CK results St. Joseph’s Phoenix

[notaclone13]

I came across a recent study summarizing CK treatment results from St. Joseph’s Medical Center Phoenix. Here’s the citation from February 2019:

CyberKnife radiosurgery for acoustic neuromas: Tumor control and clinical outcomes.
Przybylowski CJ, et al. J Clin Neurosci. 2019.
Show full citation
Abstract
Fractionated CyberKnife radiosurgery (CKRS) treatment for acoustic neuromas may reduce the risk of long-term radiation toxicity to nearby critical structures compared to that of single-fraction radiosurgery. However, tumor control rates and clinical outcomes after CKRS for acoustic neuromas are not well described. We retrospectively reviewed all acoustic neuroma patients treated with CKRS (2004-2011) in a prospectively maintained clinical and radiographic database. Treatment failure, the need for additional surgical intervention, was evaluated using Kaplan-Meier analysis. For 119 treated patients, median values were 49 months (range, 6-133 months) of follow-up, 1.6 cm3 (range, 0.02-17 cm3) tumor volume, and 18 Gy (range, 13-25 Gy) prescribed dose delivered in 3 fractions (range, 1-5 fractions). Thirty-five of 59 patients (59%) with pre-radiosurgery serviceable hearing (American Academy of Otolaryngology-Head and Neck Surgery class A or B) maintained serviceable hearing at the last audio follow-up (median, 21 months). Two of 111 patients (2%) with facial nerve function House-Brackmann (HB) grade ≤3 progressed to HB grade >3 after radiosurgery. Koos grade IV was predictive of radiographic tumor growth after radiosurgery compared to grades I to III (p = 0.02). Treatment failure occurred in 9 of 119 patients (8%); median time to failure was 29 months (range, 4-70 months). The actuarial rates of tumor control at 1, 3, 5, and 7 years were 96%, 94%, 88%, and 88%, respectively. CKRS affords effective tumor control for acoustic neuromas with an acceptable rate of hearing preservation. Further studies are needed to compare CKRS to single-fraction radiosurgery for acoustic neuromas.

Copyright © 2019 Elsevier Ltd. All rights reserved.

https://www.ncbi.nlm.nih.gov/m/pubmed/30770165/#

Food for thought for all considering Cyberknife RS.

[ANSydney]

If only these things could be done with a control group.

With Fractional CyberKnife, for 119 treated patients:
* 59% maintained servicable hearing
* 2% had facial nerve degradation
* 8% with treatment failure
* 88% tumor control at 7 years [would like to see it at 10 years]

If I get time and inclination, I'd like to compile the statistics to observation treatment. My first port of call will be https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1502035/pdf/sbs16095.pdf

[ANSydney]

Here is a table that I put together.

Characteristic	CyberKnife	Observation	Reference for Observation
Maintain Servicable Hearing	59%	59%	https://www.ncbi.nlm.nih.gov/pubmed/19887973
Facial Nerve Degradation	2%	0%	my understanding, please comment if study shows otherwise
Treatment Failure	8%	7.6%	https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1502035/pdf/sbs16095.pdf
Tumor Control	88%	92.4%	https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1502035/pdf/sbs16095.pdf

Unless there is a compelling reason, why radiate?

[Colorado Alex]

Wow. 

[notaclone13]

Thanks for the follow-up information Sydney. If only we could see into the future to know if our ANs would eventually stop growing. That has not been the case for me so far. My last MRI indicates that my acoustic nuisance now extends out of the IAC whereas 8 month previously it did not. It is now graded Koos II.

By the way, how are you doing in regard to the fire situation? Hope you are far away from danger. It is heartbreaking to see the destruction of your beautiful countryside and the loss of your wild life. Seeing the plight of the koala bear population is heartbreaking. Stay safe.

[ANSydney]

My AN is grade Koos IV (the largest possible). Unless my tumor has significant growth (>3mm) or I have sustained worsening of symptoms, I'm not convinced that active treatment is the way to go. It's a bit of a gamble, but all three treatment modalities are a gamble.

There's no real threat to populated areas from the fires. You don't see any fires unless you travel outside built up areas. Having said that, the smoke is certainly seen and smelt, so more of a risk for asthmatics. However, as you pointed out, the animal population has been savaged. More than a billion animals have died. There's also been 29 human deaths and over 2,500 homes destroyed. It's been going on for months and there is no end in sight.

[chrisabbott]

Very good question and I think a very individual answer every time?  For me, it was that I already suffered various symptoms prior to my first surgery, in fact they worsened during the 6 week wait for my op.  Terms like "mass effect on the brain stem" and scans showing my brain being pushed around obviously gives me a different perspective than someone that caught things early and might mathematically figure they have a long time before they need to make a decision.

I don't know that I would be comfortable with that opportunity to wait even if I had it, but I'm more game for surgery than drugs or radiation to be honest.

I haven't read back through the thread - seems like your recent post indicates you also have a large tumor?  Amazing how much our bodies can sometimes get away with and how little at other times isn't it?