darian1179 wrote:Hi All,
My father 57 has been recently diagonsed with stage IV colon cancer with 67% liver involvement, the biggest tumour is 9 cm. We are all devastated. He just had his 2nd round of chemo and no surgery yet. Just wondering if anyone has such a significant liver involvement and still survived? At present the doctor said there is a 1% chance of a liver resection in the future, we are not going to take that and have looked into other options such as Sirt. Anyone tried Sirt in combination with chemo? We are going to see a liver surgeon tomorrow. thanks.
Darian, while second opinions are good in these instances, I would strongly suggest that your father consider getting his second opinion from a major research-oriented NCI ranked comprehensive cancer center. Liver resections when a lot of the liver is involved are tricky; your dad needs a surgeon who does a lot of them and does them all the time. The NCI site (google "where are NCI comprehensive cancer centers?") has a map that tells people, by state, where the NCI ranked hospitals are located. With a stage IV diagnosis, your father needs more than anything a team approach - at minimum, a medical oncologist who works closely with hepatobiliary (liver) surgeons to develop and recommend a medically-appropriate course of treatment and timeline. Although I was rejected for liver resection after being referred to MSKCC by my local oncologist at my first appointment, the MSKCC onc continued to follow my case and read my scans, and when I'd made enough progress, she changed my status from unresectable to prepare for surgery.
Your father's doctor is correct that the chances of being considered resectable at initial diagnosis for most Stage IV patients with significant liver involvement is pretty small. As Hannahw mentioned, it depends on other health issues the patient may have, whether there is disease anyplace else (lungs, peritoneal cavity, bones, lymph nodes), where the tumors are and how your dad's liver functions are holding up. And while SIRT has promise in some situations, leaping to SIRT when your father has only had two rounds of chemo could be seriously premature.
Your dad could have an excellent response to chemo - which is far less invasive and dangerous than the SIRT procedure - but it may also take a few months for that to happen. Read my signature - I did nine months of Folfox + Avastin before Sloan Kettering presented my case to their tumor board as a liver resection candidate. My first scan after four rounds (two months) of chemo showed no tumor growth - but no reduction in tumor size, either, although my liver function bloodwork had dramatically improved. My second scan, after nine rounds (four months) of chemo showed a net 45% reduction in extrapolated tumor size - but I was STILL not resectable. It wasn't until after I'd had 16 rounds of chemo (nine months) that MSKCC called and said that they liked what they saw on the scans. And then, when the liver surgeon got in there, he couldn't resect after all and had to place an HAI pump (which, FWIW, is not always compatible with the SIRT procedure unless the liver surgeon is working with an SIRT team from the get-go.) I then did another 13 months of systemic Folfiri + FUDR administered directly to my liver via the HAI pump - and then, almost two years after diagnosis, the surgeons were able to resect my liver.
I had rectal cancer, and didn't have the primary tumor addressed until my first surgery (the failed liver resection.) Both surgeries were done at the same time, two surgical teams in one OR. It was a bear of a surgery, but there are studies that show that operating too soon or on the primary tumor only in stage IV patients does NOT prolong their survival. Getting a serious shot of chemo on board first, before surgery, is generally more effective when the patient has a good response to chemo. And when the patient doesn't have a good response to chemo, all of the surgery and interventional radiology (SIRT) in the world isn't going to help the patient live longer - the systemic chemo does a huge amount of the work.
Stage IV is a difficult diagnosis, Darian. When the patient responds well to one or some of the available treatments (and we have more available now than we did when I was diagnosed in 2004), the treatments can be very effective in giving patients a few more years. But the treatments - all of them - are difficult over the long term. I recently ran into a survivor on another forum (Mark
) who has been on chemo for his stage IV dx with liver mets, without a break, for nine (9) years. He tolerates long-term chemo, but as you can see from reading the posts here, nine years of chemo tolerance (and effectiveness) is the exception, not the rule. Yes, pursuing liver resection and the potential for a surgical cure is the gold standard of care for stage IV disease with liver mets. But a very small percentage of the people diagnosed in stage IV ever get to liver resection.
For now, the important thing for your father and his doctors to discover is how well his disease responds to chemo, and how well your father tolerates the chemo agents. Cutting the cancer out has to be approached carefully, because the time period prior to, during and after surgery that the patient must be off chemo is very risky (the cancer can progress unchecked without systemic chemo unless the tumors have been sufficiently damaged by a pre-op chemo load.) Your dad's best chances for surgery in the future are to get a serious dose of chemo in right now. Hope this helps.