Radioembolization for pancreatic cancer metastasis to liver?

There are many reviews neoadjuvant approached, both with and without radiation therapies. This is a good summary.
https://journals.lww.com/jpancreatology/fulltext/2019/09000/adjuvant_and_neoadjuvant_therapy_for_pancreatic.7.aspx

I believe the current thinking is chemo first to shrink/kill as much as possible. Then targeted radiation perhaps. For me, folfurinox shrink everything and result was much necrosis. Y90 to my liver stabilized the shrunken liver tumors (that merged together) so that I could have a pancreadectomy in December. Ca 19-9 scores are rising (179) so will find out results of PET and ultrasound tomorrow. If no new metastases, next step will be liver surgery

All the while I feel great and am working full time. I have lost about 30 lbs throughout 2022 and certainly had slump days but nurses were the best resource and helped me discover new ways to bounce back each time. Enjoy each day, make it productive, and never give up hope!

@gamaryanne, I agree. Oncology nurses are such an invaluable resource. I'm glad you were surrounded by a helpful team to give you support both physically and emotionally.

How are you doing? Any update from the latest imaging? (If you wish to share of course.)

I would love to share, in case it would help anyone or if anyone has walked this same path.
My PET showed no new areas but some possible activity around the necrotic tumors in my liver. The Tumor Board unanimously agreed it could not be confirmed to be a new active tumor. I’m told this is a window for surgery. So I will be having liver surgery Monday, February 20. My prayer is that the surgeon can remove all evidence of cancer in this area, resulting in NED! Afterwards, I don’t know. Perhaps look for a type of maintenance chemo? Immunotherapy?
I’m nervous about this, not being laperoscopic, but others get through it so I will too. Thank you for asking.

Can u OU tell us where you received treatment?

Dr Eddie Abdalla and Dr Harpaul Gill are my surgeon and oncologist in Atlanta.

Hi, all!
New here, and just reading all of the posts. My father (67 yo) was diagnosed with pancreatic cancer in July 2022. At the time, it was presumed to be Stage II (possibly III due to regional lymph node involvement). No distant metastases. He underwent 3 cycles of gemcitabine/abraxane with a significant biochemical response - his CA 19-9 reduced from 739 to 24! His scans showed reduction in primary tumor and resolution of enlarged lymph nodes; no liver involvement. So, he was scheduled for Whipple in December 2022. After stopping chemotherapy to prepare for surgery, he became symptomatic and subsequent scan showed some regrowth and a new, small spot on the liver, presumed to be involved. So, instead of performing the Whipple and removal of single hepatic lesion, the surgeon did a biliary bypass and gastric bypass, with no resection of primary tumor (still can't wrap my brain around this). After a 2 month surgical recovery without systemic treatment, more lesions appeared in the liver. He then started modified Folfox. His CA 19-9 was reducing and then more stabilized; scans showed a mixed response, where some lesions in the liver only had enlarged. We inquired about liver directed therapies at that time (March), and this was not considered by his oncologist. Fast forward to now (June) - he's been on Folfiri and has had a better biochemical response with the irinotecan, but again, recent scans show mixed response. Everything reducing except some areas in liver, with 2 new lesions. Now, his oncologist is considering liver directed therapy, specifically, Y-90. She has decided not to resume the Folfiri because of the disease progression in his liver (his platelets do reduce; not dangerously low and do recover during his off-weeks). I am curious why chemotherapy and Y-90 could not both be utilized if he has favorable response to irinotecan in primary tumor and regional lymph nodes? Interested to hear experiences here with Y-90 for the liver, and perhaps even SBRT for the liver and the primary tumor. He has good performance status, is maintaining his weight, and has a fair appetite - the days vary. I know he may never get back to a surgical option, but trying to keep hope with combination of systemic and localized therapies, and continued advancements with immunotherapies and even pancreatic cancer vaccine...
Thanks, and wish everyone here the best,
B