Watch and Wait or undergo surgery after radiation treatment

[melissahosken]

 I had fractionated stereotactic radiation (low dose treatments administered daily over 6 weeks) for a small tumour during the summer of 2012.  MRI's following in 2013/14 seemed to indicate a slight swelling, but signs of cell death. A recent scan in September 2015 has revealed a slight growth in the tumour.
As a result of this I have been advised to undergo a surgery (trans lab approach) which I am willing to do if the radiotherapy has been genuinely unsuccessful (apparently it normally has a 95% success rate), though I have read that either stabilization or shrinkage can take up to 4 years to happen. Do I therefore wait and see?
My dilemma is that other than around 50% hearing loss post radiotherapy I am symptom free, so do I risk a surgery that will essentially leave me worse off than I am now (definite complete hearing loss in the affected ear, risk of facial nerve damage and significant time off work) or wait and risk further growth?  It is also worth adding that there is also no guarantee the entire tumor will be removed should it pose too much risk to the facial nerve, so regrowth after surgery is also a genuine possibility, particularly as I am only 41! 

I would really appreciate insight into radiation success rates and if it would be advisable to give it a little more time?

Age 41
Diagnosis:2009
Radiation treatment: 2012
MRI 2013 - slight swelling
MRI 2014 - no change
MRI Sept 2015 slight growth

[rupert]

Did your doctor just give you one option at this point?   How much was the slight change?  Usually growth would be determined not just by one MRI but a series of consecutive MRI's  unless it was really significant.  A change of scheduled MRI's to every 6 months  would be what I have seen as normal procedure after just a slight change.  Also sometimes as the AN is dying it can change it's shape and may become smaller in one direction and larger in another.  If it was just a slight increase I would want to see a pattern over several MRI's. Just my opinion.

[sandyinwisconsin]

Hi Melissa,

I had the same treatment as you at the end of 2013.  So far my MRI's are stable and show no growth.
I believe it's common for the tumor to swell from radiation. 
If I were you, I would wait for more MRI's and get another opinion.

My tumor is around 1 cm.  Is yours small or is it big, which is causing the doctor's concern?

Sandy   

[PaulW]

Please remember that for all we know the tumour might have been doing all the growing from 0-25 months and has been stable ever since.
Their are numerous people that have tumours which remain mostly stable after radiation and never shrink.
There are also those that have tumours that have continued to grow up to 5 years before they started shrinking.

If in doubt I would certainly seek a second opinion.

I personally would try to sit it out for at least 5 years if there is minor growth and not act unless growth was significant beyond 3 Years.

There is someone on this site if I remember correctly her tumour did not shrink until 5 Years.

I know I have posted a medical paper somewhere on this site before tackling this topic.
It showed a number of tumours taking more than 4 years to eventually shrink.

[Echo]

I just met with my neurosurgeon a few weeks ago to go over my 2 year post GK MRI results.  He told me that he waits till the 5 year MRI before he will confirm if the treatment has been successful.  I'm moving in the right direction, and doing great, however, I could still hit a few bumps along the way.  I wouldn't jump into surgery at this point without having a second opinion, or at least monitoring your AN with another MRI in 6 months.  Another point to consider is that measurements on the MRI's can change depending on what angle the measurements are taken from, and as Rupert has said, the AN can change shape without changing size.

Cathie

[v357139]

I would ask your doctor what is the harm in waiting longer.  It does not sound like the growth is causing problems.  If you are not convinced his answer is right, then I suggest another opinion.  Not all doctors have the same opinion or philosophy.  It always pays to get a second opinion, especially if you have doubts on what you are hearing, like it sound like you do.

Keep us posted.