What kind of chemo after liver resection?

Glv49

Hi,
I wrote a couple weeks ago about my husband. He just finished his folfox treatment in Jan. had a PET/CT where they found a spot on his liver. He has an appt this Thurs. with a surg. onc. I have read many posts from those with liver resection, who took chemo.. or are taking it now.. could you please tell me what kind you took or are on? Our onc said she wouldn't recommend chemo, just a liver resection? She said because the folfox didn't work. Well, I think that it did work, if he only has one spot on the liver. Any info you could give us would be helpful.. we are very anxious and scared about the appt. and everything, I went thru this.. but never had any mets and have been NED since 2004. I just hope God blesses my husband with that also.. I will continue to pray for all of this in our fight.

Thanks,
Gail

dixchi

Another Option
there are some posters here who have had RFA where they use radiation
to burn out the lesion which is a lot less invasive than surgery and
is usually an outpatient procedure. You might ask your oncologist
about whether this could be considered.

Barbara

maglets

dixchi said:

Another Option
there are some posters here who have had RFA where they use radiation
to burn out the lesion which is a lot less invasive than surgery and
is usually an outpatient procedure. You might ask your oncologist
about whether this could be considered.

Barbara

chemo
Hi Gail...after my first liver re-section I did 8 mos of xeloda....this is the pill form of 5 FU and fairly easy for some people to take.

After a year and a half I had another spot on the liver and another re-section. This time both the surgeon and onc recommended chemo...for me this time it is 6 rounds of infusion of oxayplatin plus 2 weeks of oral xeloda following each infusion

Best of everything getting some answers Gail

Best wishes
Maggie

Glv49

maglets said:

chemo
Hi Gail...after my first liver re-section I did 8 mos of xeloda....this is the pill form of 5 FU and fairly easy for some people to take.

After a year and a half I had another spot on the liver and another re-section. This time both the surgeon and onc recommended chemo...for me this time it is 6 rounds of infusion of oxayplatin plus 2 weeks of oral xeloda following each infusion

Best of everything getting some answers Gail

Best wishes
Maggie

thanks... I am glad there
thanks... I am glad there are options.. I am making a list of things to ask the dr.

Gail

lisa42

post surgery chemo
Hi,

I had a liver resection in May. I was not given any post surgery chemo, but wish that I had been. My oncologist didn't see the need for it, but when I consulted with another oncologist from UCSD, he told me that he would have put me on Xeloda following my surgery.
Four months after surgery, I had a recurrence in my lungs and a "suspicious" area on my liver right where I had the surgery. I am now on major chemo again- I wonder if it wouldn't have happened if I had taken the Xeloda post surgically (which the call adjuvant chemo).
I'd get another opinion from another oncologist about it if your current onc doesn't want to put you on it. Even if he thinks the Folfox didn't work, Xeloda is different. You're thinking the Folfox did work- I'd definitely seek out another opinion on this.
Best wishes-
Lisa

Glv49

lisa42 said:

post surgery chemo
Hi,

I had a liver resection in May. I was not given any post surgery chemo, but wish that I had been. My oncologist didn't see the need for it, but when I consulted with another oncologist from UCSD, he told me that he would have put me on Xeloda following my surgery.
Four months after surgery, I had a recurrence in my lungs and a "suspicious" area on my liver right where I had the surgery. I am now on major chemo again- I wonder if it wouldn't have happened if I had taken the Xeloda post surgically (which the call adjuvant chemo).
I'd get another opinion from another oncologist about it if your current onc doesn't want to put you on it. Even if he thinks the Folfox didn't work, Xeloda is different. You're thinking the Folfox did work- I'd definitely seek out another opinion on this.
Best wishes-
Lisa

Thanks.. I will. I can't
Thanks.. I will. I can't understand why the onc doesn't think the Folfox worked. My husband was dx with a tumor in the transverse colon in June 08. They removed it, he had 6 mo of folfox, then scan showed a spot on liver. He only had 1 microscopic lymph node they said his chemo was only being given to him as a precaution. Wow.. I am glad he decided to take it, since this spot must have grown during his chemo. His CEA level is normal, as is his blood work. Only his liver enzymes were slightly elevated, which I understand can happen with chemo. I am making a list of questions to ask the surgeon. And if need be I will seek out more opinions other than his oncologist. Thanks again.

Gail

ADKer

Glv49 said:

Thanks.. I will. I can't
Thanks.. I will. I can't understand why the onc doesn't think the Folfox worked. My husband was dx with a tumor in the transverse colon in June 08. They removed it, he had 6 mo of folfox, then scan showed a spot on liver. He only had 1 microscopic lymph node they said his chemo was only being given to him as a precaution. Wow.. I am glad he decided to take it, since this spot must have grown during his chemo. His CEA level is normal, as is his blood work. Only his liver enzymes were slightly elevated, which I understand can happen with chemo. I am making a list of questions to ask the surgeon. And if need be I will seek out more opinions other than his oncologist. Thanks again.

Gail

Need 2nd opinion on post-liver resection chemo
To answer your first question, because I have already done IROX - Irinotecan and Oxaliplatin - prior to liver resection and had not had any form of 5FU systemically, I am taking Xeloda following liver resection. What your husband receives may depend on what he has already had and what he has not yet been exposed to.

I believe that it is critical to have adjuvant chemo after liver resection. I hope that you will seek a second opinion.

dixchi

Chemo
Forgot to mention that I had liver resection in 2008.....had four chemo treatments
before and eight after surgery, I had oxiliplatin, 5FU, avastin and leucovorin.
Giving chemo before and definitely after surgery has been the standard procedure for treatment according to the National Institute
of Health.....I think a second opinion would help.

Barbara

Unknown

dixchi said:

Chemo
Forgot to mention that I had liver resection in 2008.....had four chemo treatments
before and eight after surgery, I had oxiliplatin, 5FU, avastin and leucovorin.
Giving chemo before and definitely after surgery has been the standard procedure for treatment according to the National Institute
of Health.....I think a second opinion would help.

Barbara

This comment has been removed by the Moderator

snommintj

unknown said:

This comment has been removed by the Moderator

Maybe no chemo is needed
If it's a single tumor and the Dr can take large enough margins he may not need chemo. It's in your oncologist's best interest to administer chemo, if she says none is needed, maybe none is needed; or try a different oncologist.

impactzone

I go to Stanford. Stage 4
I go to Stanford. Stage 4 here. dx 9/06..colon surgery with liver met/, chemo (folfox) liver resection, more chemo..clean scans until 11/07..lung mets...surgery clean scans until 2/09 with surgery scheduled for lung met in right lobe on 3/30/09. FYI, after the last lung resection, I had a low CEA (below 1) and showed NED. The discussion came up about using chemo but Dr Fisher (my onc) recommended that because I did not have anyway of tracking this disease, that it would not be a good idea. I have found ove rthe last 3 years different oncs doing it different. With no visible disease, giving chemo may hurt you and not do anything or it may kill micromets. Glad resection is a possibility. Good luck
Chip

mom_2_3

I will be doing
As far as I know I will be doing FOLFOX after resection as it did a good job pre-surgery to shrink my liver mets. There was a bit of blue liver that was found in pathology so my oncologist might put me on Irinotecan instead....we'll find out in 2 weeks.

lisa42

mom_2_3 said:

I will be doing
As far as I know I will be doing FOLFOX after resection as it did a good job pre-surgery to shrink my liver mets. There was a bit of blue liver that was found in pathology so my oncologist might put me on Irinotecan instead....we'll find out in 2 weeks.

blue liver?
Hi,

I'm curious what is meant by a blue liver- is it literally part of the liver that is the color blue? Do they know what would cause that to happen? How would the irinotecan (also called CPT-11 and Camptosar) help with that? Just curious- sorry if I'm asking questions with answers that are unknown at the moment!

Take care!
Lisa

snommintj

lisa42 said:

blue liver?
Hi,

I'm curious what is meant by a blue liver- is it literally part of the liver that is the color blue? Do they know what would cause that to happen? How would the irinotecan (also called CPT-11 and Camptosar) help with that? Just curious- sorry if I'm asking questions with answers that are unknown at the moment!

Take care!
Lisa

Blue liver
Blue liver is not such a good thing. 5FU is a poison which combined with the oxaliplatin begin to damage the liver. The liver goes through many color and texture changes before it gets to the most damaged stage which is blue. Of course not everyone gets this condition. I'm told only those who have very strong responses to folfox get this condition. I responded extremely well to folfox and during my 2nd resection the surgeon said I was just a few steps away from blue. I only had 6 treatments of folfox before my first surgery, and three after it and my liver was damaged to the point that I can't get chemo for a year. I didn't respond at all to folfiri following my first surgery which is probably why it recurred. The liver can heal itself from this condition but it takes time. Oxaliplatin helps the cell retain 5FU for a longer period of time than it otherwise normally would. If you are very sensitive to oxaliplatin you will retain the 5FU long enough to damage liver cells as well as cancer cells. Camptosar doesn't make the cell retain the 5FU, so there may not be as much impact on the liver. However, I am skeptical of any treatment being administered with a blue liver. Please be very cautious and maybe get a 2nd opinion.

lizbiz

Folfiri+Avastin here...
I'm currently on this cocktail. Folfox didn't work for me either and I also had only one lymph node affected. I'm slated for a May liver resection.

I've done some research on the liver issues associated with both Folfox and Folfiri treatments. I was initially hoping that this was my case and that I didn't have liver mets - no such luck. Both are known to cause and/or exacerbate certain morphalogical changes (steatosis, steatohepatitis and sinusoidal issues) in the liver in some cases.

Stay strong,
Elizabeth

mom_2_3

snommintj said:

Blue liver
Blue liver is not such a good thing. 5FU is a poison which combined with the oxaliplatin begin to damage the liver. The liver goes through many color and texture changes before it gets to the most damaged stage which is blue. Of course not everyone gets this condition. I'm told only those who have very strong responses to folfox get this condition. I responded extremely well to folfox and during my 2nd resection the surgeon said I was just a few steps away from blue. I only had 6 treatments of folfox before my first surgery, and three after it and my liver was damaged to the point that I can't get chemo for a year. I didn't respond at all to folfiri following my first surgery which is probably why it recurred. The liver can heal itself from this condition but it takes time. Oxaliplatin helps the cell retain 5FU for a longer period of time than it otherwise normally would. If you are very sensitive to oxaliplatin you will retain the 5FU long enough to damage liver cells as well as cancer cells. Camptosar doesn't make the cell retain the 5FU, so there may not be as much impact on the liver. However, I am skeptical of any treatment being administered with a blue liver. Please be very cautious and maybe get a 2nd opinion.

snommintj
Who told you that having a strong response to FOLFOX correlated with blue liver? I find that very interesting as I did have a great response to that particular chemotherapy. The largest lesion I had to start was 6.2 cm and after 5 treatments that same lesion was .9 cm and 90% necrotic. I'm hoping that this also indicates the FOLFOX did a good job on the microstatic disease. Did they tell you that you didn't respond to Folfiri because you developed a lesion during that time? My oncologist is brilliant and she mentioned to me that FOLFOX may not be the adjuvant chemo. She wanted to discuss it with pathology and the surgeons some more. I will be getting FUDR through my hepatic pump. Basically I trust her opinion as this is all she does (colon cancer with liver mets). I will ask her further about additional liver damage at my next appointment.

Thanks!