Thoughts on treatment approach - stage IV recurrent

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texmexflute
Posts: 12
Joined: Mon Dec 31, 2018 9:59 pm
Location: Dallas, Texas

Re: Thoughts on treatment approach - stage IV recurrent

Postby texmexflute » Wed Dec 15, 2021 5:16 pm

I've been reading all the posts on this topic and am glad for you that there's a surgical option. I started with liver only mets and was able to have 2 surgeries, but never really got it cleared out (some were in places that were hard to get to.) Now there's lung mets and nodes. Plus my liver is a mess. I've have 2 resections, ablation on 3 mets, and SBRT 2 times for 4 mets. I even tried Y90 last summer, but needed it in 2 parts and the 1st one caused elevated liver function numbers. I wish there was a surgery option for me. I would always go for getting that beast out! Congrats and hoping all goes well for you!
62 yo Male (polio survivor) DX 2-2018
2-18 right hemi-colectomy (robotic/minimally invasive)
Stage 3b - T4N1Mx
3-18 thru 8-18 xeloda
9-18 scans indicate 4 liver mets
and possibly in omentum/peritoneum
Upgraded to stage 4
9-18 thru 11-18 4 rounds Folfiri + Avastin, 2 rounds Folfiri only
12-26-18 3 liver mets removed (robotic/minimally invasive) + omentum biopsy (no cancer)
1-19 SBRT remaining 2 liver mets that were hard to reach
2-19 begin 6 rounds of mop-up chemo but folfox this time

Rock_Robster
Posts: 620
Joined: Thu Oct 25, 2018 5:27 am
Location: Brisbane, Australia

Re: Thoughts on treatment approach - stage IV recurrent

Postby Rock_Robster » Tue Dec 21, 2021 3:11 am

Thanks all!

PVE done… now we wait.

Rob
39M Australia
2018 Dx RC, 12cm from AV
Mod diff, EMVI+, LVI+. 4 liver mets
pT3N1aM1a Stage IVa. MSS NRAS G13R
CEA: Nov-18= 14; then 2.0-3.1. Nov-21: 5.4
11/18 FOLFOX x6
3/19 Liver resection #1
5/19 25x pelvic IMRT radiation
07/19 ULAR w ileo, 1/27 LN+
08/19 Liver spot
08/19 FOLFOX x1, FOLFOXIRI x1, FOLFIRI x5
12/19 Liver resection #2
02/20 Ileo reversed
03/20 NED since Dec ‘19
11/21 35mm liver lesion; celiac LN. Some v. small (<2-3mm) lung things
12/21 PVE
1/22 Planned liver & node resection (TBC)

Gravelyguy
Posts: 372
Joined: Thu Jul 05, 2018 6:03 pm

Re: Thoughts on treatment approach - stage IV recurrent

Postby Gravelyguy » Tue Dec 21, 2021 11:47 am

Great news Rob! Praying recovery goes smoothly for you.

Dave
6/17 dx mRC t3n1m1 very low rectal tumor 2 liver Mets 1.3 cm and .9 cm

6/17 begin 4 rounds Folfox w/Vectibix
9/17 short course radiation
10/17 rectal and liver resection LAR with coloanal anastomosis (no rectum left)
11/17-3/18 8 rounds Folfox
6/18 still NED!! Takedown
8/28/18 still NED! CEA .8 new low for me
10/18/18 colonoscopy clear
12/12/18 CEA .9 still NED!
6/11/19 CEA 1.0
12/19/19 CEA 1.0 still NED!
6/17/20 CEA 1.1 still NED!
12/15/20 CEA 1.1still NED!

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CRguy
Posts: 10365
Joined: Sun Feb 10, 2008 6:00 pm

Re: Thoughts on treatment approach - stage IV recurrent

Postby CRguy » Tue Dec 21, 2021 12:51 pm

One step at a time buddy
Heading in the right direction !!!... Always

Cheers
CRguy
Caregiver x 4
Stage IV A rectal cancer/lung met
14 Year survivor
my life is an ongoing totally randomized UNcontrolled experiment with N=1 !
Review of my Journey so far

Rock_Robster
Posts: 620
Joined: Thu Oct 25, 2018 5:27 am
Location: Brisbane, Australia

Re: Thoughts on treatment approach - stage IV recurrent

Postby Rock_Robster » Wed Dec 22, 2021 1:08 am

Thanks for the well-wishes all. Back home now, still a bit sore - apparently the embolisation needle can cause a bit of bile to leak, which isn’t comfortable. Should be right soon though, then I have a multiphase CT liver booked in about 5 weeks. Fingers crossed.
Last edited by Rock_Robster on Wed Dec 22, 2021 11:25 am, edited 1 time in total.
39M Australia
2018 Dx RC, 12cm from AV
Mod diff, EMVI+, LVI+. 4 liver mets
pT3N1aM1a Stage IVa. MSS NRAS G13R
CEA: Nov-18= 14; then 2.0-3.1. Nov-21: 5.4
11/18 FOLFOX x6
3/19 Liver resection #1
5/19 25x pelvic IMRT radiation
07/19 ULAR w ileo, 1/27 LN+
08/19 Liver spot
08/19 FOLFOX x1, FOLFOXIRI x1, FOLFIRI x5
12/19 Liver resection #2
02/20 Ileo reversed
03/20 NED since Dec ‘19
11/21 35mm liver lesion; celiac LN. Some v. small (<2-3mm) lung things
12/21 PVE
1/22 Planned liver & node resection (TBC)

boxhill
Posts: 767
Joined: Fri Apr 06, 2018 11:40 am

Re: Thoughts on treatment approach - stage IV recurrent

Postby boxhill » Wed Dec 22, 2021 9:17 am

I missed all of this while away, sorry for belated support.

In the first place, I can't believe they were looking at someone else's scans!

Leaving that aside, I agree with the idea of seizing the opportunity of the surgical window, and it is great that your team is doing so. Since you can't have an MRI, a multiphase CT is the next best thing. When I had them, they picked up a little liver met that previously had been seen only by MRI.

Best of luck!! Beaming positive energy your way.
F, 64 at DX CRC Stage IV
3/17/18 blockage, r hemi
11 of 25 LN,5 mesentery nodes
5mm liver met
pT3 pN2b pM1
BRAF wild, KRAS G12D
dMMR, MSI-H
5/18 FOLFOX
7/18 and 11/18 CT NED
12/18 MRI 5mm liver mass, 2 LNs in porta hepatis
12/31/18 Keytruda
6/19 Multiphasic CT LNs normal, Liver stable
6/28/19 Pause Key, predisone for joint pain
7/31/19 Restart Key
9/19 CT stable
Pain: all fails but Celebrex
12/23/19 CT stable
5/19 MRI stable/NED
6/20 Stop Key
All MRIs NED

Rock_Robster
Posts: 620
Joined: Thu Oct 25, 2018 5:27 am
Location: Brisbane, Australia

Re: Thoughts on treatment approach - stage IV recurrent

Postby Rock_Robster » Wed Dec 22, 2021 11:22 am

boxhill wrote:Since you can't have an MRI, a multiphase CT is the next best thing.

Thanks for the message boxhill! Always great to get your thoughts and no apology necessary.

I may have misunderstood - why can I not get an MRI? I had one about a week ago to confirm the resection was viable if the PVE worked; I actually expected he would order another one prior to the surgery but instead went for the mf CT which kinda surprised me. Not that I’m second guessing though, coz this guy seems to be really good when he’s looking at the right patient’s file :shock:
39M Australia
2018 Dx RC, 12cm from AV
Mod diff, EMVI+, LVI+. 4 liver mets
pT3N1aM1a Stage IVa. MSS NRAS G13R
CEA: Nov-18= 14; then 2.0-3.1. Nov-21: 5.4
11/18 FOLFOX x6
3/19 Liver resection #1
5/19 25x pelvic IMRT radiation
07/19 ULAR w ileo, 1/27 LN+
08/19 Liver spot
08/19 FOLFOX x1, FOLFOXIRI x1, FOLFIRI x5
12/19 Liver resection #2
02/20 Ileo reversed
03/20 NED since Dec ‘19
11/21 35mm liver lesion; celiac LN. Some v. small (<2-3mm) lung things
12/21 PVE
1/22 Planned liver & node resection (TBC)

boxhill
Posts: 767
Joined: Fri Apr 06, 2018 11:40 am

Re: Thoughts on treatment approach - stage IV recurrent

Postby boxhill » Fri Dec 24, 2021 11:40 am

I thought you said you couldn't get one because of surgical clips. Oops! Clearly not what you said. 8)
F, 64 at DX CRC Stage IV
3/17/18 blockage, r hemi
11 of 25 LN,5 mesentery nodes
5mm liver met
pT3 pN2b pM1
BRAF wild, KRAS G12D
dMMR, MSI-H
5/18 FOLFOX
7/18 and 11/18 CT NED
12/18 MRI 5mm liver mass, 2 LNs in porta hepatis
12/31/18 Keytruda
6/19 Multiphasic CT LNs normal, Liver stable
6/28/19 Pause Key, predisone for joint pain
7/31/19 Restart Key
9/19 CT stable
Pain: all fails but Celebrex
12/23/19 CT stable
5/19 MRI stable/NED
6/20 Stop Key
All MRIs NED

Rock_Robster
Posts: 620
Joined: Thu Oct 25, 2018 5:27 am
Location: Brisbane, Australia

Re: Thoughts on treatment approach - stage IV recurrent

Postby Rock_Robster » Fri Dec 24, 2021 11:24 pm

boxhill wrote:I thought you said you couldn't get one because of surgical clips. Oops! Clearly not what you said. 8)

Yes sorry my bad - the surgical clips mean IRE probably wouldn’t work very well. All good with MRIs thankfully!
39M Australia
2018 Dx RC, 12cm from AV
Mod diff, EMVI+, LVI+. 4 liver mets
pT3N1aM1a Stage IVa. MSS NRAS G13R
CEA: Nov-18= 14; then 2.0-3.1. Nov-21: 5.4
11/18 FOLFOX x6
3/19 Liver resection #1
5/19 25x pelvic IMRT radiation
07/19 ULAR w ileo, 1/27 LN+
08/19 Liver spot
08/19 FOLFOX x1, FOLFOXIRI x1, FOLFIRI x5
12/19 Liver resection #2
02/20 Ileo reversed
03/20 NED since Dec ‘19
11/21 35mm liver lesion; celiac LN. Some v. small (<2-3mm) lung things
12/21 PVE
1/22 Planned liver & node resection (TBC)


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