TACE plus IRE finally

sdp
sdp Member Posts: 181
edited November 2014 in Colorectal Cancer #1

Hi,

I was dx in dec  2011 with mCRC with numerous mets in both lobes. Had folfox + erbitux , liver and colon resection July - August 2012 , maintenance erbitux for 3 months , three recurrences after that - dealt with by ire, another liver resection, and then microwave ablation - now again another recurrence in three months from last ablation and all clear. These mets are 3 cm and 4.8 cm - two other lesions show fdg uptake on the pet-ct but MRI seems to be inconclusive.

I have differing opinions from the oncologist ,surgeon and the intervention radiologist. The surgeon and radiologist who have performed all the procedures are recommending TACE. However, the oncologist is in favour of systemic chemo - folfiri + erbitux.

oncologist is of the opinion that TACE is now not recommended much and due to the frequency of recurrences ( liver only ), he is of the opinion that systemic chemo would be a better option. 

also, since the lesions are fast growing ( since recurrence with such size of lesions has happened within 3 months of last procedure ) is it advisable to wait for 7 to 10 days from now - which makes it approx 20 days from the ct-pet to commence the treatment ?

I have tried to read up on TACE on all,forums but have found mixed reviews and tales on its efficacy and also the side effects - also, the side effects of erbitux I have experienced and don't look forward to it at all.

can anyone fill me in on the side effects experienced and for how long - also, in case TACE doesn't resolve the tumours but reduces the size would it be possible to do ablation later ? Has anyone done something like that after TACE .

i would welcome any suggestions that anyone has for me.

 

------------------------

edited since last at time to include new info 

I am in Germany expecting ablation to my tumors - however, now I am told they are thinking of TACE plus RFA 

This is news to me as I came here expecting only ablation and had planned stay etc accordingly. In case of the TACE + RFA treatment they seem to be scheduling the TACE for tomorrow and RFA after 4 days !

has anyone had this kind of combo treatment before ? Are the side effects manageable ? Anything to worry about if these treatments are a few days apart ?

i have checked up now about the treatment. And it seems it is more effective than RFA or Tace by itself..

however I am worried about the fact that the treatments are few days apart 

Comments

  • tanstaafl
    tanstaafl Member Posts: 1,313 Member
    #2
    broader chemistry, daily

    Have you ever tried celecoxib/Celebrex with your chemo yet?  That is our incremental inhibitor for  hammering CEA/CA19-9 rises, along with all the other stuff with daily oral chemo.   You seem reticent to check the "little boxes" like PSK and higher vitamin D3 etc.   We've found more success through persistent coverage of many targets and daily dosing, rather than heavy chemo.    

  • lilacbrroller
    lilacbrroller Member Posts: 412 Member
    #3
    Blog

    http://www.mcrc4.com

    Hi. Do you remember Ren from this board? He tried TACE and wrote about it on his blog, linked above.  It sounded horrible to me, and probably ultimately killed him. ,I think some people on colon club have had more,favorable experiences.  Others on our board have used other means to directly deliver chemo to the liver.

    Good luck with your choices. 

    Karin

  • annalexandria
    annalexandria Member Posts: 2,571 Member
    #4
    Is the HAI pump an option?

    I know I've read of people having good luck with that when the liver is involved.  And targeted chemo to the affected area would probably be less hard on you than doing systemic chemo.

    Let us know what you decide.  And hang in there...I've had multiple recurrences and I know how hard it is to face another one.

    Big hugs~AA

  • Nana b
    Nana b Member Posts: 3,030 Member
    #5
    annalexandria said:

    Is the HAI pump an option?

    I know I've read of people having good luck with that when the liver is involved.  And targeted chemo to the affected area would probably be less hard on you than doing systemic chemo.

    Let us know what you decide.  And hang in there...I've had multiple recurrences and I know how hard it is to face another one.

    Big hugs~AA

    Ask about chemoemobilization.

    Ask about chemoemobilization. My ONC also wanted systematic chemo but stanford thought going directly to liver was best, not involving the whole body.   I do have other mets in lungs and lymph nodes but since they weren't growimg, liver was most important 

    Youtube chemoembilization stanford. 

     

    Stay Stromg. 

  • sdp
    sdp Member Posts: 181
    #6
    Nana b said:

    Ask about chemoemobilization.

    Ask about chemoemobilization. My ONC also wanted systematic chemo but stanford thought going directly to liver was best, not involving the whole body.   I do have other mets in lungs and lymph nodes but since they weren't growimg, liver was most important 

    Youtube chemoembilization stanford. 

     

    Stay Stromg. 

    Well nanab,
    I would rather

    Well nanab,

    I would rather have ablation then chemo .

    the drs who recommended the TRANS ARTERIAL CHEMO EMBOLIZATION ( TACE) were also asked about

    systemic chemo as an alternative as suggested by the oncologist - they said that there are no studies as to one has more or less benefit then the other . So I could choose either in case ablation is not on the table.

    my onco says that during emboli station they shut the blood vessels and that is permanent and that may be a problem later. 

    Non regeneration of tissue around the embolisation Etc 

  • Trubrit
    Trubrit Member Posts: 5,804 Member
    #7
    Ablation

    I had an Ablation in April. My tumour was 2.2 cm, and my surgeon said that 2 cm is usually the largest they like to do.  

    The Ablation itself was a doddle. Pain yes, but not severe and not long-lasting. 

    I have monthly CEA, and find out my latest results on Thursday. 

    I hope that they are able to do something for you that works to knock these mets down. 

    Thinking of you. 

    Sue - Trubrit

  • Nana b
    Nana b Member Posts: 3,030 Member
    #8
    Trubrit said:

    Ablation

    I had an Ablation in April. My tumour was 2.2 cm, and my surgeon said that 2 cm is usually the largest they like to do.  

    The Ablation itself was a doddle. Pain yes, but not severe and not long-lasting. 

    I have monthly CEA, and find out my latest results on Thursday. 

    I hope that they are able to do something for you that works to knock these mets down. 

    Thinking of you. 

    Sue - Trubrit

    They shut the blood vessel

    They shut the blood vessel that the tumor has created on its own, this vessel does not provide blood to the rest of the liver. 

     

     

    Transarterial chemo embolization therapy involves administration of chemotherapy directly to the liver tumor via a catheter. With this technique, the chemotherapy targets the tumor while sparing the patient many side effects of traditional chemotherapy that is given to the whole body. 

    Following chemotherapy, your physician will embolize (cut off) the blood supply to the tumors. In this manner, the tumor is treated using two different techniques. If necessary, TACE can be performed multiple times to achieve the desired response in the tumor.

     

    Good luck. 

  • sdp
    sdp Member Posts: 181
    #9
    Nana b said:

    They shut the blood vessel

    They shut the blood vessel that the tumor has created on its own, this vessel does not provide blood to the rest of the liver. 

     

     

    Transarterial chemo embolization therapy involves administration of chemotherapy directly to the liver tumor via a catheter. With this technique, the chemotherapy targets the tumor while sparing the patient many side effects of traditional chemotherapy that is given to the whole body. 

    Following chemotherapy, your physician will embolize (cut off) the blood supply to the tumors. In this manner, the tumor is treated using two different techniques. If necessary, TACE can be performed multiple times to achieve the desired response in the tumor.

     

    Good luck. 

    Finally

    Hi,

    finally my dr had the time to see the ct-pet and the MRI 

    he said it is possible for him to ablate ( either microwave or ire) !

    i am so relieved . 

  • sdp
    sdp Member Posts: 181
    #10
    sdp said:

    Finally

    Hi,

    finally my dr had the time to see the ct-pet and the MRI 

    he said it is possible for him to ablate ( either microwave or ire) !

    i am so relieved . 

    Tace plus RFA

    See the edit above.

    seems now they are talking about Tace followed by RFA in 3 days .

     

  • Trubrit
    Trubrit Member Posts: 5,804 Member
    #11
    That is hard

    I am sorry that you have made your way to the hospital only to find out that they are planning on doing something different.  How can they just 'decide' that, without some input from you? 

    I saw your name on my calendar for tomorrow, and have been thinking of you.

    I hope that you are comfortable with whatever YOU decide to do. 

    I'm sorry that I have no other advice, as you know, my surgeon did an Ablation. 

    You are in my thoughts and prayers. 

    Sue - Trubrit

     

  • sdp
    sdp Member Posts: 181
    #12
    Trubrit said:

    That is hard

    I am sorry that you have made your way to the hospital only to find out that they are planning on doing something different.  How can they just 'decide' that, without some input from you? 

    I saw your name on my calendar for tomorrow, and have been thinking of you.

    I hope that you are comfortable with whatever YOU decide to do. 

    I'm sorry that I have no other advice, as you know, my surgeon did an Ablation. 

    You are in my thoughts and prayers. 

    Sue - Trubrit

     

    One more hour to be wheeled

    One more hour to be wheeled in for the procedure - dr says that the sequential TACE and RFA is better and has good outcome  then RFA alone especially in my case where the recurrence. Is high.

    i read up on it and it seems to be correct - but the follow up RFA in 4 days .?

    normally they let it work for 6 weeks to 2 months and then do further treatment .

    imam righ now just worried about the follow up side effects - nausea being one 

  • sdp
    sdp Member Posts: 181
    #13
    sdp said:

    One more hour to be wheeled

    One more hour to be wheeled in for the procedure - dr says that the sequential TACE and RFA is better and has good outcome  then RFA alone especially in my case where the recurrence. Is high.

    i read up on it and it seems to be correct - but the follow up RFA in 4 days .?

    normally they let it work for 6 weeks to 2 months and then do further treatment .

    imam righ now just worried about the follow up side effects - nausea being one 

    Back

    I am back in the room after the procedure . It took all of 40 mins after they started.

    had abdominal pain - but taken care of by the meds - also initially felt nausea - but now is ok.

    urine is dark orange ! I mean dark. The nurse says not to worry and it is Normal.

    they asked me not to move for 6 to 8 hours - well, I didn't get up from the bed or anything  but did move my legs to a more comfortable position every once in a while 

    dr said they will do a CT scan tomorrow and then decide about the RFA on Monday. 

    after reading up I am of the opinion that maybe we should wait for a month before doimg the RFA / ablation.

    if anyone has any suggestion I would welcome it .

  • Trubrit
    Trubrit Member Posts: 5,804 Member
    #14
    sdp said:

    Back

    I am back in the room after the procedure . It took all of 40 mins after they started.

    had abdominal pain - but taken care of by the meds - also initially felt nausea - but now is ok.

    urine is dark orange ! I mean dark. The nurse says not to worry and it is Normal.

    they asked me not to move for 6 to 8 hours - well, I didn't get up from the bed or anything  but did move my legs to a more comfortable position every once in a while 

    dr said they will do a CT scan tomorrow and then decide about the RFA on Monday. 

    after reading up I am of the opinion that maybe we should wait for a month before doimg the RFA / ablation.

    if anyone has any suggestion I would welcome it .

    No suggestions

    But so  happy to hear from you, and know that all went well with the first procedure. 

    I would find it VERY hard not to move to such a long time. Good luck!

    Blessings!

    Sue - Trubrit

  • sdp
    sdp Member Posts: 181
    #15
    Trubrit said:

    No suggestions

    But so  happy to hear from you, and know that all went well with the first procedure. 

    I would find it VERY hard not to move to such a long time. Good luck!

    Blessings!

    Sue - Trubrit

    TACE update

    Dr did a temporary embolistation of the entire liver and then gave 50mg of dioxirubicin direct to liver.

    no side effects for 24 hours and then it hit - fatigue, fever, lack of appetite , nausea - the works

    fever lasted 6 to 8 hours - now gone except the fatigue and anit of nausea - lack of appetite remains

    rfa is scheduled for monday morning 

    my recurrences are liver only and after a complete treatment the mets rise again after 60 days -

    hence ce I have to have frequent treatments to the liver - I don't know how long it will go on 

    dr says he can effectively do TACE atleast 5 times - I read somewhere that you can take 500 mg of dioxirubicin in a life time 

    any suggestions for keeping recurrence at bay or to delay the same ?

  • Nana b
    Nana b Member Posts: 3,030 Member
    #16
    sdp said:

    TACE update

    Dr did a temporary embolistation of the entire liver and then gave 50mg of dioxirubicin direct to liver.

    no side effects for 24 hours and then it hit - fatigue, fever, lack of appetite , nausea - the works

    fever lasted 6 to 8 hours - now gone except the fatigue and anit of nausea - lack of appetite remains

    rfa is scheduled for monday morning 

    my recurrences are liver only and after a complete treatment the mets rise again after 60 days -

    hence ce I have to have frequent treatments to the liver - I don't know how long it will go on 

    dr says he can effectively do TACE atleast 5 times - I read somewhere that you can take 500 mg of dioxirubicin in a life time 

    any suggestions for keeping recurrence at bay or to delay the same ?

    Juicing
    diet 
    no red meat
    no

    Juicing

    diet 

    no red meat

    no sugar

     no white bread

    supplements. 

     

    Exercese. Smile. Laugh. Giggle. Meditate. Yoga  

     

     

     

  • tanstaafl
    tanstaafl Member Posts: 1,313 Member
    #17
    sdp said:

    TACE update

    Dr did a temporary embolistation of the entire liver and then gave 50mg of dioxirubicin direct to liver.

    no side effects for 24 hours and then it hit - fatigue, fever, lack of appetite , nausea - the works

    fever lasted 6 to 8 hours - now gone except the fatigue and anit of nausea - lack of appetite remains

    rfa is scheduled for monday morning 

    my recurrences are liver only and after a complete treatment the mets rise again after 60 days -

    hence ce I have to have frequent treatments to the liver - I don't know how long it will go on 

    dr says he can effectively do TACE atleast 5 times - I read somewhere that you can take 500 mg of dioxirubicin in a life time 

    any suggestions for keeping recurrence at bay or to delay the same ?

    CV

    I would look into a combination of coQ10, taurine and N-acetylcysteine to help offset doxorubicin  CV damage.

  • sdp
    sdp Member Posts: 181
    #18
    tanstaafl said:

    CV

    I would look into a combination of coQ10, taurine and N-acetylcysteine to help offset doxorubicin  CV damage.

    Thanks 
    RFA scheduled in few

    Thanks 

    RFA scheduled in few hours - have cough and phlegm 

    hope the general anaesthesia is possible ! 

    Will update after procedure

    thanks everyone for their support and guidance 

  • janderson1964
    janderson1964 Member Posts: 2,215 Member
    #19
    sdp said:

    Thanks 
    RFA scheduled in few

    Thanks 

    RFA scheduled in few hours - have cough and phlegm 

    hope the general anaesthesia is possible ! 

    Will update after procedure

    thanks everyone for their support and guidance 

    Good luck SDP

    Good luck SDP

  • sdp
    sdp Member Posts: 181
    #20
    sdp said:

    Thanks 
    RFA scheduled in few

    Thanks 

    RFA scheduled in few hours - have cough and phlegm 

    hope the general anaesthesia is possible ! 

    Will update after procedure

    thanks everyone for their support and guidance 

    tace plus ire

    Finally the TACE was followed up with ire to two lesions - tace was on 13 th Nov and ire on 17 th Nov

    One day hospital stay each time.

    Had nausea , mild fever , fatigue !

    Manageable and tolerable if I rested.

    Ct scan was done day after procedure and Dr said it went well.

    Now  aback home in India from Germany. 

    Resting for a few days then going to meet my local oncologist for further treatment options

    There is no HAI pump here in India and the Germans don't recommend

    So treatment choice is systemic folfiri or xeliri with erbitux   and maybe tace on regular intervals

    I think the side effects may be overwhelming

    Have asked my local oncologist about the adapt protocol.

    He says xelodahas it's own toxicity in long term and since I am already on aspirin it is same as celebrex.

    Have also got the gene testing and chemo sensitivity done and I will post that later.

    However, the mutation is in two genes and there doesn't seem to much in terms of results rather than all regular chemo may work on tumour.

     

     

     

     

  • lp1964
    lp1964 Member Posts: 1,239 Member
    #21
    sdp said:

    tace plus ire

    Finally the TACE was followed up with ire to two lesions - tace was on 13 th Nov and ire on 17 th Nov

    One day hospital stay each time.

    Had nausea , mild fever , fatigue !

    Manageable and tolerable if I rested.

    Ct scan was done day after procedure and Dr said it went well.

    Now  aback home in India from Germany. 

    Resting for a few days then going to meet my local oncologist for further treatment options

    There is no HAI pump here in India and the Germans don't recommend

    So treatment choice is systemic folfiri or xeliri with erbitux   and maybe tace on regular intervals

    I think the side effects may be overwhelming

    Have asked my local oncologist about the adapt protocol.

    He says xelodahas it's own toxicity in long term and since I am already on aspirin it is same as celebrex.

    Have also got the gene testing and chemo sensitivity done and I will post that later.

    However, the mutation is in two genes and there doesn't seem to much in terms of results rather than all regular chemo may work on tumour.

     

     

     

     

    Dear Friend,

    You went through a lot lately. Please, take care of yourself and I hope that all this work and sacrifice will pay off.
    laz

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