Postby Rock_Robster » Thu Feb 02, 2023 6:13 pm
I’m sorry about the news, that is indeed a bit shit.
I had SBRT radiation on a fairly large liver lesion which was hard up against my right hepatic vein - the result of recurrence 2 years after an R1 resection in the same spot. I’m fortunate that my tumour has always been quite radiosensitive but man that stuff blew it out of the water. “Entirely dead” was the assessment on scans about 6 weeks later, and in the view of the oncs that area is the last thing I’m likely to need to worry about. The local control rates from liver SBRT are very good up to at least 2 years out - could be longer but good data gets more limited. It isn’t as good as surgery, but it may not be too far off and is a damn sight better than just chemo. The key is being able to safely get a serious kill dose onto the tumours (I had 100 Gy-equivalent over 3 lesions - techs said it was the highest they’d seen; felt like I’d been hit by a truck, but it’s worked so far). Key is getting a really good rad onc, as there’s some detailed planning required to get the best results without too much collateral damage. Good luck.
PS: just to confirm - CyberKnife is a brand rather than a technology; it’s effectively a type of SBRT/SABR radiation. In the Australian context patients - particularly in WA - will often be pointed to the private CyberKnife clinics in Claremont. CyberKnife was cutting-edge (pun intended) at the time it came out in 2001 and still does very good branding/marketing, but these days it has arguably been surpassed by the newer Varian TrueBeam machines that use the same concept. The main advantages are the ability to deliver larger doses over much shorter periods (so you have far fewer treatment days, and less time for tumour regrowth in between), and the ability to do concurrent cone-beam scanning which can reduce the need for fiduciary markers and (potentially) improve treatment accuracy and effective dose delivered. You do need to be immobilised more as it doesn’t do live tumour tracking, but this isn’t typically a big issue for livers where breath-hold (exhalation) is typically sufficient (and Varian have a visual breathing tracking system too which works very well). If you’ve been referred for CyberKnife, I would also have a consult somewhere like Icon or GenesisCare (or one of the major public hospitals like SCGH) that all use the newer machines to compare what they’re offering you. Overall results don’t appear to differ greatly on average, but the patient experience and impact might.
To give you an idea of their marketing reach - I even had one doctor in Brisbane suggest I fly 5 hours to Perth to get CyberKnife, when I live 15 mins from an Icon centre that has Varian equipment. SMH.
PPS: there are things that can be done surgically with tumours that abut veins - eg removing entirely, or reconstructing the vein. I’m not saying it’s necessarily the best idea, but make sure the surgeon you’re talking to has all these tools in their bag - many don’t. Ideally head of HPB or Upper GI at major public teaching hospital or cancer centre would be the way to go. I can suggest some east coast names if you don’t mind a plane ride.
One other dimension to consider is that you can do SBRT/SABR after surgery, but once you’ve had SBRT/SABR most surgeons would want to wait at least ~6 months before operating/ablating on the same organ - so sequencing of options can be important.
Last edited by Rock_Robster
on Fri Feb 03, 2023 7:31 pm, edited 2 times in total.
2018 Dx RC 12cm high
G2 EMVI LVI, 4 liver mets
pT3N1aM1a Stage IVa MSS NRAS G13R
CEA: Nov-18: 14 > 2
Dec - Feb-23: 17-19
3/19 Liver resect
5/19 Pelvic IMRT
8/19 Liver met
8/19 FOLFOX, FOLFOXIRI, FOLFIRI
12/19 Liver resect
11/21 Liver met, PALN, sub-cm lung mets
3-4/22 PVE, lymphadenectomy, liver SBRT
9/22 Liver met, PALN
10/22 PALN SBRT
11/22 Liver mets, nodes, peri nodules. Xeloda+Avastin
1/23 Liver/lungs stable. Lymph/peri undetectable