...what are your views if someone statistically should be treated with radiation (older with a small AN), however, he is highly symptomatic, with dizziness, a wonky head, etc. Does that change the calculation? I understand radiation caps symptoms at current levels but doesn't reduce them. So, you're stuck with the symptoms you have, no better, no worse. If surgery could actually reduce the symptoms, and that was the primary goal, regardless of possible hearing loss, even some facial paralysis, would that change the treatment determination? Thanks.
Jeff
Jeff, the "statistics" you refer to are antiquated. It was (and still is, by some people) feared that radiation could cause malignancy several decades after treatment. Hence, the preference used to be that only older people should take that risk, as they would be dead from natural causes long before malignancy could develop in later years. However, this viewpoint was based on the use of much higher doses of radiation, applied with far less accuracy, than is the case today. In fact, statistics show that the chance of getting a malignant tumor as a result of having radiosurgery (one treatment) or radiotherapy (two or more treatments, in smaller doses) is virtually no greater than the risk to the general population (i.e., it's a statistically insignificant difference, amounting to a fraction of a percent).
Radiation is a viable option for more than just small tumors, too. In most cases, an AN up to 3 cm in size (ANs are typically categorized as a medium-size tumor below that size) can be safely treated with radiation.
There is no guarantee that radiation will "cap symptoms at current levels," as you put it, but that is almost always the case in the long term. Around 25% of CK patients actually notice gratifying improvement in their balance, as I did beginning roughly six months after I was treated. Many radiation patients suffer through an increase in the severity of their symptoms for up to a year or so after treatment, but the increase is almost always transient (resolving over time, returning to the "level" they were at immediately before treatment). With CK at least, you are only likely to have an increase in the intensity of symptoms you already had right before getting treated. For example, if you haven't had vertigo lately, CK is not likely to cause vertigo for you -- even if you had vertigo years ago when the tumor first started becoming symptomatic. In exceedingly rare cases, a patient who has received radiation will see an increase in symptoms that persists; no type of treatment is without risk.
To my knowledge, no surgeon will promise you that surgical resection will abate your symptoms. Just because a tumor that has been removed is no longer putting pressure on cranial nerves it was previously impacting, that doesn't mean that the damage it has already caused will be reversed. But around 20-25% of CK patients who were treated at Stanford also see "gratifying shrinkage" of their tumor over a 5-year period after treatments. In my case, my AN swelled 33% in volume after treatment but then shrank 59% during months 5-11 post-treatment -- a very unusually high rate of shrinkage. This probably explains why my balance has improved so remarkably following CK (and I also regained a little bit of hearing in my bass frequencies, although I lost a little in my midrange at the same time). The bottom line is that you should not expect your current symptoms to abate as a result of
any type of treatment, including surgery. If it happens that you are one of the lucky ones who do see symptoms improve, count that as icing on the cake (the cake itself is tumor control).
From your last comment, I assume you meant "balance problems" when you referred to "symptoms" that might possibly improve, notwithstanding possible hearing loss and facial paralysis due to surgery (your inference). Even if one could predict such a tradeoff was likely (again, you can't), the value of trading one symptom for another (a complication from treatment) would be a very personal choice that one cannot possibly cast in broad terms for everyone. For example, a professional musician might value their hearing over their balance, whereas a gymnast might place higher value on retaining their balance. Personal preferences aside, Dr. Chang (esteemed neurosurgeon and CK practitioner at Stanford University Medical Center) generally places the goals of treatment in the following order of importance:
1. Control the tumor's growth (it should be noted that recurrence can happen with either surgical resection or radiation, but it is rare -- roughly 2% chance, when treated by the best doctors of either discipllne).
2. Preserve facial-nerve function
3. Preserve balance
4. Preserve hearing
I hope this info helps.
Best wishes to all,
TW
