Postby Rock_Robster » Mon Mar 21, 2022 8:52 pm
OK scans are in; not perfect but definitely could be worse. There’s the larger awkward liver met that we knew about, plus two new smaller liver lesions toward the edge of segment V. Nothing noted on lymph nodes (unsurprising given everything macroscopic was theoretically removed and there’s still fluid/inflammation from surgery 2 weeks ago). Good news is the lung thing is either stable at 2.8mm or not a met - either one is fine with me right now. Other good news is the surgeon clarified that he believes he got all the lymph nodes he could see, though is still concerned for residual microscopic disease.
The 3 liver things are suitable for SBRT (or SBRT/RFA mix), which is great. However given the new liver lesions have come up relatively recently, the rad onc is concerned about a lack of systemic control and wants me to do some chemo before the radiation treatment. Surgeon agrees.
However, my usual oncologist (now in another state) is recommending SBRT on everything now, then surveillance. Reckons the chance of an amazing chemo response is relatively low now, and given we can treat everything we can see directly, he doesn’t like administering chemo for disease he can’t see and can’t measure a response. He accepts it’s almost guaranteed something else will appear in time, but feels that if all I’m left with is microscopic peri-nodal disease then that may be quite indolent, and we would deal with anything when it happens. More chemo now is unlikely to change the course, and just make me feel worse with more side effects.
He did concede that some chemo now would be reasonable/arguable (eg maybe 4 cycles and scan), but that he wouldn’t be pushing it and he certainly wouldn’t be delaying SBRT to do it.
I’m with meeting the (new) local oncologist on Thurs evening. I doubt he’ll agree with my usual onc, so this should be interesting.
My personal view is it’s hard to argue against doing some chemo now, but it’s tough to go against my oncologist. This guy is good. He’s a colorectal / liver cancer specialist, university professor and Lab Head / PI in CRC trials and research. Well-recognised as one of the best in the country (Australia) for CRC. He’s done an amazing job of balancing risk and benefit, and keeping me not just alive but also with an extremely good quality of life throughout my 3+ years so far since stage IV diagnosis.
Aiming for a plan by end of the week.
Thanks again for all the messages of support and well wishes!
Last edited by
Rock_Robster on Mon Mar 21, 2022 10:15 pm, edited 10 times in total.
41M Australia
2018 Dx RC
G2 EMVI LVI, 4 liver mets
pT3N1aM1a Stage IVa MSS NRAS G13R
CEA 14>2>32>16>19>30>140>70
11/18 FOLFOX
3/19 Liver resection
5/19 Pelvic IMRT
7/19 ULAR
8/19 Liver met
8/19 FOLFOX, FOLFOXIRI, FOLFIRI
12/19 Liver resection
NED 2 years
11/21 Liver met, PALN, lung nodules
3/22 PVE, lymphadenectomy, liver SBRT
10/22 PALN SBRT
11/22 Liver mets, peri nodule. Xeloda+Bev
4/23 XELIRI+Bev
9/23 ATRIUM trial
12/23 Modified FOLFIRI+Bev
3/24 VAXINIA (CF33 + hNIS) trial