Treatment Options > Radiation / Radiosurgery

Radiation Therapy - Long Term Total Necrosis?

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doogey:
I've been reading several posts from people who have had some form of radiation therapy (CK / GK, etc).  Some people have experienced positive results showing certain stages of necrosis after many months after the initial treatment.  For those people who have had radiation therapy, has anyone actually shown "total necrosis" (the tumor is totally dead)?  And, if so, how long did this take after the initial therapy?  Did total necrosis require only the single treatment, or multiple treatments?

I'm still trying to decide if radiation therapy is the choice I will make.

Thanks,

Jeff

ppearl214:
Hi Jeff and great question.  I know Mark is over 6 yrs out post-CK. Hoping he sees this post and chimes in... I do believe he would be a good one to answer this.

Phyl

Evan:
Jeff:

There are several studies that you may want to look at.  One of the only long term studies for radiation was through the U. of Pitts, under Dr. Lunsford.  He did a 10 year study between 1987 and 97  comparing treatments, results, recurrences, etc.  I believe if you check on the U. of Pitt Gamma Knife center, you will find some reference to that.  Other than individual experiences, which are going to be important, this study is still, according to my reading, the only long term study on radiation and the effects.

Good luck.

Evan

tony:
Our sheffield Gamma Knife centre has pub a ten year, and shorty a fifteen yr
study for NF2s - due to the slow growth/swelling issue
most are reluctant to call tumour dead until 19 -24mths post treatment
NFs are renown for being harder to stop
- Noren recorded a regrowth at 9 yrs !!!
Mind you at 9 yrs, is it a regrowth, or a new one close to the first ?
Hard to call.. methinks
Best regards
Tony

Mark:
Because Phyl wished it , I am here! Sounds like the Genie in the lamp doesn't it  ;D

Actually, I will be 6 years out as of my next MRI and Audiogram in November, so I guess I'm about 5.5 years now. When I last talked with Dr. Chang at my 4 yr check up I believe he had indicated that they usually look at the 3 year mark as definitive in tumor control and had not had one fail after that point in time.

My sense is that while necrosis is a positive process when seen on a MRI it is not a 100% indicator of long term success. The typical progression in terms of  MRI's is that the AN enhances as all white pre-treatment, then usually at 6 months to a year it displays various degrees of dark spotting which indicates cell necrosis, finally it shows up as all white which represents the scarring over of the remaining tumor ( I call this the carcass stage  ;)) It is always important to realize that MRI's are only snapshots in time and depending on each individual they may or may not see the spotting stage, which doesn't mean it didn't happen.

I think Bruce raises a good point about whether the 2-3% of quoted regrowth for radiosurgery is new growth or a failed treatment. While the accuracy of different radiosurgical systems is bandied about on this forum frequently, I think the aspect of each machines ability to treat irregular shaped tumors ( or non-isocentric) is a key issue that is overlooked too often.  a system that doesn't have flexibility of targeting the beams could have good accuracy but result in hitting some parts of the AN very hard and others not hard enough, which is known as hot and cold spots. So it is possible to have early MRI's show noticeable necrosis where a hot spot was hit and then potentially experience a regrowth if one section of the AN was not hit with a lethal dose. That was ultimately one of the reasons I chose CK because of the ability of the robotic arm to position itself at any angle to insure a uniform dose to the AN.

Bruce is also correct that the AN will never disappear after radiosurgery and while it may or may not shrink, it should not grow any more which is the goal. I can't remember exactly what my last measurement was but it was around 1.5 cm or about 25% smaller than the size at time of treatment. Most likely, it will stay at this size going forward and not show any further reduction.

Hope that helps, back to the lamp  ;D

Mark

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