ANA Discussion Forum
Watch and Wait => For those in the 'watch and wait' status => Topic started by: nursepam on September 09, 2015, 12:32:51 pm
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Has anyone had Surgery after Radiation to remove their Acoustic Neuroma?
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I know Dr. Schwartz at House Clinic in Los Angeles discussed this. I know he will evaluate your MRI and medical records for free, and give you a free phone consultation. It wouldn't hurt to send him your package. He is highly regarded, especially at this stage in his career.
2100 W 3rd St #111, Los Angeles, CA 90057
(213) 483-9930
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Great suggestion Mcrue!
Jane
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Thank you! I will look into that.
Pam
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3245992/
Conclusion
Tumor pseudoprogression should be anticipated and not considered to be treatment failure. In our series, 23% of VS treated with radiosurgery underwent pseudoprogression, with onset at 6 months and, most commonly, regression by 24 months. VS that begin to enlarge only after 24 months are likely to be treatment failure, and a second intervention should be considered only at this stage.
In our series, there was no association between transient tumor enlargement and clinical deterioration. Therefore, we would advocate baseline imaging only to document the maximum stable size of VS after radiosurgery, and no salvage therapy should be instituted before 36 months, unless there is clinical need to intervene.
We did not identify any clinical or dosimetric parameters that could predict tumor pseudoprogression in our series. Further studies are required to understand the biological mechanisms of tumor pseudoprogression and to identify clinical predictors of this phenomenon.
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Thanks for this information PaulW. Since post GK MRIs are used only to check for treatment failure how important do you think it is that they be with contrast agent? I have had four MRIs with contrast so far and want to avoid unnecessary exposure in the future. My doctor wants to use contrast agent on all future MRIs.
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Unless you are allergic or have issues with the contrast I would want the extra clarity. Keep in mind that the frequency of the MRI's decrease as time goes by. I had one at 2 years and one at 4 years. After my 6 year it will probably be 3 or 4 years before another one. That will take me 10 years out and that will probably be the end of the MRI's.
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Yes, extra clarity is good. However, on July 27, 2015 the FDA announced that it is investigating the risk of brain deposits following repeated use of gadolinium based contrast agents. Apparently there is some evidence that in some patients the deposits will remain years after the last MRI. There is no data which conclusively proves the deposits are a major health issue. And hopefully the FDA investigation will soon resolve the question. In the interim I wonder whether the extra clarity provided by the gadolinium is worth the possible future risk from the brain deposits for those who are getting routine post GK MRIs merely to see if there has been treatment failure.
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Hopefully not failure but, successful treatment :) As noted the frequency of MRI's will be reduced over time. I would ask your doctor about the issue, and see if they feel it is imperative to use the dye in your case.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3245992/
Conclusion
Tumor pseudoprogression should be anticipated and not considered to be treatment failure. In our series, 23% of VS treated with radiosurgery underwent pseudoprogression, with onset at 6 months and, most commonly, regression by 24 months. VS that begin to enlarge only after 24 months are likely to be treatment failure, and a second intervention should be considered only at this stage.
In our series, there was no association between transient tumor enlargement and clinical deterioration. Therefore, we would advocate baseline imaging only to document the maximum stable size of VS after radiosurgery, and no salvage therapy should be instituted before 36 months, unless there is clinical need to intervene.
We did not identify any clinical or dosimetric parameters that could predict tumor pseudoprogression in our series. Further studies are required to understand the biological mechanisms of tumor pseudoprogression and to identify clinical predictors of this phenomenon.
interesting report - thanks for the link