Radiosurgery Studies

[Mark]

JB,

Thank you for the effort of providing a sample list of "librarian certified" radiosurgery studies. It is a marvelous addition to the discussion Kate and I were adding and makes the point much more effectively than I was doing that the AN world web site statement of:

 "The importance of peer review. Many surgeons have published their results in peer reviewed journals. By contrast few radiation treatment centers have done so. Only one Gamma Knife center (University of Pittsburgh) and no FSR centers, to our knowledge, have so far published in peer reviewed journals."

is just flat out inaccurate based on what you posted. Candidly, unless one can can answer "yes" to the question "I have located every study ever done on radiosurgery in the last 30 years and have validated their study design and peer review status", it is irresponsible and downright silly to make such a claim on a web site.

Thanks for a great post

Mark

 The CyberKnife®: Potential in Patients with Cranial and Spinal Tumors. By: Chang, Steven D.. American Journal of Cancer, Nov2005, Vol. 4 Issue 6, p383-393, 11p, 2c; (AN 19238947)

   Long-Term Follow-up of Acoustic Schwannoma Radiosurgery With Marginal Tumor Doses of 12 to 13 Gy. By: Chopra, Rahul; Kondziolka, Douglas; Niranjan, Ajay; Lunsford, L. Dade; Flickinger, John C.. International Journal of Radiation Oncology, Biology, Physics, Jul2007, Vol. 68 Issue 3, p845-851, 7p; DOI: 10.1016/j.ijrobp.2007.01.001; (AN 25342094)

   Acoustic neuroma radiosurgery with marginal tumor doses of 12 to 13 gy. By: Flickinger, John C.; Kondziolka, Douglas; Niranjan, Ajay; Maitz, Ann; Voynov, George; Lunsford, L. Dade. International Journal of Radiation Oncology, Biology, Physics, Sep2004, Vol. 60 Issue 1, p225-230, 6p; DOI: 10.1016/j.ijrobp.2004.02.019; (AN 14250540)

   Single-fraction vs. fractionated linac-based stereotactic radiosurgery for vestibular schwannoma: a single-institution study. By: Meijer, O.W.M.; Vandertop, W. P.; Baayen, J. C.; Slotman, B. J.. International Journal of Radiation Oncology, Biology, Physics, Aug2003, Vol. 56 Issue 5, p1390, 7p; DOI: 10.1016/S0360-3016(03)00444-9; (AN 10233991)

   Management of acoustic neuromas with fractionated stereotactic radiotherapy (FSRT): Long-term results in 106 patients treated in a single institution. By: Combs, Stephanie E.; Volk, Sigrid; Schulz-Ertner, Daniela; Huber, Peter E.; Thilmann, Christoph; Debus, Jürgen. International Journal of Radiation Oncology, Biology, Physics, Sep2005, Vol. 63 Issue 1, p75-81, 7p; DOI: 10.1016/j.ijrobp.2005.01.055; (AN 18233426)

   Role of intracanalicular volumetric and dosimetric parameters on hearing preservation after vestibular schwannoma radiosurgery. By: Massager, Nicolas; Nissim, Ouzi; Delbrouck, Carine; Devriendt, Daniel; David, Philippe; Desmedt, Françoise; Wikler, David; Hassid, Sergio; Brotchi, Jacques; Levivier, Marc. International Journal of Radiation Oncology, Biology, Physics, Apr2006, Vol. 64 Issue 5, p1331-1340, 10p; DOI: 10.1016/j.ijrobp.2005.10.030; (AN 20524387)

   Functional outcome after gamma knife treatment in vestibular schwannoma. By: Hempel, J.; Hempel, E.; Wowra, B.; Schichor, Ch.; Muacevic, A.; Riederer, A.. European Archives of Oto-Rhino-Laryngology, Aug2006, Vol. 263 Issue 8, p714-718, 5p, 8 charts; DOI: 10.1007/s00405-006-0054-6; (AN 21540812)

   Long-term follow-up reveals low toxicity of radiosurgery for vestibular schwannoma. By: Rutten, Isabelle; Baumert, Brigitta G.; Seidel, Laurence; Kotolenko, Snezana; Collignon, Jacques; Kaschten, Bruno; Albert, Adelin; Martin, Didier; Deneufbourg, Jean-Marie; Demanez, Jean-Pierre; Stevenaert, Achille. Radiotherapy & Oncology, Jan2007, Vol. 82 Issue 1, p83-89, 7p; DOI: 10.1016/j.radonc.2006.11.019; (AN 23761172)

   Optimal dose of stereotactic radiosurgery for acoustic neuromas: a systematic review. By: Weil, R. S.; Cohen, J. M.; Portarena, I.; Brada, M.. British Journal of Neurosurgery, Aug2006, Vol. 20 Issue 4, p195-202, 8p; DOI: 10.1080/02688690600886108; (AN 22249486)

   Fractionated stereotactic radiotherapy for the treatment of vestibular schwannomas: combined experience of the Toronto-Sunnybrook Regional Cancer Centre and the Princess Margaret Hospital. By: Szumacher, Ewa; Schwartz, Michael L.; Tsao, May; Jaywant, Satish; Franssen, Edmee; Wong, C. Shun; Ramaseshan, Ramani; Lightstone, Alex W.; Michaels, Howard; Hayter, Charles; Laperriere, Norm J.. International Journal of Radiation Oncology, Biology, Physics, Jul2002, Vol. 53 Issue 4, p987, 5p; (AN 7836489)

   Fractionated stereotactic radiotherapy for acoustic neuromaPresented at the 1st Canadian Radiosurgery Society Meeting, Banff, Alberta March 4–5, 2005 (oral); the 19th Annual Meeting of Canadian Association of Radiation Oncology, Victoria,... By: Eng-Siew Koh; Barbara-Ann Millar; Cynthia Ménard; Howard Michaels; Mostafa Heydarian; Shenaz Ladak; Sharon McKinnon; John A. Rutka; Abhijit Guha; Gregory R. Pond; Normand J. Laperriere. Cancer (0008543X), Mar2007, Vol. 109 Issue 6, p1203-1210, 8p; (AN 25518396)

   Fractionated Conformal Radiotherapy in Vestibular Schwannoma: Early Results from a Single Centre. By: Horan, G.; Whitfield, G.A.; Burton, K.E.; Burnet, N.G.; Jefferies, S.J.. Clinical Oncology, Sep2007, Vol. 19 Issue 7, p517-522, 6p; DOI: 10.1016/j.clon.2007.02.017; (AN 26033957)

   Fractionated Conformal Radiotherapy in Vestibular Schwannoma: Volume Data and Cranial Nerve Toxicity. By: Whitfield, G.A.; Horan, G.; Daly, M.M.; Fife, K.M.; Moody, A.M.; Wilson, C.B.. Clinical Oncology, Apr2007, Vol. 19 Issue 3, pS32-S32, 1p; DOI: 10.1016/j.clon.2007.01.369; (AN 24148404)

   Quality of life following microsurgery, radiosurgery and conservative management for unilateral vestibular schwannoma. By: Sandooram, D.; Grunfeld, E.A.; Mckinney, C.; Gleeson, M.J.. Clinical Otolaryngology & Allied Sciences, Dec2004, Vol. 29 Issue 6, p621-627, 7p; DOI: 10.1111/j.1365-2273.2004.00881.x; (AN 14945766)

[tony]

What a wonderful list
bet this took some time to assemble ?
Can I add one more

"Journal of Neurology Neurosurgery and Psychiatry 2003;74:1288-1293
© 2003 BMJ Publishing Group
 PAPER
Clinical experience with gamma knife stereotactic radiosurgery in the management of vestibular schwannomas secondary to type 2 neurofibromatosis
J G Rowe, M W R Radatz, L Walton, T Soanes, J Rodgers and A A Kemeny "

The point here is this is one of the "only" (or very few)
surveys where all the patients are exclusively NF2 - and at a 100 plus over 10 years
maybe the largest long term follow up
Most other surveys either exclude NF2 -
or have so few 3-4-5, as to be statistically unreliable
Best regards
Tony

[ppearl214]

wipes sleep from eyes, takes a sip of strong coffee, sits back and reviews list of studies noted.....

[Kate B]

Mark,

Thank you for the list. It is quite lengthy..If you note the list for example, Dr. K ( and UPMC) are the US studies and from the institution that my statement acknowledges..The rest seem to be international institutions.  Are any of them in the United States? 

I will look into what has become peer reviewed and change statements accordingly. Again, whether something has been a peer reviewed study may or may not be important to all people. There are many studies...not all are peer reviewed.

 Here is the current statement on the UPMC site:

"Confusion amongst patients exist because the information from internet sources, newsletters, support groups, and physicians has not always been validated and supported by outcomes data. Although we are asked to provide our opinions, our comments should not be based on myth, conjecture, training bias, or socioeconomic concerns."


 A published medical study is different from a "peer reviewed" medical study. 
Your term "librarian approved" is misleading. She reported what was peer reviewed  as accepted by the medical profession not what she deems peer reviewed. She references Ulrich's.

Did you hear back from Dr. Chang yet? In an earlier post you were going to write him to find the peer reviewed studies about cyberknife.  I would really like to have that data and am looking forward to your info from him.

Kate

[Mark]

kate,

to your points-

Thank you for the list. It is quite lengthy..If you note the list for example, Dr. K ( and UPMC) are the US studies and from the institution that my statement acknowledges..The rest seem to be international institutions.  Are any of them in the United States?

Again, this list was compiled by JB and reflects a sample of a search of "scholarly articles" which the librarian he spoke with was a good indicator of having "peer reviewed" status. I'm sure if he copied everything he found you would have numerous from US institutions. In my google search I found numerous studies from Pitt, UVA, Stanford, Wisconsin and other teaching medical  centers in many of the same periodicals noted in his list. My interpretation of the second part of your statement is that if they weren't done in the US, then they aren't as good as those done abroad. I would hope you aren't suggesting that high quality studies can only be done here.

I will look into what has become peer reviewed and change statements accordingly. Again, whether something has been a peer reviewed study may or may not be important to all people. There are many studies...not all are peer reviewed.

Absolutely agree with you, and that is essentially the point I've tried to make in every part of discussion as to why I take exception to bullet 6 on your web site for why people choose surgery over radiation. The clear implication is that radiosurgery is more of a risk because it has less studies than surgery that have gone through an external validation. I think it is apparent that the author of that statement in no way extensively researched or validated the premise. If you will, I have provided a peer review and have yet to see a compelling set of facts to support it. Also, in a peer review process, it is responsibility of the study author to address questions and concerns of methodology , not the reviewers. The burden here is for the author of the statement to prove the basis for it, not for me to disapprove it.

Did you hear back from Dr. Chang yet? In an earlier post you were going to write him to find the peer reviewed studies about cyberknife.  I would really like to have that data and am looking forward to your info from him.

No, I've been traveling on business all week and this is not one of my highest priorities in life. However, you seem to have misinterpreted what I said I was going to ask him about. In my post, I indicated that I was simply going to validate my understanding of the peer review process for studies within Stanford as a university entity and within the periodicals he typically submits to. I have no intention of making a request of him to provide all "peer reviewed studies of CK".  it would be unreasonble to assume he has visibility or access to that universe and I already know that all of his CK related studies, including the one I posted have gone through that process through a previous conversation. I will probably drop him a note this weekend, but I am very sensitive to not imposing any request on him that impacts his personal time or contact with patients with real issues which most folks who have used him on this board would agree is very generous.

Mark

[ppearl214]

*sits back and listens with extreme interest....*

[Kate B]

Here are their quotes directly. Interpret them as you may.

The librarian told me how to identify whether an article is peer reviewed. Dr. K. told me the process.

"I hold to the standard set by the medical community related to the definition of peer review: for radiation and surgery.  One cannot write whatever they want and expect to have it published. The conclusions must be soundly based on the data only, and not discuss topics that the data did not address. It(peer review) is the process by which scientific articles or data is reviewed and scrutinized by other (usually 3-6) people (neurosurgeons, radiation oncologists etc), prior to it being suitable for publication in a medical journal. This (peer review) is the highest standard in medicine.
This process (peer review) usually takes about 3-4 months, followed by a 4-6 month delay in the journal article being published.�
Quote by Doctor Kondziolka in an e-mail

Again, writing a "scholarly article" does not mean it is peer reviewed. Conducting a google search and being published even in PUB MED doesn't mean peer reviewed according to the librarian in her quote. 
I  contacted the librarian several years ago and this was her response:

"Not all journals selected for Index Medicus are peer-reviewed , nor do we designate which journals are reviewed.  You can look up a journal title in Ulrich's International Periodicals Directory published by RR Bowker
and if it has the designation "refereed" the journal is peer-reviewed.�
C. Williard e-mail

Reference librarian at the Nat’l Llib of Med

[jb]

Mark, Tony: Glad you guys liked my list!     I personally thought it was great to see all the research efforts going into this part of the AN issue.

Again, I just came up with it using a research database available online through my local library; it's called "Academic Search Premier", part of EBSCOHost Research Databases.  I know it's available via many libraries throughout the US, and my own library has been using it for years.  Just need a library card to access it from my home computer.  Anyway, one of the nice features is that they have a screen to only include  "Peer Reviewed, Scholarly Journals" in the search, so I made sure that box was checked.  Then just entered collections of relevant terms, eg, "radiosurgery", "radiotherapy", "acoustic neuroma", etc.  and got out a bunch of results.  I just handpicked some that looked interesting to me, so it's not meant to be a comprehensive list by any means.  (Tony, I did see a couple of NF2 articles and I'm sorry I didn't think to include them.  Not sure if it was one you mentioned or not.  If I get a chance, I'll try to take another look this weekend.)

Kate:
Since a lot of hits came from "International Journal of Radiation Oncology, Biology, and Physics," I ended up visiting their website.  A direct quote from their Guide for Authors: "All manuscripts submitted to the IJROBP are subject to peer review, and only those that are of the highest scientific quality are accepted for publication."  They've been publishing since 1976, so I can only assume they're pretty familiar with the process by now.

JB

[sgerrard]

It may also be worth noting that the "International Journal of Radiation Oncology, Biology, and Physics"  is  "The Official Journal of the American Society for Therapeutic Radiology and Oncology."

Anyone planning to read any of these? I'm sticking to the ANA book club myself. 

Steve

[leapyrtwins]

It may also be worth noting that the "International Journal of Radiation Oncology, Biology, and Physics"  is  "The Official Journal of the American Society for Therapeutic Radiology and Oncology."

Anyone planning to read any of these? I'm sticking to the ANA book club myself. 

Steve

You know, I've been having trouble sleeping lately, so I might just pick them up 

Seriously, it amazes me that people on this forum do this kind of research and can even discuss it.  I wouldn't know where to start; this stuff is just way over my head.
It is interesting though.

Jan

[ppearl214]

Ya know.... I'm watching this one like a hawk. Now, not to sound peeved or anything, but CB's former life in the UK was as a university librarian.  Librarians can tell me this... can tell me that... in his case, many compile the raw data only as they have no bearing on performing the experiments in obtaining the raw data and present back to those that do the testing that brings forth the raw data.

I have faith in each and every person researching AN's to take the data as presented to them and to research to the best of their abilities.  Each person interprets data as their mind tells them.  There can be peer reviews, librarian data, official reports.  Bottom line, to me is this.... it's US, the patient, that know best.   Yes, I reviewed studies before I opted to make my AN treatment decsion.... but, it was YOU all that helped me make the final decision, not a bunch of reports that were not written in laymen terms.  HEI sent me info that confused the heck out of me and was biased.  Radio-treatments that I researched befuddled the heck out of me and also showed bias.  But it was YOU all that helped bring the realization of what lay before me as it was first hand experiences from each and every one of you that made the difference.

Debate all you want.... tear apart reports as you see fit.  Answer or by-pass answering questions as you see fit. 

People reach out here for one-to-one experiences and stories and support. I have faith in you all, as you already have done for so long, to not confuse the heck out of newly diagnosed AN'ers.  I have faith in you all to keep this debate respectable, answer if asked, admit "I don't know" if you truly don't know, don't play guessing games and most of all......remember that the key here is support of others.....

This has confused many.... just remember that.
Thanks.
Phyl

[leapyrtwins]

Phyl -

I'm fascinated by this stuff also.  I don't understand the majority of it, but I'm fascinated nonetheless.

Jan

[ppearl214]

Jan,

Oh, no one isn't saying that it isn't facinating..... I'm getting communications that many are confused..... so, not barring the debate, but reminding everyone to discuss with answers (no sidelining on answers...), to understand that each person will interpret as they do in their own minds........ and that the purpose of this discussion forum is "support". Like many, I enjoy a lively debate, but when threads get hijacked (and I commend Mark for moving the discussion here to a new thread) and such, then, my job is to step in to make sure things remain in line... nothing more.

CB was a university librarian as well as worked the mathematics dept at the London School of Economics in London England for 15 yrs, helping to compile raw data for dept heads at the school. I have, in a round about way, discussed this with him..... and have been given the inside mindset of the typical librarian in helping to compile info.... thus, I say no more about the debate and research itself.... but hope that everyone that is enjoying this debate also keeps in mind that we have newly diagnosed folks here that may hold this of interest but the goal remains here of "support", as well as education. Some are already confused in their new diagnosis and this discussion may enhance the confusion, as already previously shared.

Nothing more.

I return you all to your lively debate...

Phyl

[ceeceek]

Well Said Phyl,
support is the idea, and I too am enjoying the debate.....was wondering if to get Dr M and Dr S involved...
It is a shame about stereotactic radiation peer eval info and that it is not more readily identified and available, but it does indeed certainly exist. I find however it is similar to acupuncture in that if it is concluded that it works, after that point, not too much additiional study is completed in that particular manner.
Please continue with the debate I have found it interesting and informative..after I can actually understand some of it, but would agree with you that to someone new, with no medical background it can be really confusing.
Ceecee