CT Scan results after 12 FOLOX w/ Avastin Treatments -what do you think

Devasted

We received the CT Scan results today from last scan after 12 treatments:
Conclusion:
Interval increase in size of multiple hepatic Metastases.
Nonspecific rectal wall thickening

Again seen are multiple hepatic metastases. These have increases slightly in size in the interval since the prior study of 12/2/09. There is a lesion in the superior right hepatic lobe which measures 3.4 cm in diameter. This previously measured 2.8 cm in diameter.

There is a lesion in the left lobe which now measures approximately 3.6 cm in diamete, previously 2.3 cm.

No adrenal lesion.

No ascites or abscess.

The lung bases are clear. No evidence of metastatic nodules.

No change in chest since 12/28/09.

We meet with onc. monday morning....can anyone please help with questions we should
ask or what we should do at this time? As always....thanks for your help.

Sundanceh

D
Hi D

Just my thoughts and opinions here:

The way I'm reading this is that you've done 12 treatments of chemo; at this point, whether it was Folfox, Folfirit, 5fu, Avastin, or Xeloda, the multiple spots have taken a half to whole cm increase.

It looks like the growth was slowed down with the treatments, but they still continued to grow despite the treatments. The positive I can make for this part of it, is that at least the rate was "slowed." At least, it did not take off exponentially. Without the treatments, I'm sure the story would have been worse.

The other good news is that it appears to be confined to the liver and has not spread to any other sites. That is also good news, a victory to be sure, although it may not seem like it - but any good news is just that - good news. And not spreading is a good thing.

But now, what to do? What to ask?

1. I would ask the onc if there were any more convential treatments available to you?
2. I would ask if you could take Avastin and Xeloda as a "hold at bay" treatment plan for the
time being?
3. If convential treatments had been exhausted, I would inquire about clinical trials?
4. I would ask if there were hopes of a liver resection or RFA (radio frequence ablation)?
5. What about an HAI pump - injects chemo straight into liver?
6. Could CyberKnife be used on the areas in question either alone or with RFA?

I would consider all the things that were discussd and weigh them carefully. At that point, even if I felt like I believed in what was said, or that it made sense...I would consider getting a 2nd opinion. At this point, you could weigh the evidence between the two opinions and make the best decision that you could possible make.

Remember, there is no "absolute" Right or Wrong answer - only that you made the best decision that you could, with the evidence that you have, and the opinions of professional medical people.

I think that if you all or the onc you select, are all in agreement, at least that is a plan, and you can move forward with enought confidence that you BELIEVE what you are doing is right. And you can't go wrong there

You're at the CROSSROADS now in your treatment plan. This next move or impending move is critical in the battle, I think.

I wish I knew more to tell you, but if this were my appointment, what I've written you, is what I would ask and do, if it were me. I'm supporting you all the way - want so much for things to turn around and see a decrease in tumor sizes.

I'm sending you these thoughts and all the well wishes I can muster for your Monday onc appointment

P.S. I also wanted to say thank you for that post the other day that Diane opened for Blue Boy - it was so good to hear from you again too - I have missed you as well. You've always been so supportive and kind to me - I hope that this post offers you support from me as well.

Take care, D!
-Craig

Marauders99

Sundanceh said:

D
Hi D

Just my thoughts and opinions here:

The way I'm reading this is that you've done 12 treatments of chemo; at this point, whether it was Folfox, Folfirit, 5fu, Avastin, or Xeloda, the multiple spots have taken a half to whole cm increase.

It looks like the growth was slowed down with the treatments, but they still continued to grow despite the treatments. The positive I can make for this part of it, is that at least the rate was "slowed." At least, it did not take off exponentially. Without the treatments, I'm sure the story would have been worse.

The other good news is that it appears to be confined to the liver and has not spread to any other sites. That is also good news, a victory to be sure, although it may not seem like it - but any good news is just that - good news. And not spreading is a good thing.

But now, what to do? What to ask?

1. I would ask the onc if there were any more convential treatments available to you?
2. I would ask if you could take Avastin and Xeloda as a "hold at bay" treatment plan for the
time being?
3. If convential treatments had been exhausted, I would inquire about clinical trials?
4. I would ask if there were hopes of a liver resection or RFA (radio frequence ablation)?
5. What about an HAI pump - injects chemo straight into liver?
6. Could CyberKnife be used on the areas in question either alone or with RFA?

I would consider all the things that were discussd and weigh them carefully. At that point, even if I felt like I believed in what was said, or that it made sense...I would consider getting a 2nd opinion. At this point, you could weigh the evidence between the two opinions and make the best decision that you could possible make.

Remember, there is no "absolute" Right or Wrong answer - only that you made the best decision that you could, with the evidence that you have, and the opinions of professional medical people.

I think that if you all or the onc you select, are all in agreement, at least that is a plan, and you can move forward with enought confidence that you BELIEVE what you are doing is right. And you can't go wrong there

You're at the CROSSROADS now in your treatment plan. This next move or impending move is critical in the battle, I think.

I wish I knew more to tell you, but if this were my appointment, what I've written you, is what I would ask and do, if it were me. I'm supporting you all the way - want so much for things to turn around and see a decrease in tumor sizes.

I'm sending you these thoughts and all the well wishes I can muster for your Monday onc appointment

P.S. I also wanted to say thank you for that post the other day that Diane opened for Blue Boy - it was so good to hear from you again too - I have missed you as well. You've always been so supportive and kind to me - I hope that this post offers you support from me as well.

Take care, D!
-Craig

Craig, what a great post.
Craig, what a great post. "Devastated", I read your post again and again trying to figure out what to say. Should I offer my own experiences? The things I've discovered in research? I think what Craig offers you here could not have been said any better. Your situation sounds similar to mine with multiple liver lesions, seemingly confined to the liver for now. The only thing I'll add is that it appears that different people respond to different treatments with varying success. FOLFOX worked for me. FOLFIRI has yielded the same non-favorable results you just received. Its tough. It can send you into a tailspin when you want things moving favorably.Maybe a different conventional treatment will work for you. Again, Craig's advice is sound. In fact, all the advice I've received on this board has been helpful. I'm becoming addicted to this place. Keep us posted.

Scott

Devasted

Marauders99 said:

Craig, what a great post.
Craig, what a great post. "Devastated", I read your post again and again trying to figure out what to say. Should I offer my own experiences? The things I've discovered in research? I think what Craig offers you here could not have been said any better. Your situation sounds similar to mine with multiple liver lesions, seemingly confined to the liver for now. The only thing I'll add is that it appears that different people respond to different treatments with varying success. FOLFOX worked for me. FOLFIRI has yielded the same non-favorable results you just received. Its tough. It can send you into a tailspin when you want things moving favorably.Maybe a different conventional treatment will work for you. Again, Craig's advice is sound. In fact, all the advice I've received on this board has been helpful. I'm becoming addicted to this place. Keep us posted.

Scott

Thanks Craig and Marauders99
Craig, as always thanks and well said...I've been checking the site but haven't posted
because we didn't have much going on but I have learned so much from you all and don't
have much info to share, we're still learning.

Marauders99...thanks, appreciate the post. When you say "seemingly confined to the liver"
.... could you offer more from your experience?

Marauders99

Devasted said:

Thanks Craig and Marauders99
Craig, as always thanks and well said...I've been checking the site but haven't posted
because we didn't have much going on but I have learned so much from you all and don't
have much info to share, we're still learning.

Marauders99...thanks, appreciate the post. When you say "seemingly confined to the liver"
.... could you offer more from your experience?

Sure. When I was Dx during
Sure. When I was Dx during Oct 2008, the colonoscopy reveal a nasty primary tumor in my rectum. A CT scan the next day, followed by CT scans every three months since indicate lesions only on my liver with no evidence of it having spread further. Maybe I am being optimistically naive thinking it won't go anywhere else but that's what my hopes are. Anyway my treatment has been 12 cycles of FOLFOX w/ Avastin reducing the liver lesions to about 30, followed by radiation to the primary tumor during Spring 2009. Resection of the primary tumor July 2009 with removal of 4 involved lymph nodes, w/ illesotomy which was reversed Oct 2009. Since then I have been on a Irinotecan / Avastin / Xeloda regimen and my latest colonoscopy at the end of Jan 2010 indicated all clear in the colon. THe CT scan the next day indicated stability in my liver.
So, "seemingly confined to the liver" was meant to say that all indicators I have say that the liver is the only place anything is going on right now. Based on multiple doctor consults and the posts of people here make me realize that I can't expect things won't change. Just trying to stay positive.
Sorry if this was more than you were looking for in terms of an answer.

Scott

Devasted

Marauders99 said:

Sure. When I was Dx during
Sure. When I was Dx during Oct 2008, the colonoscopy reveal a nasty primary tumor in my rectum. A CT scan the next day, followed by CT scans every three months since indicate lesions only on my liver with no evidence of it having spread further. Maybe I am being optimistically naive thinking it won't go anywhere else but that's what my hopes are. Anyway my treatment has been 12 cycles of FOLFOX w/ Avastin reducing the liver lesions to about 30, followed by radiation to the primary tumor during Spring 2009. Resection of the primary tumor July 2009 with removal of 4 involved lymph nodes, w/ illesotomy which was reversed Oct 2009. Since then I have been on a Irinotecan / Avastin / Xeloda regimen and my latest colonoscopy at the end of Jan 2010 indicated all clear in the colon. THe CT scan the next day indicated stability in my liver.
So, "seemingly confined to the liver" was meant to say that all indicators I have say that the liver is the only place anything is going on right now. Based on multiple doctor consults and the posts of people here make me realize that I can't expect things won't change. Just trying to stay positive.
Sorry if this was more than you were looking for in terms of an answer.

Scott

Thanks for the info
Scott,

Thanks for the additional info. I am naive and try to be optimistic but know
exactly what you mean. That's why I asked because I think the same thing. This is
all new to us and somehow I thought there would be radiation, chemo, surgery and
you're done...but we'll do whatever we need to do...

My husband was dx'd in June 09 and did xeloda, radiation and 12 rounds of folfox w/
avastin and the mets were stable but have increased slightly. Don't know if surgery
is possible...

Glad to hear you have some good news. Thanks so much for your info. This site has
been very encouraging.

Thanks again,
cheryl