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Stage IV Liver Mets (Biliary Tract Cancer)
jiwlee
Posted: Tuesday, June 14, 2011 6:13 PM
Joined: 6/14/2011
Posts: 1


My mother has stage IV ampullary cancer that has metastasized to her liver (5cm tumor).  The disease has been resistant to treatment with  several chemotherapy regimens.  We would like to know if your center, in general, can treat such cases.

My mother is currently a patient within the UPMC system (Heritage Valley). If we would like an appointment, can we set it up without a referral?  Do we--ourselves--need to get her file transferred?

Thank you!


My mother was diagnosed with ampullary cancer 2+ years ago.  She promptly had a Whipple surgery with adjuvant Gemzar chemotherapy.   The outcome appeared very favorable at the time-- good surgical margins and no lymph node involvement.  However, about a year ago,  a CT-scan showed a single masss in the liver (3cm) and a possible mass at a lymph node near the celiac plexus.  I’m not 100% positive, but I think the liver mass is across segments 5 and 6 of the liver.  Upon this terrible news, she was put on FOLFOX.  Tumor markers still shot up and CT scans showed no response.  Because of this, she was ruled out for surgical resection and RFA.  With the failure of this and another chemo regimen, the oncologist basically said that was all that could be done.  Since then, all we’ve been doing is watching her nutrition and fitness—until  several weeks ago.  In the past 6 weeks she’s lost 15 lbs and counting, felt persistent abdominal pain, been nauseous after most meals, become quite fatigued, and shown a little jaundice in her eyes.  A CT scan showed the liver mass grew to 5.5 cm and the lymph node mass grew a bit as well.   No new masses were seen. Lab tests show her ALT and bilirubin levels are elevated.   She’s had standard radiotherapy on her celiac plexus area for pain alleviation of the lymph node mass but nothing for her liver—where the real danger lies.

I have read about CyberKnife and yttrium-90 radioembolization long ago, but never really moved on the ideas.  I read positive things about their latest uses in treating liver tumors, both primary and secondary.  However, our oncologist said CyberKnife was only for the brain and lungs and that he wasn’t too familiar with yttrium-90.  Furthermore, a family friend who happens to be a radiation oncologist basically scoffed at the notion of CyberKnife.  These words of discouragement led me to put these possible avenues of hope on the backburner.  However, that was then and the straits have become much more dire now.  This past week, I happened upon this forum as well as some peer-reviewed medical literature looking for an impetus for me to aggressively pursue CyberKnife and/or SIRT.

Thank you for sticking with my story—it’s wordy but I’ll cut to the chase now.  Do you think my mother could be a candidate for CyberKnife?  Perhaps SIRT?  

If I were to take action, I know the UPMC Liver Cancer Center to be very good and would try to get in the door there.  Would you consider it “not impolite” for me to email the doctor directly?  I want to try to get validation from “the guy” to move my father and mother into supporting  this course of action.  I don’t have enough “firepower” to override the opinions of her oncologist and our family friend at the moment.

Thank you very, very much.    



radsrus
Posted: Wednesday, June 15, 2011 6:58 PM
Joined: 10/10/2008
Posts: 4435


Her oncologist and radiation oncologist don't in all likelihood have any idea what can be done with CK or spheres. I think that either might be a valuable treatment. The choice woiuld depend on what was available locally and on the details of things when looking at the scans. UPMC has CK, but I don't know for sure if they treat liver. I would get her seen by a center that does both. She certainly sounds like a good candidate for one or the other.

Usually you can just make an appointment for her to be seen at the center of your choice. But doctors are going to be reluctant to get involved in family disputes.


 

Clinton A. Medbery, III, M.D.
St. Anthony Hospital Cyberknife Center
(405) 272-7311
buddy@swrads.org

Mail to:
Clinton A. Medbery, III, M.D.
Southwest Radiation Oncology
1011 N. Dewey Ave. #101
Oklahoma City, OK 73102

 


 

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