SBRT with curative intent

[singingholly]

Any examples of long term success? Anybody that has been radiated instead of resected and got rid of that lesion forever?
I'm looking for alternatives to surgery for a most likely cancerous infiltration of the diaphragm (probably due to closeness to a liver met now gone...).
Other suggestions? RFA? This tumor is 3x1,5 cm now and shrunk with chemo, so I guess I'll have some more chemo to reduce it the more it's possible.
Thank you, guys.
Olivia

[Girl111]

I also wanted some
Info on this procedure as my dad has 1 liver met of 15mm and we are also looking at other options incase he does not agree to surgery or is not suitable for surgery .

I also want to
Know can it be curative ?

[janderson]

Funny you brought that up. My insurance just turned me down for the second time to get SBRT on my thoracic lesions stating it is "investigation" and there is no evidince that it will benefit a stage IV colon cancer patient.. I even told them I have 2 oncologist, 4-radiation oncologist, 3-interventional radiologist who recommended it. I know several have had it done here. I am filing a complaint with the state now. This is BS to me.

The funny thing I always bragged about how good my insurance is. I never had a problem like this in 9 years of fighting cancer.

[Maia]

I'm looking for alternatives to surgery for a most likely cancerous infiltration of the diaphragm (probably due to closeness to a liver met now gone...).
Other suggestions?

1.
I posted this for Phoung in other thread, so I'm kind of copying and pasting it here (I also will mention this to pog, who's dealing with the liver too).

Check out this: MRI-guided-FUS (Magnetic Resonance Guided Focused Ultrasound Surgery). (You many find it also under the name of HIFU ablation: High-intensity focused ultrasound ablation). No radiation, no incision. It has been used in China since many years ago, in some places of Europe (Italy, yes) and this year finally started to be used at 2 locations in USA). Because it's not radiation, the procedure can be repeated in the same area, and also you can have radiation, later, if needed.

What it is : Ultrasound surgery — healing without cuts (please, do watch! Here, if that link doesn't work: https://www.youtube.com/watch?v=x4lA-M3zbdU I like to imagine a near future where the mainstream treatment for cancer is this 'surgery' and the systemic treatment is immunotherapy )

For the liver: http://www.fusfoundation.org/diseases-a ... ver-cancer

I don't know if they are treating patients, if they have a trial, etc. but in Milano, you should check with Dr Franco Orsi, at the Istituto Europeo di Oncologia, Unità di Radiologia Interventistica. He's probably the best at HIFU/ focused ultrasound surgery in Italy, one of the best at world level, and he's there in Milano He hopefully will know about *other* ablation options, if HIFU is a no go.

If in Milano you're being treated at the Ospedale Niguarda Cà Granda, Dr Invernizzi may know about HIFU too.

One article by Dr Orsi:

Orsi F, Arnone P, Chen W, Zhang L. High intensity focused ultrasound ablation: A new therapeutic option for solid tumors. J Can Res Ther 2010;6:414-20

Abstract:
Surgery has been the standard of care in selected cases with solid tumors. However, a majority of patients are unable to undergo surgical resection because of the tumor sites, advanced stages, or poor general condition. High intensity focused ultrasound (HIFU) is a novel non-invasive technique that is capable of producing coagulative necrosis at a precise focal point within the body, without harming overlying and adjacent structures even within the path of the beam. Diagnostic ultrasound was the first imaging modality used for guiding HIFU ablation in the 1990s. Over the last decade, thousands of patients with uterine fibroids, liver cancer, breast cancer, pancreatic cancer, bone tumors, renal cancer have been treated with ultrasound imaging-guided HIFU (USgHIFU) worldwide. This USgHIFU system [Chongqing Haifu (HIFU) Tech Co., Ltd., Chongqing, China] was first equipped in Asia, now in Europe. Several research groups have demonstrated that HIFU is safe and effective in treating human solid tumors. In 2004, the magnetic resonance guided focused ultrasound surgery (MRgFUS) was approved by the United States Food and Drug Administration (FDA) for clinical treatments of uterine fibroids. We conclude that HIFU offers patients another choice when no other treatment available or when patients refused surgical operation. This technique may play a key role in future clinical practice.
http://www.cancerjournal.net/article.as ... ulast=Orsi

2. The other technology you may want to check out is IRE/NanoKnife technology. You have here a fellow from the forum that got the procedure done with it: Unresectable mets in liver - great solution. Let me know if you need help finding info about availability in your area.

[singingholly]

Maia... Istituto Europeo di Oncologia IEO is where I had lung surgery, where they found that thing on the diaphragm!!! THANK YOUUUUUUUUU!!!
I... love you.
Olivia

[singingholly]

Oh dear, janderson... I hate hearing of such absurd problems... May be of some help to show documents? Please keep me informed...
Olivia

[mojo_qize]

My wife has had SBRT twice this year: in February for liver mets, this month for small spots on the lungs.
Our onc says we are still on a curative intent path, but the SBRT doc made it clear the procedure is for local tumor control (there is no systemic component).
She told us they are seeing local control up to 90% at two years (the tumor treated is under control; does not mean disease is not progressing elsewhere).
This recent study doesn't report numbers quite that high, but does report 70% local control at 1 year:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3355948/

[weisssoccermom]

janderson - I can only tell you what I found out while helping a friend who wanted to have the procedure done. It seems that most insurances have a limit on the number of lung mets that a patient can have before they approve the procedure. In checking for my friend, she was turned down for having more than THREE....now it didn't matter where they were....a patient could have two in one lung and two in another....it was the TOTAL number of lung mets that ultimately mattered. After reading her insurance company's policy, I found almost the exact same wording on a number of other carriers. In researching further, it appears that there is a standard 'policy making entity' outside of the insurance companies, made up of doctors and other medical professionals, etc. that insurance companies appear to follow. What we never did find out was this scenario. Suppose a patient has a total of say five mets.....two in one lung and three in the other. SBRT was off the table initially. However, suppose the patient has VATS on the lung with three mets (let's just hypothetically say they were all positioned perfectly for the procedure).....would that patient now only have TWO mets and be eligible for SBRT??? Or, suppose a patient has a situation where he/she has four mets, undergoes chemo and one of the mets 'disappears'. Is that patient now eligible for SBRT? Those are questions we never did get the answers to.

[vancouver eve]

I have had SBRT several times and would be ablle to receive it again should I require it.
There is a more superior machine called the VERO and our Cancer Clinic is raising funds to be able to buy the VERO machine. We will be the first clinic in Canada to have such a wonderful machine. In the entire world there are only 22 machines. These machines will be able to treat tumors that would otherwise not be able to be treated.

[Rob in PA]

My sbrt was with curative intent both years I had it done. While it did not cure me, I do believe it bought me time and was a better option for me than chemo and got me to the point where I could have surgery. I have zero regrets doing sbrt.

Best

Rob

[stars9979]

great information thank you

[Maia]

Olivia, I just remembered that you have some researchers there in Italy working on an adoptive cell transfer (ACT) protocol for CRC, which is a kind of very personalized immunotherapy. I posted some links for you in this thread, months ago... just for you to check it again, in case it helps

viewtopic.php?f=1&t=46656&p=342151#p342151

[singingholly]

Thank you angel! Of course it helps!

[AngelaN]

I am a bit distressed. DH has Stage 4, colon and Liver mets - 11 rounds of FOLFOX, 3 of FOLFIRI. Had his colon and liver mets resected. Two weeks ago had his L upper lobe removed for 3 mets and 1 in LLL wedged. He has one more met in his RUL and because of the location it would require RUL removal so the plan is SBRT. We are obviously going for curative intent. Are you saying that SBRT won't eliminate that last met? I have had several patients who have had SBRT and it "cures" them... Maybe I am reading too much into this. In 9 months there have been no new mets so our prayer is that he has SBRT, then more FOLFIRI and then we will be talking about the Xeloda/celebrex combo.

[janderson]

Maia I am so glad to see you posting again. I have been following nanoknife for a couple of years but kind of forgot about recently. The link you provided to Vilcas post has me considering it again in light of my current insurance woes. Especially concidering University of MD is only about 4 hours from me. I am sure my insurance will reject it since they rejected SBRT but we are prepared to pay out of pocket for the best options. They could hopefully get all of my thoracic lesions and hopefully y90 will shink the liver tumor enough to zap that as well. I also am in contact with MD Anderson acout the DCVax Direct trial for my liver spot.

I am still determined to get the state to force my insurance to pay for SBRT. It is a matter of principle now.

My onc just told me he is seeing a worrisome trend towards insurance companies rejecting proceedures for long term fighters. That makes sense since for the first 8 1/2 years i had no insurance issues.