Re: Experimental Treatment for Liver Cancer (inoperable)?

From: Orac (orac_at_mac.com)
Date: 06/27/04 

Date: Sun, 27 Jun 2004 15:50:42 GMT

In article <1gfy924.qty36q1ircz2oN%down@thekraal.com>,
 down@thekraal.com (madiba) wrote:

> Thomas T. Veldhouse <veldy71@yahoo.com> wrote:
>
> > Steph <steph@vancouver.island> wrote:
> > > Don't get too carried away, Orac.
> > > About 15% of patients with liver mets are technically suitable for
> > > "curative" surgery, and about 15% are alive at 5 years.
> > > 15% of 15% is 2%............
> > >
> >
> > Honestly, that is alright. I am just looking for options with an open
> > mind. We can explore the feasibility of each option after we know what
> > they are. That was exactly the information I was looking for. I am
> > also looking for anything more that people can provider ... again, as
> > the subject suggests, perhaps an experimental treatment (nevermind
> > qualifying for the treatment ... that is a followup issue). I am
> > looking at this as part of an attempt at brainstorming any solutions,
> > whether real, possible, unlikely or pure fantasy.
> >
> > All, thanks for the help so far.
>
> Assuming your dad has been correctly re-staged we are then talking
> palliative treatment, ie keep him comfortable, pain-free and extending
> his life by a couple of years. In addition to Orac's suggestions of
> surgery, chemo and RF-ablation he could also consider embolization and
> chemo-embolization of the liver tumor. This is done by interventional
> radiologists. Stereotactic radiosurgery using a LINAC may be offered in
> your area, this could handle the liver met, the pelvic LNs and the
> operation site* from where the mets are presumeably coming. LINACs are
> the domain of the radiation oncologist. Your dad's preoperative
> radiochemotherapy not only did not downstage his tumor (it was upstaged
> at surgery) but also failed to prevent locoregional recurrence, so try
> finding another radiation center should he decide to go for stereotactic
> radiation. This treatment requires very accurate targeting with high
> doses of radiation, much more so than 'normal' radiation he received
> before surgery.

That is also a good suggestion. Radiofrequency ablation (RFA) seems to
have supplanted cryoablation (freezing) of liver tumors. There's decent
evidence that RFA is a good palliative technique for inoperable liver
metastases from a colorectal primary. There may even be a mild survival
advantage to RFA. However, I'm not aware of evidence LINAC of pelvic
lymph node metastases is of value for palliation or increasing median
survival. 

-- 
Orac        |"A statement of fact cannot be insolent."
            |
            |"If you cannot listen to the answers, why do you
            | inconvenience me with questions?"