Gamma Knife vs. Cyber Knife

[MDemisay]

Which treatment is more effective?
 I'm trying to decide which to go with...I can only have CT scan with contrast for targeting purposes because of a very old surgery for 3 AVM's  which left 70 metal clips.

 I had AN surgery in 2004 to debulk a tumor, which unfortunately has regrown a little. I am trying to set up a second opinion from someone else. The neurosurgeon just happens to do Gamma Knife as well. But the Oncologist with whom he works doesn't have much experience targeting with CT scans with contrast. He's only done 12. Should I be concerned?

Mike

[PaulW]

Without the MRI it will be difficult to define where the tumour boundaries are, making the procedure more challenging.
I would try posting your question with the Radiosurgery Society

http://patientforum.therss.org/yaf_topics3_Acoustic-Neuroma.aspx

[MDemisay]

Thank you, Paul! I will try to contact them. It helps to know that someone cares out there and that they are fighting this together. Together we are stronger than we are separately, that is for sure!

Are you a part of the New York division?

Your AN friend,
Mike

[PaulW]

New York!
Must go there one day...
I live about as far from New York as you can get.
Adelaide, Australia

[Tumbleweed]

Which treatment is more effective?
 The neurosurgeon just happens to do Gamma Knife as well. But the Oncologist with whom he works doesn't have much experience targeting with CT scans with contrast. He's only done 12. Should I be concerned?

Mike

You should be concerned. Find a doctor/oncologist team that treat many ANs each year. Brain surgery of any kind -- including radiosurgery -- is a highly complex and risky affair. You want a team of doctors who are extremely experienced and well-practiced on the procedures involved.

In answer to your other question:
CK and GK are roughly equally effective at stopping tumor growth; the choice of doctor and medical facility potentially have a far greater impact on outcome. The (somewhat subtle) differences between the two procedures mostly lies in their potential for inflicting collateral damage, their historical track record and the patient's relative comfort level during the procedure.

CK delivers a more homogeneous dose to the tumor compared with GK. CK delivers only 15% higher dose to the center of the tumor than at the periphery, whereas GK delivers fully double (100% greater) dose at the center compared to at the periphery. CK advocates believe that GK's higher dose at the center of the tumor increases the chance of damage to nearby healthy tissue. Also, GK delivers one large dose to the tumor because one treatment is all you can do with GK (this is because a ring is fitted to your head for the treatment and, once it's removed, there's no way to get it exactly in the same place for a second treatment). With CK, on the other hand, a thermoplastic mask is custom-fitted to your head and the tumor's location (in relation to the mask and your bony structures) is plotted into the computer; on followup visits for treatment, they put the mask on your head again and you're ready for the next dose. This flexibility allows CK to apply smaller doses to the tumor than GK with each treatment; together, the smaller doses add up to the same total biologically equivalent dose as you would get with GK's one and only treatment, but (theoretically, at least) the hearing nerve and other healthy tissue has time to recover in between treatments (whereas the tumor supposedly doesn't recover as quickly). Presumably due to the fractionating of dosage, studies show CK yields slightly better results at preserving hearing compared with results for GK. Furthermore, GK's ring is screwed into the head (the screws stop at the skull) to keep it stationary (so that the radiation stays focused on the tumor), a mildly invasive procedure. CK is totally non-invasive: a series of overhead X-rays tracks the patient's head movements and tells the computer-controlled CyberKnife machine which way to move to track any small movements the patient may make so that the radiation stays centered on the tumor. GK advocates say that's all well and good, but GK has about 40 years of track record, whereas CK has been around a lot less time and is not as proven of a treatment as GK. (CK was approved by the FDA in 1999, although Stanford University Medical Center has been using it since 1994 in clinical trials because their Dr. Adler invented CK.)

I recommend you ask CK practitioner Dr. Steven Chang (sdchang@stanford.edu) to review your related medical records and give his recommendation, which he'll do for free. Also, contact the University of Pittsburgh Medical Center (UPMC) and ask for a free review and recommendation; they specialize in GK. Both Stanford University Medical Center (Dr. Chang) and UPMC are world renowned centers for treating ANs. Whether you choose CK or GK, you'll be in the very best hands.

Best wishes,
TW

[MDemisay]

Dear TW,

Thank you! It has been a blessing to me to journey back to this forum, certainly, it has been vastly helpful.

Without trying to make you feel sorry for me, I have been on this journey for a long time, it seems.

I have been very fortunate in my life, but, I do not want to experiment with myself, while I count myself as a very lucky survivor of an AVM surgery done in 1973 (that's when brain surgery was in it's infancy), I am not done, I can certainly inspire others to not give up, that the brain is a very remarkable instrument(organ), it is truly worth fighting for!

I will take everything that you have advised and will certainly think about it.

I try to live my life to the fullest, to live without fear, but this recurrent AN nightmare keeps pulling me back. Let me explain, in 2004, while I was confused about being diagnosed with an AN, I panicked and while I was gathering information I went to another website for Brain Tumors and I stayed there while I was there (that site is for helping those that are there primarily with metastatic brain tumors) I learned that since you only go around once, you may as well " eat all the chocolate you can while you have the chance", in other words live with no regrets or as little as possible.

That theory has proved useful, but I'm not done yet with this life! If I can inspire others to act, then so be it!

Usually, I am a very positive person( or so I see myself). My wife of 32 years doesn't agree and could use the caregivers forum on here.

So for now, thank you for what you have said, it will I think allow me to ask questions at least!

Mike

Ps. I will keep others informed about my choices, it's certainly good to be back among people who understand that as well as quality of life we want quantity!