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Cyberknife for 2.5cm AN advisable?
Posted: Thursday, November 29, 2018 5:00 PM
Joined: 11/27/2018
Posts: 1

I am 34 years old and I am diagnosed with 2.5 x 2 x 1.9 AN. Its slightly pushing on the brain stem. Symtoms: 1. Moderate hearing loss with 65% word recognition on right ear (Other side hearing is pretty good) 2. Mild tinnitus (so far and hope it stays that way) 3. Started feeling light headedness recently (once a day) Tinnitus started 3 months ago and had a bout of hearing loss 1 month back which bounced back to normal (atleast I thought until the audiology test) by itself in three days. Subsequent tests, MRI etc showed the aforementioned AN size. I have consulted 4 famous doctors so far and here is a quick summary 1. 1 surgeon is completely against radiotherapy for this tumor size & age 2. 2 surgeons say both radiotherapy and surgery are options. But given that brain stem compression is already there, they recommend surgery as a preferable treatment 3. 1 surgeon suggests both are good options with slight preference to radiotherapy because as per stats radiotherapy has better outcome in terms of facial nerve protection and possible hearing loss stabilization. He finally said I have to choose, but I could see his pref is with radiotherapy (CK). My questions: 1. One surgeon said that tumor kill % goes down as tumor size increases and a salvage surgery would be needed down the line. He is of opinion GK/CK won't match the typically quoted kill rate % of 95% for 2.5cm AN. Is that accurate? Is a regrowth chance high? 2. Many studies indicate and surgeons also mention that no matter what I do, in 5 years time hearing will be completely lost anyway. How correct is this information? Are there instances where someone has retained pre-treatment hearing levels for more than 10 years after radio therapy? 3. When 2.5cm AN swells, am I at more risk of symptoms that may not come down for many years? Any other severe symptoms that I should consider? I read more -ve stories for CK/GK on large tumors vs good outcomes. I understand ppl tend to post bad experiences more than good experiences. Whats the typical outcome in your experience treating tumors of sizes @ 2.5cm? Its a divided house for my case and looking to get more opinions as I think through my choices. Any feedback is greatly appreciated. Thanks
Posted: Friday, November 30, 2018 7:57 AM
Joined: 10/10/2008
Posts: 4435

1. That size tumor can readily be treated with CK, and expectations of control are very high. The best available evidence is that the Koos grade does not really alter the outcomes. There are some in the Gamma Knife world who might argue that tumors greater than 6 cc are not optimal candidates for radiosurgery but we have not found that limitation with CK. In our series, we have consistently offered CK for tumors less than 3 cm maximum diameter, with only rare exceptions. 2. Surgery carries more risks when used up front. It might be better used for possible salvage if needed. 3. Most series of CK treated patients show hearing preservation in about ⅔ of patients, assuming you do not have neurofibromatosis. 4. Your tinnitus may not improve after treatment. With proper planning, you would not expect any adverse effects on the brainstem. 5. That lightheadedness may stay the same or even worsen somewhat for a while. Most commonly, it is not a long-term problem of any great significance.

Clinton A. Medbery, III, M.D. Southwest Radiation Oncology

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