Value Machine Or Experience - Option of New CK Facility

[Mayfete]

I've been reading lots of info and posts.  I hope someone can clear up confusion on my part.

From the ANUSA website:

"The source of radiation used in radiosurgery is either radioactive cobalt or a linear accelerator. The radiation is called a gamma ray when it comes from a cobalt source (such as the gamma knife) and an x-ray when is comes from a linear accelerator (LINAC). Both devices can equally produce the desired therapeutic radiation. The treatment team usually consists of surgeon, radiophysicist, and a radiation oncologist working together to develop a treatment plan based on the size and shape of the tumor. Their experience and expertise is far more important than the machine producing the radiation."

I'm definitely leaning toward CK and I live in Oregon.  There's a brand new CK in Seattle.  If one has the option to go there or Stanford, is the value in the machine? the doctor? experience?

 
 

[russ]

Hello;
  My feeling is the Dr and their experience is more important than the newness of the machine or center.
  Yes; I agree, the two types of rays are equally effective. They are right next to each other on the spectrum.
  Some may disagree on GK vs. CK; Even radiation providers. Both have proven track records of success. GK's is longer.
  Wow! Coast to coast! You might check the Dr's experience record in Seattle. They may have obtained CK experience elsewhere.
  Good luck to you!

  Russ

[Raydean]

As to the Doctor I can state with all honesty that you couldn't be in better hands then with Dr. Sandra
Vemeaulen who is co director the the Seattle CK.  She is an remarkable person, very knowledgable, experienced and is looked well upon by her peers.  She is also on the board of IRSA, which also speaks well for her.

Best to all
Raydean

[Mark]

Mayfete,

I would agree that the generation source of the radiation is a non issue. Both cobalt and linear accelerator are equally effective in terms of biological impact on the tumor. Negative to the cobalt is it's disposal, but that is a hospital issue, not a clinical one.

I would agree with both Russ and Raydean that the experience of the physicians in radiosurgery in general is important, but less so than in a surgical approach where the level of experience and outcome difference can be dramatic. Nor do I sense that the type of machine is necessarily a big differentiator in terms of evaluating experience. A doc who has a long time with a GK and now has a CK would be perfectly comfortable to me even if the CK had been there only a few weeks. Keep in mind that radiosurgery with these machines is a) very computerized and b) involves a complete team review of treatment plans.

The only time I would worry about CK experience is for the facilities just getting the syncrony software to treat non cranial tumors ( prostate, lung, spine, etc) . An AN is pretty basic for a CK even if the doc using it has most of their expereince with a GK. Treatment of other tumors is the new horizon created by the CK technology and protocols are being developed, so specific CK experience is critical in those situations since GK can't do those kind of treatments

Mark

[Mayfete]

I appreciate all of your comments.  I'm still on a learning curve.

[ppearl214]

Hi Mayfete,

I can't chime in on anything diffferent than what the gang has already noted here, but I can share that I am now 2-mos post CK, having it done here in Boston. I was the 3rd AN that BI treated (since they had just rec'd their CK machine 9 mos prior) but have complete faith in the technology (as well as the GK technology with it's long-term proven record).

For me, there are deciding factors between the 2 that I used to weigh out.

1. Single dose vs. fractionated
2. Metal headframe vs. plastic mesh mask
3.  Accuracy of the beam
4.  Potential risks for both (both, for me, were the same)
5. Experience of the locations in treating AN's

Both, you are back at work in  no time, no "recovery" time and minimal immediate side affects.

Regardless of which form you may choose, I know you'll make the best "well informed" decsion that you can.

Phyllis

[Mayfete]

After severe vertigo and 4 days in hospital last March, I was diagnosed with 'Acute Viral Labyrinthitis' and as an "Oh, by the way . . ." was told I have a small AN.  Returning home, I saw local ENT who agreed with diagnosis.  He did give me 3 neurosurgeon names - none of whom are associated with local Gamma Knife center - but he didn't see any urgency seeing them since tumor is small.  I decided not to pursue his recommendations.

I've questioned viral diagnosis and wondered if AN wasn't cause of everything.  Voicing this brought questions of "how could AN cause such sudden symptoms?"  Latest ANA Notes article "Learning to Turn a Deaf Ear" confirmed to me that symptoms can indeed appear suddenly.  My thanks for that article. 

I've decided to go for CK and contacted Stanford and Seattle.  Seattle's CK nurse was helpful to talk with, but she indicated they are dealing with some "political issues" right now using CK for brain tumors.  She thought they would be resolved, but for now, most brain cases are being referred to Gamma Knife.  Because I don't live in Seattle, she said I could send my films for review without appearing for a consultation appointment, but I didn't get the impression that this is routine.  She also confirmed that while the machine does alot, the final treatment plan is determined by the radiation oncologist and the physicist and that their experience is important.  So even with CK and all it's automation, the ANUSA recommendation for "treatment from a medical team with substantial acoustic neuroma experience" remains valid advice.

Stanford was wonderful.  Their CK nurse returned my call promptly, answered my questions, and was very helpful.  Stanford has weekly review conferences of films sent.  My films are off and hopefully will be reviewed this week.  I anticipate hearing their recommendation soon.  There's no delay getting in.  She said that if CK is advised, I could be scheduled in a week.  Even this step is such a relief.  After researching everything I could, I'm satisfied that whatever they recommend will be the best for me.  Their facility seems to run 'like a well-oiled machine'.  Peace of mind is priceless.

My thanks again to all who share their experiences and knowledge here.  Whether I've responded to your messages or not, your messages have helped me tremendously.

[HeadCase2]

Even with radiosurgery, experience in treating AN is important.  Gamma Knife dosages used to treat ANs have been steadily declining, with lower dosages being just as effective in killing off the AN tissue, and related to less side-effects (like facial nerve damage).  I would want the team designing my radiosurgery treatment to be up on the latest dosage protocols, etc., for treating ANs.
  I would also prefer to be treated at an institution that has been using their Gamma Knife or Cyber Knife for some period of time. I'm certainly no expert on radiation machines, but like any complex machine they require calibration.  By that I mean when you set up a new machine you check out it's accuracy in terms or dosimetry (does it accurately deliver the dose of radiation that you ask it to deliver), and in terms of location (how accurately does it deliver the radiation to the 3 dimensional area you've programmed in for treatment).  Calibration would be important for a new machine, as well as an existing machine periodically.  For Gamma Knife, Cobalt 60 has a half life of 5.27 years, which means that after 5.27 years half the Cobalt in the Gamma Knife source would have degraded, reducing the radiation being produced.  So the Cobalt 60 source has to be both calibrated and replaced periodically.
  The Quality Assurance Review Center http://www.qarc.org, which does research on radiotherapy quality assurance, asks a lot of questions about the calibration of radiation machines, see their QARC Questionnaire for Stereotactic Radiosurgery (SRS) with a Gamma Knife at http://www.qarc.org/benchmarks/SRSGamma.pdf.   It may be worth asking your potential treatment center about calibration of their machine.
  In the final analysis we put a lot of faith in the doctors we decide to be treated by, expecting that they handle all the right questions and details for treatment.  This is one of the reasons using an experienced AN treatment team is so important.
Regards,
 Rob

PS My apologies to those that perhaps didn't need more to worry about.  The devil is in the details.  I can't help myself-- I'm an engineer. 

[ppearl214]

Hi Geeky-Rob!

Great points you make... and wanted to chime in with one more that falls in line with what you note about GK and calibration. It's also important to ask how often or when the metal headframe was calibrated as well that is used in GK.  Just like the radio-machines, the metal headframe needs to be calibrated as it can also affect efficacy in the single dose GK treatment.

Signed,
Not-so-geeky-Phyl
(I only sell the semi's... )
Cruise Director!

[Mayfete]

Rob,

Thanks for the details.  I hope someone knowledgeable is  minding the machine with so much to keep current: calibration; half-life; etc.  Still waiting to hear recommendation.

Mayfete

[okiesandy]

I am just going to add a little here. I ran into my radiation oncologist in the Airport last week. He was on his way to Florida to help get them started with thier cyberknife center. Believe me, the newbies are not newbies to this tech. The prepare for this for a long time. They have the backing and knowlege  of other doctors that have gone before them. My doctor says it is a small and very close knit community for the cyberknife people. I know he has such high hopes that more and more will opt for this treatment for a varity of problems.

Sandy