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Thread: SIRT procedure

  1. #1
    Experienced User
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    SIRT procedure

    My first post here. Stage IV colorectal cancer. 49 years old. Just finished 11th Chemo treatment. 3 liver lesions measuring 7 MM or less. They want to do a Selective Internal Radiation Therapy along with continued Chemo. Has anyone had this done before ?
    Last edited by mike49; 02-09-2015 at 02:48 PM.

  2. #2
    Super Moderator Top User po18guy's Avatar
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    Mike, I have moved your thread to the colon and rectal cancer forums, as I believe it will receive much more attention there. All the best to you.
    05/08-07/08 Tumor appears behind left ear. Followed by serial medical incompetence on the parts of PCP, veteran oncologist and pathologist (misdiagnosis via non-diagnosis). Providential guidance to proper care at an NCI designated comprehensive cancer center.
    07/08 Age 56 DX 1) Peripheral T-Cell Lymphoma-Not Otherwise Specified. Stage IV-B, >50 ("innumerable") tumors, bone marrow involvement.
    08/08-12/08 Four cycles CHOEP14 + four cycles GND (Cyclofosfamide, Doxorubicin, Vincristine, Etoposide, Prednisone & Gemcitabine, Navelbine, Doxil)
    02/09 2) Relapse.
    03/09-06/13 Clinical trial of Romidepsin > long-term study. NED for 64 twenty-eight day cycles, dose tapered.
    07/13 3) Relapse, 4) Suspected Mutation.
    08/13-02/14 Romidepsin increased, stopped for lack of response. Watch & Wait.
    09/14 Relapse/Progression. Visible cervical nodes appear within 4 days of being checked clear.
    10/06/14 One cycle Belinostat. Discontinued to enter second clinical trial.
    10/25/14 Clinical trial of Alisertib/Failed - Progression.
    01/12/15 Belinostat resumed/Failed - Progression. 02/23/15
    02/24/15 Pralatrexate/Failed - Progression. 04/17/15
    04/15 Genomic profiling reveals mutation into PTCL-NOS + AngioImmunoblastic T-Cell Lymphoma. Stage IV-B a second time. Two dozen tumors + small intestine (Ileum) involvement.
    04/22/15 TEC (Bendamustine, Etoposide, Carboplatin). Full response in two cycles. PET/CT both clear. Third cycle followed.
    06/15-07/15 Transplant preparation (X-rays, spinal taps, BMB, blood test, MUGA scan, lung function, CMV screening, C-Diff testing etc. etc. etc.) Intrathecal Methotrexate during spinal tap.
    BMB reveals 5) 26% blast cells of 20q Deletion Myelodysplastic Syndrome MDS), a bone marrow cancer and precursor to Acute Myeloid Leukemia.
    07/11-12/15 Cyclofosfamide + Fludarabine conditioning regimen.
    07/16/15 Total Body Irradiation.
    07/17/15 Moderate intensity Haploidentical Allogeneic Stem Cell Transplant receiving my son's peripheral blood stem cells.
    07/21-22/15 Triple dose Cyclofosfamide + Mesna, followed by immunosuppressants Tacrolimus and Mycophenolate Mofetil.
    07/23-08/03/15 Marrow producing zero blood cells. Fever. Hospitalized two weeks.
    08/04/15 Engraftment occurs, and blood cells are measurable - released from hospital.
    08/13/15 Day 26 - Marrow is 100% donor cells. Platelets climbing steadily, red cells follow.
    09/21/15 Acute skin Graft versus Host Disease arrives.
    DEXA scan reveals Osteoporosis.
    09/26/-11/03/15 Prednisone to control skin GvHD.
    11/2015 Acute GvHD re-classified to Chronic Graft versus Host Disease.
    05/2016 Tacrolimus stopped. Prednisone from 30-90mg daily tried. Sirolimus begun. Narrow-band UV-B therapy started, but discontinued for lack of response. One treatment of P-UVAreceived, but halted due to medication reaction.
    09/16/16 Three skin punch biopsies.
    11/04/16 GvHD clinical trial of Ofatumumab (Arzerra) + Prednisone + Methylprednisolone begun.
    12/16 Type II Diabetes, Hypertension - both treatment-related.
    05/17 Extracorporeal Photopheresis (ECP) begun in attempt to control chronic Graft-versus-Host-Disease (cGvHD. 8 year old Power Port removed and replaced with Vortex (Smart) Port for ECP.
    05/2017 Chronic anemia (low hematocrit). Chronic kidney disease. Cataracts from radiation and steroids.
    06/17 Trying various antibiotics in a search for tolerable prophylaxis.
    08/17 Bone marrow biopsy reveals the presence of 2% cells with 20q Deletion Myelodysplastic Syndrome, considered to be Minimum Residual Disease.
    12/17 Bone marrow biopsy reveals no abnormalities in the marrow - MDS eradicated. The steroid taper continues.
    01/18 Consented for Kadmon clinical trial.
    03/18 Began 400mg daily of KD025, a rho-Associated Coiled-coil Kinase 2 Inhibitor (ROCK2).
    09/18 Due to refractory GvHD, Extracorporeal Photopheresis halted after 15 months ue to lack of additional benefit.
    10/18 I was withdrawn from the Kadmon KD025 clinical trial due to increasing fatigue/lack of benefit.
    11/18 Began therapy with Ruxolitinib (Jakafi), a JAK 1&2 inhibitor class drug. Started at half-dose due to concerns with drug interactions.

    To date: 1 cancer, relapse, second relapse/mutation into 2 cancers, then 3 cancers simultaneously, 20 chemotherapy/GVHD drugs in 11 regimens (4 of them at least twice), 5 salvage regimens, 4 clinical trials, 5 post-transplant immuno-suppressant/modulatory drugs, the equivalent of 1,000 years of background radiation from 40+ CT series scans and about 24 PET scans.
    Both lymphoid and myeloid malignancies lend a certain symmetry to the hematological journey.

    Believing in the redemptive value of suffering makes all the difference.

  3. #3
    Moderator Top User Fourlegsgood's Avatar
    Join Date
    Aug 2011
    Posts
    987
    Mike.

    Sorry you have to be here but we have a great crowd of people with lots of varied experiences so I would hope someone can chime in with a bit of help for you.

    Nick
    Age 1/2 way to 120 plus 1. Symptom of blood in stools May 2011. Colonoscopy June 2011 confirmed rectal cancer. CT scan June 2011 showed no spread to other organs. Anterior resection July 2011 plus 50% bowel removed due to thickening observed during operation. Biopsy confirmed stage 2 in rectum only. Completed 8 cycles of precautionary capecitabine (4600mg Xeloda). Returned to horse riding 6 weeks post op, jumping 2weeks later and first competition 2 weeks after that. July 2012 - CT scan clear. June 2014 - CT scan clear. December 2014 - Colonoscopy clear. July 2017 - 6 year CT scan clear.

  4. #4
    Super Moderator Top User po18guy's Avatar
    Join Date
    Feb 2012
    Posts
    10,337
    Being completely unfamiliar with this, I decided to do a bit of research. Here are a couple of links that are informative. If those tumors have been deemed to be non-resectable, the SIRT seems to be an effective and very reasonable method of delivering radiation directly to the tumors. As well, it also damages the veins that feed those tumors. SIRT strikes me as a minimally invasive, low-risk procedure. What you might look into is the experience and history of the physicians and the center where you will have your procedure.

    http://www.insideradiology.com.au/pa...2#.VNaJ4CiAR5g

    http://www.sirtex.com/us/patients/ab...ked-questions/
    05/08-07/08 Tumor appears behind left ear. Followed by serial medical incompetence on the parts of PCP, veteran oncologist and pathologist (misdiagnosis via non-diagnosis). Providential guidance to proper care at an NCI designated comprehensive cancer center.
    07/08 Age 56 DX 1) Peripheral T-Cell Lymphoma-Not Otherwise Specified. Stage IV-B, >50 ("innumerable") tumors, bone marrow involvement.
    08/08-12/08 Four cycles CHOEP14 + four cycles GND (Cyclofosfamide, Doxorubicin, Vincristine, Etoposide, Prednisone & Gemcitabine, Navelbine, Doxil)
    02/09 2) Relapse.
    03/09-06/13 Clinical trial of Romidepsin > long-term study. NED for 64 twenty-eight day cycles, dose tapered.
    07/13 3) Relapse, 4) Suspected Mutation.
    08/13-02/14 Romidepsin increased, stopped for lack of response. Watch & Wait.
    09/14 Relapse/Progression. Visible cervical nodes appear within 4 days of being checked clear.
    10/06/14 One cycle Belinostat. Discontinued to enter second clinical trial.
    10/25/14 Clinical trial of Alisertib/Failed - Progression.
    01/12/15 Belinostat resumed/Failed - Progression. 02/23/15
    02/24/15 Pralatrexate/Failed - Progression. 04/17/15
    04/15 Genomic profiling reveals mutation into PTCL-NOS + AngioImmunoblastic T-Cell Lymphoma. Stage IV-B a second time. Two dozen tumors + small intestine (Ileum) involvement.
    04/22/15 TEC (Bendamustine, Etoposide, Carboplatin). Full response in two cycles. PET/CT both clear. Third cycle followed.
    06/15-07/15 Transplant preparation (X-rays, spinal taps, BMB, blood test, MUGA scan, lung function, CMV screening, C-Diff testing etc. etc. etc.) Intrathecal Methotrexate during spinal tap.
    BMB reveals 5) 26% blast cells of 20q Deletion Myelodysplastic Syndrome MDS), a bone marrow cancer and precursor to Acute Myeloid Leukemia.
    07/11-12/15 Cyclofosfamide + Fludarabine conditioning regimen.
    07/16/15 Total Body Irradiation.
    07/17/15 Moderate intensity Haploidentical Allogeneic Stem Cell Transplant receiving my son's peripheral blood stem cells.
    07/21-22/15 Triple dose Cyclofosfamide + Mesna, followed by immunosuppressants Tacrolimus and Mycophenolate Mofetil.
    07/23-08/03/15 Marrow producing zero blood cells. Fever. Hospitalized two weeks.
    08/04/15 Engraftment occurs, and blood cells are measurable - released from hospital.
    08/13/15 Day 26 - Marrow is 100% donor cells. Platelets climbing steadily, red cells follow.
    09/21/15 Acute skin Graft versus Host Disease arrives.
    DEXA scan reveals Osteoporosis.
    09/26/-11/03/15 Prednisone to control skin GvHD.
    11/2015 Acute GvHD re-classified to Chronic Graft versus Host Disease.
    05/2016 Tacrolimus stopped. Prednisone from 30-90mg daily tried. Sirolimus begun. Narrow-band UV-B therapy started, but discontinued for lack of response. One treatment of P-UVAreceived, but halted due to medication reaction.
    09/16/16 Three skin punch biopsies.
    11/04/16 GvHD clinical trial of Ofatumumab (Arzerra) + Prednisone + Methylprednisolone begun.
    12/16 Type II Diabetes, Hypertension - both treatment-related.
    05/17 Extracorporeal Photopheresis (ECP) begun in attempt to control chronic Graft-versus-Host-Disease (cGvHD. 8 year old Power Port removed and replaced with Vortex (Smart) Port for ECP.
    05/2017 Chronic anemia (low hematocrit). Chronic kidney disease. Cataracts from radiation and steroids.
    06/17 Trying various antibiotics in a search for tolerable prophylaxis.
    08/17 Bone marrow biopsy reveals the presence of 2% cells with 20q Deletion Myelodysplastic Syndrome, considered to be Minimum Residual Disease.
    12/17 Bone marrow biopsy reveals no abnormalities in the marrow - MDS eradicated. The steroid taper continues.
    01/18 Consented for Kadmon clinical trial.
    03/18 Began 400mg daily of KD025, a rho-Associated Coiled-coil Kinase 2 Inhibitor (ROCK2).
    09/18 Due to refractory GvHD, Extracorporeal Photopheresis halted after 15 months ue to lack of additional benefit.
    10/18 I was withdrawn from the Kadmon KD025 clinical trial due to increasing fatigue/lack of benefit.
    11/18 Began therapy with Ruxolitinib (Jakafi), a JAK 1&2 inhibitor class drug. Started at half-dose due to concerns with drug interactions.

    To date: 1 cancer, relapse, second relapse/mutation into 2 cancers, then 3 cancers simultaneously, 20 chemotherapy/GVHD drugs in 11 regimens (4 of them at least twice), 5 salvage regimens, 4 clinical trials, 5 post-transplant immuno-suppressant/modulatory drugs, the equivalent of 1,000 years of background radiation from 40+ CT series scans and about 24 PET scans.
    Both lymphoid and myeloid malignancies lend a certain symmetry to the hematological journey.

    Believing in the redemptive value of suffering makes all the difference.

  5. #5
    Experienced User
    Join Date
    Feb 2015
    Posts
    54
    Quote Originally Posted by po18guy View Post
    Being completely unfamiliar with this, I decided to do a bit of research. Here are a couple of links that are informative. If those tumors have been deemed to be non-resectable, the SIRT seems to be an effective and very reasonable method of delivering radiation directly to the tumors. As well, it also damages the veins that feed those tumors. SIRT strikes me as a minimally invasive, low-risk procedure. What you might look into is the experience and history of the physicians and the center where you will have your procedure.

    http://www.insideradiology.com.au/pa...2#.VNaJ4CiAR5g

    http://www.sirtex.com/us/patients/ab...ked-questions/
    They are small about 7milimeters but in 3 different spots. Mass in the Sigmoid colon is no longer visible on a CT Scan. CEA count below 1. CEA was 90 when I started Chemo. Working, got my appetite back, Gained weight back. Generally feeling ok but why does this SIRT sound more like a last hope than a cure. I'm eight months into this but it doesn't sound like I've got much hope despite feeling better now than before I strarted Chemo.

  6. #6
    Experienced User
    Join Date
    Feb 2015
    Posts
    54
    Having it done at University of Penn. Hospital

  7. #7
    Well Mike I hate to see you here but this is a great place to be when you need to be here.

    "why does this SIRT sound more like a last hope than a cure"

    Let me give you some general information about Colon Cancer Mets in the liver per my Dr.

    1. Colon Cancer in the colon is a nuisance. Colon Cancer in your liver will kill you.
    2. Mets in the liver are all about location, location and location. If they can be surgically removed that is the way to go. If not!!!
    3. Chemo is a real hit or miss on mets in the liver. Sometimes it kills them, sometimes it reduces them and then sometimes it does nothing or only works for a short period of time.
    4. External directed beam radiation can only be used on one met. If you have more than one it is not an option.
    5. SIRT has a growing body of results for tumors that cannot be surgically removed. If successful it may result in you becoming a candidate for surgery or external beam radiation. (Note: if one met cannot be surgically removed then normally you are not a candidate for surgery, if you have multiple mets and SIRT kills the one keeping you from having surgery then you possibly become a candidate for surgery and a possible cure.)


    With that information I have always looked at SIRT as one more tool in the chest to get me to a possible cure.

    You are in my thoughts and prayers.
    Age 49 Male
    5/18/12 - Family Dr ordered emergancy CT and colonsopy
    5/23/12 - Diagnosed with Stage 4 Rectal Cancer w/mets in Liver
    6/28/12 - Combined lower bowel resection and liver resection.
    9/7/12 - Last day of Chemo. Folfox Blood Clot in Leg.
    1/25/13 - Last day of Second Round of Chemo Folfox
    4/25/13 - Ostamy Reversal
    9/9/13 - Clear Scan-High CEA
    9/16/13 - Pet Scan shows 4 new spots in Liver
    10/3/13 - Second Liver Resection removes tumor #6,7,8,9.
    11/1/13 - Started FolFiri
    5/13/14 - Pet scan shows 3 large tumors in the Liver. Time to see Surgeon again.
    6/12/14 - Third Liver Resection removes Tumor #10,11,12.
    7/16/14 - Started Xeloda and Avastin
    9/22/14 - Fistula goes septic. 2 Major Surgeries later Permanent Ostomy.
    12/19/14 - Started Xeloda and Avastin again
    5/22/15 - 3 new tumors in my liver. No surgery this time.
    12/15/15 - micro-spheres(Y90) failed completely All tumors growing
    2/5/16 - Started Lonsurf and antibiotics

  8. #8
    Top User
    Join Date
    Jan 2013
    Posts
    1,492
    Mike49, welcome to the forum---no one wants to be here, but it is the best place if you need it. Lots of support for caregivers and patients. We help each other as best we can. Best of luck and prayers for the journey. Strike said it very well. Look at it as a tool to get you to possible cure. This is a long road with many ups and downs, often called a rollercoaster and as some here and my son's doctor said this is a marathon and not a sprint. My son received care at MD Anderson, but I did live 35 minutes from U Penn for 11 years. Prayers for your journey. If you don't pray, then read "prayers" as good wishes.

    Amanda
    Caregiver to son, 32 , 5/18/2011 Stage IV
    Sigmoid colectomy , liver biopsy 5/18/2011
    6cm sigmoid tumor, low grade (well-to-mod. differentiated)
    6 of 33 lymph nodes +
    FOLFOX /Avastin 6/2011-8/2011
    Rt hepatectomy on 9/20/2011---70%
    2012
    FOLFOX /Avastin 4 cycles 1/31 stopped-low platelets
    3/5 CT clear
    4/ PET scan showed peritoneal mets
    4/24 splenic embolization for low platelets
    FOLFIRI/ Avastin 5/12-8/12
    Consult for HIPEC 8/12 denied---tumors too many, possibly in ureter.
    5FU/ Avastin 8/2012-2/2013
    12/5/12 scan tumors stable
    12/12 aranespt
    2013
    3/5 tumor progression in abdomin
    Restart FOLFIRI/ Avastin with lower dose of Irinotecan 3/11-3/25
    nuelasta shots
    ER - bowel obstruction 4/4
    Port removed 4/12
    Port replaced 5/9
    ER 30 hrs
    Erbitux in, Irinotecan lowered 5/20 & 6/17
    9/17scan indicates stable
    9/18-27 & 10/7-11 small bowel obst.
    Erbitux & Irinotecan 11/5, 12/2
    Bowel obst. 12/31
    2014
    1/8 urether stent
    1/17 Hospice
    3/27 started his heavenly journey

  9. #9
    Experienced User
    Join Date
    Feb 2015
    Posts
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    Despite the Chemo I really don't feel all that bad.I guess the question I am too chicken to ask the Doctor is how much longer do I have to live ?

  10. #10
    Senior User Bob W's Avatar
    Join Date
    Sep 2014
    Posts
    328
    I bet he answers thusly: "anywhere from now until then" (doubt he will give you a projection-I live with the thought that today is the important one and maybe tomorrow will be interesting)

    Bob W
    now 61 years old
    Diagnosed, CRC July 14, 2014
    CT spotted worries on liver and kidneys
    MRI said no big deal
    Sigmoid out, resection September 3, 2014
    September 4, 2014 advised stage 2, no node involvement
    Home September 5, 2014
    Hemorrhaging September 8, 2014
    In hospital found a bleeder
    Home September 12, 2014

    07/21/2015 follow-up colonoscopy 1 year post diagnosis-not whistle clean but dang near it!

    0700/2018 follow-up to be scheduled

 

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