency that I don't think we can be completely dogmatic with any conclusions about adenoid cystic carcinoma.

Good luck.

-Dr. West

PS: It's not just you. I'm facing a payer coverage issue for an appealing treatment for one of my own patients today that I'm told probably won't be covered no matter how hard I huff and puff.

+++++++++++++++++++++++++
Dr. Howard (Jack) West
Medical Oncologist
City of Hope Cancer Center
Duarte, CA

Founder & President
Global Resource for Advancing
Cancer Education