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: 676
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
40M Australia
2018 Dx RC, 12cm high
Mod diff, EMVI, LVI. 4 liver mets
pT3N1aM1a Stage IVa. MSS NRAS G13R
CEA: Nov-18= 14; then ~2. Nov-21: 5.4
11/18 FOLFOX x6
3/19 Liver resection
5/19 25x pelvic IMRT radiation
7/19 ULAR & ileo, 1/27 LN
8/19 Liver lesion
8/19 FOLFOX, FOLFOXIRI, FOLFIRI x7
12/19 Liver resection
NED
2/20 Ileo reversed
11/21 Liver met & celiac node; 2-3 tiny lung things, indeterminate
12/21 PVE
3/22 Nodal spread & 3 liver lesions. Lymphadenectomy
4/22 Liver SBRT x 5

Gravelyguy
Posts: 378
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!
12/16/21 CEA 1.2 still NED!

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CRguy
Posts: 10377
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
15 Year survivor
my life is an ongoing totally randomized UNcontrolled experiment with N=1 !
Review of my Journey so far

Rock_Robster
Posts: 676
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.
40M Australia
2018 Dx RC, 12cm high
Mod diff, EMVI, LVI. 4 liver mets
pT3N1aM1a Stage IVa. MSS NRAS G13R
CEA: Nov-18= 14; then ~2. Nov-21: 5.4
11/18 FOLFOX x6
3/19 Liver resection
5/19 25x pelvic IMRT radiation
7/19 ULAR & ileo, 1/27 LN
8/19 Liver lesion
8/19 FOLFOX, FOLFOXIRI, FOLFIRI x7
12/19 Liver resection
NED
2/20 Ileo reversed
11/21 Liver met & celiac node; 2-3 tiny lung things, indeterminate
12/21 PVE
3/22 Nodal spread & 3 liver lesions. Lymphadenectomy
4/22 Liver SBRT x 5

boxhill
Posts: 787
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
5/20 MRI stable/NED
6/20 Stop Key
All MRIs NED

Rock_Robster
Posts: 676
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:
40M Australia
2018 Dx RC, 12cm high
Mod diff, EMVI, LVI. 4 liver mets
pT3N1aM1a Stage IVa. MSS NRAS G13R
CEA: Nov-18= 14; then ~2. Nov-21: 5.4
11/18 FOLFOX x6
3/19 Liver resection
5/19 25x pelvic IMRT radiation
7/19 ULAR & ileo, 1/27 LN
8/19 Liver lesion
8/19 FOLFOX, FOLFOXIRI, FOLFIRI x7
12/19 Liver resection
NED
2/20 Ileo reversed
11/21 Liver met & celiac node; 2-3 tiny lung things, indeterminate
12/21 PVE
3/22 Nodal spread & 3 liver lesions. Lymphadenectomy
4/22 Liver SBRT x 5

boxhill
Posts: 787
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
5/20 MRI stable/NED
6/20 Stop Key
All MRIs NED

Rock_Robster
Posts: 676
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!
40M Australia
2018 Dx RC, 12cm high
Mod diff, EMVI, LVI. 4 liver mets
pT3N1aM1a Stage IVa. MSS NRAS G13R
CEA: Nov-18= 14; then ~2. Nov-21: 5.4
11/18 FOLFOX x6
3/19 Liver resection
5/19 25x pelvic IMRT radiation
7/19 ULAR & ileo, 1/27 LN
8/19 Liver lesion
8/19 FOLFOX, FOLFOXIRI, FOLFIRI x7
12/19 Liver resection
NED
2/20 Ileo reversed
11/21 Liver met & celiac node; 2-3 tiny lung things, indeterminate
12/21 PVE
3/22 Nodal spread & 3 liver lesions. Lymphadenectomy
4/22 Liver SBRT x 5

Rock_Robster
Posts: 676
Joined: Thu Oct 25, 2018 5:27 am
Location: Brisbane, Australia

Re: Thoughts on treatment approach - stage IV recurrent

Postby Rock_Robster » Wed Feb 16, 2022 3:07 am

Just a brief update for those following the ridiculousness of my process to arrive at a treatment plan - we now have one!

After the successful PVE (future liver remnant went from 26% to around 40%), I’m now booked for liver surgery on 4 March - a right hepatectomy and removal of the celiac nodes. Given this is my 3rd liver resection the surgeon was clear that if he gets in there and can’t complete safely he’ll be backing out and we’ll do SBRT instead. But I’m extremely pleased they’re giving it a go - they’re going to have 3 surgeons (two of which are liver transplant guys) to give it the best chance and also deal with any unforeseen issues (given I’ll be down to my last hepatic vein by the end of it!). Fortunately after the PVE the total volume to remove is “only” around 60%. The hospital is a liver transplant centre so they also have a nice hepatobiliary ward, which is a first for me.

Then if that goes well we’ll likely look to line up some SBRT for the little lung thing/s. Fingers crossed.

Thanks to all for the advice as always.

Rob
40M Australia
2018 Dx RC, 12cm high
Mod diff, EMVI, LVI. 4 liver mets
pT3N1aM1a Stage IVa. MSS NRAS G13R
CEA: Nov-18= 14; then ~2. Nov-21: 5.4
11/18 FOLFOX x6
3/19 Liver resection
5/19 25x pelvic IMRT radiation
7/19 ULAR & ileo, 1/27 LN
8/19 Liver lesion
8/19 FOLFOX, FOLFOXIRI, FOLFIRI x7
12/19 Liver resection
NED
2/20 Ileo reversed
11/21 Liver met & celiac node; 2-3 tiny lung things, indeterminate
12/21 PVE
3/22 Nodal spread & 3 liver lesions. Lymphadenectomy
4/22 Liver SBRT x 5

Claudine
Posts: 680
Joined: Tue Mar 12, 2019 2:41 pm
Location: Montana

Re: Thoughts on treatment approach - stage IV recurrent

Postby Claudine » Wed Feb 16, 2022 9:43 am

Looks like you’ve got all the chances on your side with such a solid team. I hope there are no unforeseen complications and they can remove all the tumors successfully!
Wife of Dx 04/18 (51 yo). MSS, KRAS G12A, no primary
Lytic met L4 vertebrae, EBRT 04/18, SBRT 02/19
Resect small intestine 05/18 (no cancer - Crohn's)
Failed adjuvant Xelox ; Folfiri + Avastin 03/19 to 01/20
6.7 cm left adrenal mass 03/19, successful resection 02/20
Multiple small lung nodules (03/19) now gone/calcified
L3-L4-L5 fusion surgery and partial corpectomy 05/20
CEA since 03/19: high 81.1, low 3.2, now 66
MRI 2/11/22: rectal adenocarcinoma pT3 pN0 stage 2A
LAR surgery April 11

JJH
Posts: 391
Joined: Mon Apr 24, 2017 7:26 am

Re: Thoughts on treatment approach - stage IV recurrent

Postby JJH » Tue Mar 01, 2022 2:34 am

Rock_Robster wrote:... I’m now booked for liver surgery on 4 March - a right hepatectomy and removal of the celiac nodes...
Rob

Rob -

Sending best wishes for a successful surgery and a quick, trouble-free recovery this week.

Take care ...
"The darkest hour is just before the dawn" - Thomas Fuller (1650)

Rock_Robster
Posts: 676
Joined: Thu Oct 25, 2018 5:27 am
Location: Brisbane, Australia

Re: Thoughts on treatment approach - stage IV recurrent

Postby Rock_Robster » Tue Mar 01, 2022 5:03 am

JJH wrote:
Rock_Robster wrote:... I’m now booked for liver surgery on 4 March - a right hepatectomy and removal of the celiac nodes...
Rob

Rob -

Sending best wishes for a successful surgery and a quick, trouble-free recovery this week.

Take care ...

Thanks JJH! You have a very good memory :)
40M Australia
2018 Dx RC, 12cm high
Mod diff, EMVI, LVI. 4 liver mets
pT3N1aM1a Stage IVa. MSS NRAS G13R
CEA: Nov-18= 14; then ~2. Nov-21: 5.4
11/18 FOLFOX x6
3/19 Liver resection
5/19 25x pelvic IMRT radiation
7/19 ULAR & ileo, 1/27 LN
8/19 Liver lesion
8/19 FOLFOX, FOLFOXIRI, FOLFIRI x7
12/19 Liver resection
NED
2/20 Ileo reversed
11/21 Liver met & celiac node; 2-3 tiny lung things, indeterminate
12/21 PVE
3/22 Nodal spread & 3 liver lesions. Lymphadenectomy
4/22 Liver SBRT x 5

Rikimaroo
Posts: 394
Joined: Tue Dec 20, 2016 8:48 pm
Location: Florida

Re: Thoughts on treatment approach - stage IV recurrent

Postby Rikimaroo » Tue Mar 01, 2022 5:53 pm

Rob,

Wishing you a very successful surgery, and looking forward to see your continued contribution here, your so knowledgeable!!

Best
Rikimaroo
RC T3N1M0 12/16
MSS - NRAS Mutation
Chemo Rad, CCR - W&W 5/2017
Recurrence 11/2017
CT Scan 11/2017 Liver Met 5.5cm Stable, Stage IV
LAR/Liver Resect 4/2018
Reversal 10/18
CEA highest 500, lowest .8 throughout process, waiting for latest
Recurrence left vesical/pelvic sidewall - 10/7/2019 resect perm bag,
CEA rise Feb/May 3.7, 8.8, 30, Recurrence in Pelvic
CEA 40 right now, but was 57, so folfiri to beat it back down.
Lots of chemo for the past 4 years.

roadrunner
Posts: 240
Joined: Sun Jan 12, 2020 8:46 pm

Re: Thoughts on treatment approach - stage IV recurrent

Postby roadrunner » Wed Mar 02, 2022 7:42 pm

Rob:

Good luck indeed with the upcoming surgery! I hope your recovery is swift and smooth.
7/19: Rectal cancer: Staged as IIIA, T2N1M0
approx 4.25 cm, low/mid rectum, mod. well diff.
8/22 -10/14 4 rounds FOLFOX neoadjuvant, 3 w/Oxiplatin (side effects/reduced size est. 70-75%)
neoadjuvant chemorad 11/19
4 rounds of FOLFOX July-August 2020
ncCR found 10/20; biopsies negative
TAE 11/20, tumor cells removed, lung nodules orig id’d 6/20 stable Nov 2020
Chest CT 3/30/21 small growth in 2 nodules (3 and 5mm)
VATS 12/8/21 sub-pleural met 7mm.
SBRT for remaining nodule 1/22
CT 3/22: Clear


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