Beating the Odds: Determined to Live, a Mother Fights a Devastating Liver Cancer Diagnosis

When Rosie Giacosa was diagnosed with cholangiocarcinoma, a rare and dangerous cancer of the bile ducts, she didn’t want to hear anything discouraging about her prospects of survival. Instead, she set her sights solidly on the future, ignoring the dismal numbers.

“I would not let my doctor speak of stages or statistics, or tell me anything negative about my condition,” says the mother of two from Coral Gables. “I told him flat-out at our first clinic.”

Her physician at Baptist Health Miami Cancer Institute, hematologist-oncologist Fernando de Zarraga Jr., M.D., was happy to honor that choice and focus on a treatment plan. Within days of their first meeting, Ms. Giacosa began an aggressive regimen of chemotherapy, followed by an innovative approach to radiation aimed at shrinking her tumor.

Today, she credits Miami Cancer Institute’s unique combination of compassion and resolve for helping her fight her dire diagnosis. Once her cancer was under control, she was able to receive a liver transplant in Texas and is now in remission.

“I will forever be grateful to Miami Cancer Institute and all of its doctors for keeping me on the path to healing during that tumultuous first year,” she says. “Their care was nothing short of lifesaving.”

Seeking Expert Care Close to Home

Ms. Giacosa’s cancer was discovered in June 2021, when she was 52, after she returned home from a vacation. Feeling poorly and rapidly deteriorating, she asked her husband to take her to the emergency department at Baptist Hospital.

“Within a few hours, it was clear that this wasn't something minor — this was something major,” she recalls. Scans and her extremely elevated bilirubin count brought to light a four-centimeter tumor near her liver. She was glad she was in a hospital that she trusted.

“Baptist Hospital has been the warm blanket that always just hugged us every time that we needed something,” she says, noting her now-adult children were born there. “It was there for us in moments of joy. It was there for us in moments of sorrow. And it was there when I needed it most, during my devastating diagnosis.”

Cholangiocarcinoma is a cancer of the ducts that carry bile from the liver to the small intestine. Only about 8,000 people in the United States are diagnosed with it each year. The prognosis is generally poor, with a five-year survival rate of around 10-15 percent.

Making a Plan to Fight

Ms. Giacosa’s tumor was wrapped around an artery and blocking the hepatic duct, causing a life-threatening bile buildup in her liver. She needed a stent to get it flowing again, and eventually a catheter to allow it to drain.

At the same time, over several months, she received four treatments of a combination cisplatin-gemcitabine chemotherapy. Cisplatin is a platinum-based drug that works by damaging the DNA of cancer cells, killing them. Gemcitabine blocks the synthesis of DNA and RNA, preventing cancer cell growth and division. “It wasn't easy,” she says. “It took a toll.”

In addition to dealing with the toxicity of chemotherapy, Ms. Giacosa kept getting infections around her stent, landing her back in the hospital. “Any one of those infections could’ve ended my life, but my team of doctors fought hard to save my life and keep me on my healing journey,” she says. “They never gave up.”

As an added strategy, Ms. Giacosa was administered an innovative, high-dose radiation therapy by Michael Chuong, M.D., medical director of Miami Cancer Institute’s Department of Radiation Oncology.

“I was very grateful that I was part of a world-renowned institution that was willing to invest in the state-of-the-art, latest technology to help people like me with really difficult cases of cancer,” she says. “The MRI-guided radiation obliterated my tumor and was a key factor in giving me a chance at the transplant list.”

Understanding the Radiation Treatment

Since 2018, Miami Cancer Institute has been at the international forefront of treating cancer tumors using the MRIdian Linac, the first FDA-approved MR-guided radiation therapy system. The system “marries” the technology used for highly targeted radiation treatments with magnetic resonance imaging (MRI). This allows continuous real-time tumor tracking during treatment delivery, which is not possible with other types of treatment machines.

“This is something that is not available at most cancer centers throughout the United States, or even internationally,” Dr. Chuong says. “We here at Miami Cancer Institute have been one of the early pioneers of this technology that allows us to offer more effective and safer treatment for even the most challenging tumors.”

When surgery is not an option, this system enables extremely high, ablative doses of radiation to be delivered noninvasively in an outpatient setting and without anesthesia. Research has demonstrated that it can be especially effective in eradicating tumors throughout the body — sometimes in as few as one session — while rarely causing significant side effects.

Combining radiation with real-time visualization allows oncologists to define very tight treatment margins. The system is so advanced that it even automatically pauses if the tumor shifts out of position when the patient breathes, resuming only after the tumor returns to exactly the correct position. It also allows for the radiation oncologist to adapt, or modify, the radiation treatment each day to account for changes in the tumor position from day-to-day.

“This allows us to deliver pinpoint radiation to liver and bile duct tumors, and many others, with a level of precision and accuracy that has never been possible before,” Dr. Chuong says. “With standard radiation machines, you can’t safely treat these tumors with such a high dose without injuring other organs nearby.”

Taking the Next Step into the Future

Once stabilized, Ms. Giacosa fought to join a transplant program in Texas. It offered an uncommon approach to treating cholangiocarcinoma, but she says, “From day one, we had always said we were leaving no stone unturned.”

The lengthy process was an emotional roller coaster, but she soon found herself being rolled into surgery. As she underwent the transplant, her husband called Dr. de Zarraga in Miami to let him know. “He could not have been happier,” Ms. Giacosa says. “That's the Baptist difference — you know, people care. I always felt that the doctors and nurses were very invested in my case, in my progress, in my succeeding in all of this.”

Now in remission for more than two years, she’s a volunteer mentor and advocate for others awaiting transplants. She has been able to see her daughter get married and spend time with her grandson. Although she consulted with leading cancer institutions throughout the country, she continues to be closely monitored at Miami Cancer Institute.

“Everywhere we went, they applauded the efforts of Miami Cancer Institute and Baptist Hospital. They all agreed that the treatment they put me on was the right treatment for me for that particular moment,” she says. Now, she adds, “I feel amazing and deeply thankful every single day.”

Michael Chuong, M.D., medical director of Baptist Health Miami Cancer Institute’s Department of Radiation Oncology

Fernando de Zarraga Jr., M.D., hematologist-oncologist at Baptist Health Miami Cancer Institute