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Question about Side effects on nonfunctional pituitary mass
ChrisS
Posted: Friday, September 02, 2016 12:24 PM
Joined: 9/2/2016
Posts: 4


No laughing please.. I'm actually asking about my dog!  We successfully used Cyberknife on another dog with 2 miningiomas about 5 years ago (who had an amazing recovery and lived to be 20!!!) .. and as luck would have it... we have another dog with a brain tumor.. this one has a few other complications.. He has a single non-functional pituitatary mass, the radiologists and oncologist radiologist all say it can be successfully treated.

He also has a liver lesion and a mass on his left adrenal that is non-invasive.  He has tested normal for cushings oddly.  One of his internists has suggested that some how the adrenals are balancing it all out.. and mentioned it was rare to see someone with a pituitary mass and an adrenal mass be cushings free.

The radiology oncologist had said that there could be increased risks doing cyberknife on the brain mass because of the other issues in his abdomen. 

(Since his symptoms are currently related to his brain tumor we decided to treat the brain tumor first and then work on the other issues)

From our experience with the first dog.. I was under the impression that CK is very safe, even when there are other parts of the body compromised because it's so accurate and if there's any damage it would be very close to the site of radiation.  Am I correct in thinking this?

What our concerns have been in trying to figure out if we were going to treat him with CK were related to him being put on prednisone and potential issues with his cortisol levels / becoming cushinoid  and /or the prednisone reducing his immunity and making him more susceptible to complications.  The radiation oncologist said that we'd have him on a taper dose of prednisone at an anti-inflamatory level vs. immunosupressant level and thought it would be safe..   so I'm a little confused and wondering if there are side effects that can be high risk to him in his life or adrenals directly from the CK.

Any feedback, experience, advice is greatly appreciated.

Thank you

Chris S





radsrus
Posted: Friday, September 02, 2016 2:17 PM
Joined: 10/10/2008
Posts: 4435


Other than the loss of any remaining pituitary function, the biggest risk of pituitary treatment with the CK is visual damage

Clinton A. Medbery, III, M.D. Southwest Radiation Oncology buddy@swrads.org
ChrisS
Posted: Friday, September 02, 2016 4:27 PM
Joined: 9/2/2016
Posts: 4


Thanks.. that makes me feel better.. I knew about those risks.. I just wasn't sure if we were missing anything. 

The other question I had  was the radiology oncologist had suggested only doing 2 treatments vs. the full course of 3 because of what was going on in his abdomen..  She said that's usually what they do with humans and they are trying to follow the human protocol. She also said most of her clients have opted for 3 treatments.. one opted for 1 treatment and only 5 opted for the 2 treatments.   The other radiologist oncologist who was going to do regular stereotactic said to run the full course and he was confident he could zap the whole thing... This radiologist oncologist also thought she could zap the whole thing with a full course too,

Is there any reason to only do 2 treatments? vs. the full 3? on a pituitary mass with an adrenal mass and a liver lesion?

She told us we had up until the day we do our mapping to decide which route we go.  

Now the other thing.. one of our neurologists said he saw microbleeds in the MRI... When he showed me I didn't see anything.. he sent it to a radiologist to have it read who said it was probably from hypertension and stress. The radiology oncologist didn't see the microbleeds when she looked at the MRI.  She said she was going to have her neurologist look at it too to see if he saw anything, I haven't heard back from her about it.

Is there a greater risk of bleeds in this situation. Or is it just the same risk that anyone would have? 

If I remember correctly from our last go - during mapping they're going to do another MRI / CT scan as well  - and will be able to have another look.

Thank you!!!



radsrus
Posted: Saturday, September 03, 2016 5:02 AM
Joined: 10/10/2008
Posts: 4435


I usually try to treat pituitary tumors in a single fraction if it can be done safely. But it is not really rational to discuss just the number of treatments, since the dose for each treatment is critical. Two treatments could be substantially more biologically effective, or substantially less so, then three fractions depending on dose delivered.

Clinton A. Medbery, III, M.D. Southwest Radiation Oncology buddy@swrads.org
ChrisS
Posted: Tuesday, September 06, 2016 7:36 AM
Joined: 9/2/2016
Posts: 4


Thank you Dr. Medbury,
Is there a reason that you prefer to treat pituitary tumors with 1 dose vs. breaking it down?  (aside from time and scheduling and convenience for the patient)

The person who is doing CK for Buster does it very differently than the doctor who did it on our other dog.  This one prefers to have at least a day off in between treatments (assuming to try and keep swelling down and the tumor from dieing too fast with limited space in the skull?) 

Her reasoning for giving 2 treatments was that there were other things going on in the body that she thought would be negatively impacted by CK to the pitutiary mass.. (This part still has me baffled since my understanding is that CK radiation to the pituitary should in no way have any repercussions on his abdomen or anywhere else in his body other than perhaps near by tissue if he flinches during radiation?)  I'm still trying to get clarfication from her on why she said this.

Our first dog who had treatments had a planning day on Monday, Tuesday was off and wed, thurs and fri he had treatments and was done.  He went in on Monday essentially curled up in a ball and came out running on Friday and wanting to play.   It was almost like magic!  I know this was an older machine.. one of the first CK's made.

Thank you

Chris



radsrus
Posted: Thursday, September 08, 2016 3:50 AM
Joined: 10/10/2008
Posts: 4435


I think (without much data to support it) that single fraction is more effective if it ca neb delivered safely

Clinton A. Medbery, III, M.D. Southwest Radiation Oncology buddy@swrads.org
ChrisS
Posted: Thursday, September 08, 2016 7:47 PM
Joined: 9/2/2016
Posts: 4


Thank you!




 

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