Malignancy after Gamma Knife?

[jsanders1379]

I read a scary article on medscape that said they were seeing a small number of benign ANs converting to malignant after Gamma Knife. Does anyone know anything about this? stats?

[Jim Scott]

Jeanne ~

I have read such reports and the number is infinitesimal.  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3312586/  However, for AN patients, whenever radiation is employed, the risk of possible future malignancy has to be recognized and accepted - or not.  I accepted it when I underwent my 26 FSR treatments and do not regret the decision.  Its a very personal choice and knowing the risks without being disproportionally frightened into inaction is always beneficial. 

Jim

[MDemisay]

Dear Jeanne,

I must weigh in here as well...I agree with Jim we must all choose our options here with a large AN pressing on your balance nerve(as I had in my case) or compromising your sense of hearing and balance and threatening your other systems as well do you do nothing because of a small percentage of malignancy or do you act proactively to hopefully curb your handicap and prevent yourself from becoming more handicapped?

The answer was plain to me and the choice was clear, I acted! I could go on and on the best thing I can recommend is to read my blog in the AN Issues section called THE YELLOW FLAG. You only get so many chances to slow down. Life is like a car race sometimes!

Fortunately, I got a lot of them (as you will see if you read THE YELLOW FLAG). By coming here to this forum and chatting with Jim and I you were given another one. It is not for me to say when you should stop watching and waiting that is up to you and your neurosurgeon (and ultimately God).

Welcome to the forum since you are a new member, come back often as we all have, share your story with us, we all have a unique story to tell. I have been a member since February of last year when I went into a panic at having to undergo Gamma Knife in June. The folks here calmed me down by just responding!

I was calmed by others and could reasonably discuss my fears, now that I have completed my treatment, I have chosen to give back or "pay it forward"!  I welcome you to join us on this strange AN trip that we all seem to be on together.


For now I urge you to do your research,research,research then choose and let God do the rest.

I will be praying for you.

Mike

[jsanders1379]

I know it is a small percentage, but I also had total body radiation (enough to kill a person-getting rid of my diseased bone marrow ) as preparation for my bone marrow transplant 16 yrs. ago. In fact my transplant center said that radiation is probably the cause of my AN, and also that I'm at increased risk of head and neck malignancies because of the previous radiation. So I'm in a real quandary about treatment options. I do keep researching, but it seems each new article makes it that much harder to decide. Thanks so much for responding-Jeanne

[nftwoed]

I know it is a small percentage, but I also had total body radiation (enough to kill a person-getting rid of my diseased bone marrow ) as preparation for my bone marrow transplant 16 yrs. ago. In fact my transplant center said that radiation is probably the cause of my AN, and also that I'm at increased risk of head and neck malignancies because of the previous radiation. So I'm in a real quandary about treatment options. I do keep researching, but it seems each new article makes it that much harder to decide. Thanks so much for responding-Jeanne

Hi;

  Conversion to malignancy occurs in a very few. It is rare. Who knows whether the AN was not destined to become malignant anyhow?
  Last year, Mayo Clinic reported a case of a conversion to malignancy 9 years after GK. I wondered how they could claim GK caused it. It's in a research article at PubMed however.
  Conversion would be somewhat greater in NF-2.
  Question: Is that more or less dangerous than potential surgical complications?

[PaulW]

This issue probably needs to be put into perspective.
Any treatment has risks, and the risks of death from malignancy are acknowledged as being less than the risks of general surgery.
So the risk of dying from having your tonsils out is more than dying from malignant transformation.

http://www.anesthesiaweb.org/risk.php

Due to the low number of malignant transformations there is still some question over whether the radiation caused the malignancy or whether it was going to happen anyway. Radiation will cause some malignant transformations, but the real risk remains unknown.
The risk remains unknown because its so rare. If they happenned all the time we would have worked out the risk by now.
 
Malignancy also does not necessarily mean death. Many had the growth detected by MRI, and the tumour removed, the malignancy was found but it hadn't spread, it remained within the AN. 

Some people are also more susceptible to radiation and cancer, are these transformations only happenning in people with this natural susceptibility? I dont think anybody knows the answer to that.

The total amount of radiation you receive is also proportional to the volume of your tumour.

My AN was 10mm x 5mm x 5mm and had a volume of 0.15cm3
A 3cm AN has a volume of 10.6cm3

The amount of radiation to treat a 3cm tumour is 70 times higher. Presumably increasing the risk of malignant transformation by 70 times.

Nuclear accidents, Hiroshima and Nagasaki, Atomic testing in the 50's and 60's The risks of higher levels of radiation in general over the longer term are reasonably well understood.

In the recent Fukushima nuclear accident, nuclear cleanup workers were exposed to 2Gy over their entire bodies.
If you undergo a Bone Marrow transplant you will receive 8Gy over your entire body.
So getting 13Gy to something the size of a Tic-Tac or at worst a golf ball seems pretty inconsequential.   

The risk of malignant transformation is real and everybody undergoing radiation treatments needs to be aware of the potential consequences, however it needs to be put into perspective with the risks of surgery, or the increased risks of treatment later by doing nothing for a growing AN.

[PaulW]

Wow, I didn't realise you had a bone marrow transplant..
I was writing my post when you posted your reply.

Check it out with your doctors, but I suspect the risk of malignancy and cancer anywhere in the body caused by the bone marrow transplant is already high. The added risk of treating a small tumour like yours is likely to be very small in comparison to what you have already been through.

This is my personal opinion only. Please check with a medical professional

[MDemisay]

Dear Jeanne,

I didn't realize you had other radiation exposure in your life me too. In 1970 I had my second aneurysm (stroke) which left me unable to write with my right hand, unable to speak and with double vision in 1974 I had another aneurism following a 12 hour microsurgary Dr. Michelson found the third aneurism that I had had when I was 10 in 1967.  From 1974 until 2004, I didn't have a concern about my brain health isn't that a good long run?   

You are right to be cautious given your history! But at what point do you give up worrying and choose a path? I am not a doctor, I am just a person who was given another chance to do some research to get advice from people here and have made a treatment decision.

 
Use your time wisely THE YELLOW FLAG time, it is not easy to make a decision such as this.  Take your time and consider your choices carefully.
Seek medical help. Use the resources of the ANA.

We will be here for you!  We will be praying for you.


Godspeed come back often and share your journey with us!

Mike