Gamma Knife (Radiosurgery) VS FSRT (Fractionated Stereotactic Radiotherapy)

[toliaman]

Hello!

My mom was recently diagnosed with AN (2.6 cm).
She's gone to a few different doctors and everyone has different opinions.
One has recommended surgery for a tumor her size, another one recommended Gamma Knife Surgery (also called Stereotactic Radiosurgery) which happens in one sitting. However, the doctor that she's leaning most towards, recommended FSRT or Fractionated Stereotactic Radiotherapy. He suggested about 20 sessions of it.

He claims that FSRT is an even more advanced form of radiation with higher success rates than Gamma Knife Surgery, and lower risks of side effects such as loss of facial function (her hearing loss is unfortunately permanent but she's come to peace with that).
However, reading some articles and studies online has left me with mixed feelings about FSRT as some sources claim that it's only used in a few subset of patients who CANNOT get Gamma Knife Surgery due to larger tumors.

So my question is - have any of you experienced or heard about others' experiences with FSRT for a tumor her size? Do you know if one has benefits over the other or when one is more suitable than the other?

Any and all information would be very helpful!!

TL;DR: Please share if you have any experience with Fractionated Stereotactic Radiotherapy (FSRT) and know of its advantages/disadvantages over Gamma Knife Surgery. Essentially Radiosurgery vs. Radiotherapy.

Thanks in advance!

[mwatto]

Hi I had fractionated cyberknife 5 years ago - so far so good. Has shrunk by half and no side effects I know of-hearing and balance are fine -I monitor with a yearly MRI no contrast.

[DanFouratt]

Like my friend Mwatto I went CK this fall.  For a various reasons I am following up this Friday. I went out on a trip the day after the event.  I drove 2.5 hours so my wife could shop for shoes, we also had to pick up a gift for my son.  Walked 3 miles through the event, then drove home.  No issues. Another member here is trying to answer the same question. You may reach out to her.

Mwatto, how does your doctor take the no contrast approach.  I have been told it is needed and I would like not to do it long term.

Thanks,
Dan

[mwatto]

Hi Dan I beleieve that contrast is inflammatory and can accumulate over time.  I needed it for diagnosis but since then its just about tracking and these days the technology at my imaging facility is excellent and the radiologist technician agrees its not needed- if they do flag anything then sure I will have contrast. If I did need contrast I would again make certain my kidneys can cope (always a good idea to check renal function first) plus I had a saline flush after.
I keep all my own MRI reports to check myself and then when I have any consults I feel my questions are pertinent -for example re nerve pain I asked for a focus on the trigeminal nerve last time. Personally I am not a fan of contrast and my specialist and imaging facility agree with me. If I need it in an emergency situation then ok.

[SP]

Hi toliaman,

In my experience each specialist recommended their solution, be it surgery, radiosurgery or radiotherapy. I went for the least invasive most experienced team and I had fractionated CyberKnife @ Stanford,  9 years ago, for a large AN max 3.2cm.

The treatment was a success, although I do now have significant hearing loss on left hand side, my tinnitus & facial numbness has improved over time. I also monitor regularly with an MRI no contrast.

best of luck for your mom,
Stella

[DanFouratt]

Hi Toliaman,

I am preparing to meet with a newbie tomorrow who mentioned radiation.  I went beck through the archives.  I came across a presentation "Radiation Treatment for Acoustic Neuroma"  (7/27/2022) where at the 13 minute mark he shows four options of radiation.  He then goes on to state that there is little difference on the machines.  He states, which I always believe, is that if you own a CK you will say CK is the best....

I hope everything is good with your mom.

Dan