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Hearing after Ck treatment
Mayd3
Posted: Friday, February 13, 2009 10:38 PM
Joined: 10/10/2008
Posts: 2


I have an acoustic neuroma with about 50% hearing loss with 92% speech recognition.  I was told by a Ck doctor that most patients will have hearing loss after Ck treatment.  I am wondering if this will take away any useful hearing.  Would GammaKnife be better in order to keep my hearing at the same level?  Doctors in Pittsburgh say that there is a 50-60% chance of keeping the hearing at the exact same level with Gk.  I wonder what happens to the other 50%of Gk hearing?


radsrus
Posted: Saturday, February 14, 2009 4:38 AM
Joined: 10/10/2008
Posts: 4435


Where in the world was the CK doctor who said that all patients will have hearing loss? The data does not show that. It is not completely clear, but there may be a 10-15% improvement in hearing preservation with CK compared with GK (75% versus 60%). This is data on retaining serviceable hearing. The rest of the people do not retain serviceable hearing.


 

Clinton A. Medbery, III, M.D.
St. Anthony Hospital Cyberknife Center
(405) 272-7311
buddy@swrads.org

Mail to:
Clinton A. Medbery, III, M.D.
Southwest Radiation Oncology
1011 N. Dewey Ave. #101
Oklahoma City, OK 73102

 


Mayd3
Posted: Saturday, February 14, 2009 10:26 PM
Joined: 10/10/2008
Posts: 2



Thanks for your reply.  I am confused about whether to go ahead with cyberknife or gammaknife.   I am concerned because I have been having facial tingling and numbness and do not want things to get worse. 
Dr. J
Posted: Sunday, February 15, 2009 5:34 AM
Joined: 10/11/2008
Posts: 1070


You can do either.  Some of us believe that fractionated CK may preserve hearing better than GK.  Dr. Lunsford is an excellent neurosurgeon who has extensive experience in treating acoustics and specializes in stereotactic radiosurgery.  There is no doubt that CK is far more comfortable than GK since no head frame is required.

 

Jerome J. Spunberg, M.D., FACR, FACRO
CyberKnife Center of Palm Beach
jspunberg@radiationoncologyinstitute.com
(561) 799-2828

 

Radiation Oncology Institute
10335 N. Military Trail, Suite C
Palm Beach Gardens, FL 33410
(561) 624-1717


radsrus
Posted: Sunday, February 15, 2009 5:41 AM
Joined: 10/10/2008
Posts: 4435


We have not seen 100% of patients get hearing loss, and I don't think that Stanford has reported that, although I could be wrong. I'll find out.


 

Clinton A. Medbery, III, M.D.
St. Anthony Hospital Cyberknife Center
(405) 272-7311
buddy@swrads.org

Mail to:
Clinton A. Medbery, III, M.D.
Southwest Radiation Oncology
1011 N. Dewey Ave. #101
Oklahoma City, OK 73102

 


radsrus
Posted: Sunday, February 15, 2009 6:02 AM
Joined: 10/10/2008
Posts: 4435


Their publication:

Neurosurgery:
June 2005 - Volume 56 - Issue 6 - pp 1254-1263
doi: 10.1227/01.NEU.0000159650.79833.2B
Clinical Studies: RADIOSURGERY: STEREOTAXY: TUMOR
Staged Stereotactic Irradiation for Acoustic Neuroma
Chang, Steven D.; Gibbs, Iris C.; Sakamoto, Gordon T.; Lee, Elizabeth; Oyelese, Adetokunbo; Adler, John R. Jr.
Collapse Box
Abstract

OBJECTIVE: Stereotactic radiosurgery has proven effective in the treatment of acoustic neuromas. Prior reports using single-stage radiosurgery consistently have shown excellent tumor control, but only up to a 50 to 73% likelihood of maintaining hearing at pretreatment levels. Staged, frame-based radiosurgery using 12-hour interfraction intervals previously has been shown by our group to achieve excellent tumor control while increasing the rate of hearing preservation at 2 years to 77%. The arrival of CyberKnife (Accuray, Inc., Sunnyvale, CA) image-guided radiosurgery now makes it more practical to treat acoustic neuroma with a staged approach. We hypothesize that such factors may further minimize injury of adjacent cranial nerves. In this retrospective study, we report our experience with staged radiosurgery for managing acoustic neuromas.

METHODS: Since 1999, the CyberKnife has been used to treat more than 270 patients with acoustic neuroma at Stanford University. Sixty-one of these patients have now been followed up for a minimum of 36 months and form the basis for the present clinical investigation. Among the treated patients, the mean transverse tumor diameter was 18.5 mm, whereas the total marginal dose was either 18 or 21 Gy using three 6- or 7-Gy fractions. Audiograms and magnetic resonance imaging were obtained at 6-months intervals after treatment for the first 2 years and then annually thereafter.

RESULTS: Of the 61 patients with a minimum of 36 months of follow-up (mean, 48 mo), 74% of patients with serviceable hearing (Gardner-Robinson Class 1-2) maintained serviceable hearing at the last follow-up, and no patient with at least some hearing before treatment lost all hearing on the treated side. Only one treated tumor (2%) progressed after radiosurgery; 29 (48%) of 61 decreased in size and 31 (50%) of the 61 tumors were stable. In no patients did new trigeminal dysfunction develop, nor did any patient experience permanent injury to their facial nerve; two patients experienced transient facial twitching that resolved in 3 to 5 months.

CONCLUSION: Although still preliminary, these results indicate that improved tumor dose homogeneity and a staged treatment regimen may improve hearing preservation in acoustic neuroma patients undergoing stereotactic radiosurgery.



 

Clinton A. Medbery, III, M.D.
St. Anthony Hospital Cyberknife Center
(405) 272-7311
buddy@swrads.org

Mail to:
Clinton A. Medbery, III, M.D.
Southwest Radiation Oncology
1011 N. Dewey Ave. #101
Oklahoma City, OK 73102

 


Romie
Posted: Monday, October 28, 2013 2:09 PM
Joined: 10/25/2013
Posts: 4


Dr. Medbery, If you could go to any one doctor in the country to perform CK for an acoustic neuroma, who would you go to. Mine is 4 x 6 x 9 mm and it is not close to the brain stem. I obviously would like to preserve as much of my hearing as possible. Also, with respect to the radiation doctors who say watching and waiting is best, is that really the best option to preserve hearing or is that because they would prefer that you lose your hearing on your own so that their CK treatment doesn't get pegged as the cause for the hearing loss. If CK could preserve my hearing better by getting it done now rather than wait, I would do it, but that would go against the recommendation I have been given. It has been 1.5 years since I found out and it all started with a sudden hearing loss event. Ear drum steroid shots brought back some of my hearing, but it is not what it used to be and feels like it is slipping all the time. I don't have another appointment until July 2014. I really would like to know who would be a good CK doctor to get another opinion, but don't know where to start. I have limited funds and need to be as efficent as possible. I would however travel to where ever the doctor is located.
radsrus
Posted: Monday, October 28, 2013 4:21 PM
Joined: 10/10/2008
Posts: 4435


Go to someplace close to where you live. For the most part, treating AN's is not really all that demanding technically.You are losing hearing now, so you have little to lose by getting treatment. I fail to see much advantage to waiting. In someone with normal hearing, perhaps, but you are going to lose your hearing from the tumor if you don't get it treated. CK has about a 60-75% chance of preserving hearing.

 

Clinton A. Medbery, III, M.D.
St. Anthony Hospital Cyberknife Center
(405) 272-7311
buddy@swrads.org

Mail to:
Clinton A. Medbery, III, M.D.
Southwest Radiation Oncology
1011 N. Dewey Ave. #101
Oklahoma City, OK 73102

 


Romie
Posted: Monday, October 28, 2013 5:48 PM
Joined: 10/25/2013
Posts: 4


Thanks Dr. Medbery for your reply.
Romie
Posted: Monday, October 28, 2013 5:58 PM
Joined: 10/25/2013
Posts: 4


Dr. Medbery, One more question. This was originally posted in 2009. It details the staged treatments and the radiation amounts usually used. Has this changed any at all since 2009. In other words. have they perfected their technique any further since then, or are these protocols the gold standard for what is still used, in general. I know there are exceptions. I am looking for any further technilogical advances in the specific combination of radiation amounts along with staging the appointments (i.e. 3 every other day, etc.). Thanks. METHODS: Since 1999, the CyberKnife has been used to treat more than 270 patients with acoustic neuroma at Stanford University. Sixty-one of these patients have now been followed up for a minimum of 36 months and form the basis for the present clinical investigation. Among the treated patients, the mean transverse tumor diameter was 18.5 mm, whereas the total marginal dose was either 18 or 21 Gy using three 6- or 7-Gy fractions. Audiograms and magnetic resonance imaging were obtained at 6-months intervals after treatment for the first 2 years and then annually thereafter.
radsrus
Posted: Tuesday, October 29, 2013 2:44 AM
Joined: 10/10/2008
Posts: 4435


Probably the only thing that has changed since then is an increasing interest in reducing the cochlear dose.

 

Clinton A. Medbery, III, M.D.
St. Anthony Hospital Cyberknife Center
(405) 272-7311
buddy@swrads.org

Mail to:
Clinton A. Medbery, III, M.D.
Southwest Radiation Oncology
1011 N. Dewey Ave. #101
Oklahoma City, OK 73102

 


Romie
Posted: Tuesday, October 29, 2013 9:53 AM
Joined: 10/25/2013
Posts: 4


Thanks Again Dr. Medbery Romie
 

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