surgery after radiation

[targa72e]

Just found this study on Pub Med thought people might be interested its a small sample to draw conclusions.

john

Limb CJ, Long DM, Niparko JK.

Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Hospital, Baltimore, MD 21287, USA. climb@jhmi.edu

OBJECTIVES: As stereotactic radiation has emerged as a treatment option for acoustic neuromas, cases that require surgical salvage after unsuccessful radiation have emerged. We present a comparison of the technical challenges faced by the surgeons in the treatment of irradiated versus nonirradiated acoustic neuromas. STUDY DESIGN: Matched case-control series. METHODS: We identified nine patients with acoustic neuromas that required surgical resection after radiation therapy. Cases were performed with suboccipital and translabyrinthine approaches. Nine nonirradiated case-control subjects matched for age, sex, tumor size, and surgical approach were identified for purposes of general comparison. Operative findings and outcomes were compared for the two groups. RESULTS: Surgical removal was found to be significantly more difficult after radiation therapy because of increased fibrosis and adhesion to adjacent nervous structures, particularly at the porus acousticus. Excessive scarring hindered identification of the facial nerve and added uncertainty as to the completeness of tumor removal. Decompression of the internal auditory canal (IAC) dura and resection of neoplasm in the IAC before cerebellopontine angle dissection was required for facial nerve identification. Operative time was significantly longer for irradiated cases, and facial nerve outcomes tended to be poorer, particularly when facial nerve dysfunction prompted the salvage procedure. CONCLUSIONS: Surgical salvage of acoustic neuromas after radiation therapy is feasible, but it presents technical challenges beyond that associated with primary surgical therapy. Poorer outcomes of postoperative cranial nerve status were caused primarily by anatomic changes at the nerve/tumor interface. As surgical experience with the irradiated acoustic neuroma grows, operative observations should be incorporated into the counsel provided to patients with acoustic neuromas as they weigh different management options.

PMID: 15630374 [PubMed - indexed for MEDLINE]

[Windsong]

This was interesting reading...

What year was this study done pleae?

And which type of stereotactic surgery was being compared to which type of  operative surgery? ( i.e. trans lab. occipital, retro-sigmoid etc?)

I find comparisons really confusing without knowing all the details for everything,  really.


Thanks.

[jamie]

I think House's study was more recent, and they listed exactly how many were considered more difficult, it wasn't every one. I find those studies questionable because they have no way of knowing the texture or resectablity of a tumor before radiation. Do they gauge it off their experience in general? I'm sure some tumors are more difficult then others to resect even without radiosurgery. I know scar tissue can interfere, I would really like to see a study on how much more difficult tumors that regrow after microsurgery are to resect due to scar tissue. Just to be fair. I'd be willing to bet the results would be very similar.

Thanks for sharing the info.  

[targa72e]

Sorry I thought I copied over the date, it was Jan 2005 from Laryngoscope. I agree that more info would be better, I thought it was interesting because Johns Hopkins does surgery and Radiosurgery.


John

[jamie]

I thought it was interesting because Johns Hopkins does surgery and Radiosurgery.

Well, any honest provider of radiosurgery will inform patients that surgery may be more challenging if the radiosurgery fails. My doctor advised me of that possibility, but again the same possibility exists for regrowth after a failed microsurgery.

[Mark]

I think all the information we can get on these issues is great for consideration and discussion. As I read the abstract and some of the related posts my initial observations would be

1) the sample (9) is extremely small and I'm not sure how the "matched case" methodology makes sense. Given most surgeons don't know what they'll find until the actual surgery occurs it would certainly suggest subjectivity on which cases were selected. Overall with a sample that small, it still would suggest that the number of failures in radiosurgery is minimal which rephrases the question to how much do you worry about being in the 2-3% that have this risk

2) having read a variety of abstracts on both surgical and radiosurgical results, the lack of statistical validation of the conclusions is notable. That may be a function of the very small sample, but most of the statements are subjective as opposed to quantatative.

3) Johns Hopkins does do both radiosurgery and surgery. However, 2 of the authors ( long and Niparko) are neuro-otolargyngolists who have a primary focus and vested interest in the surgery option. Without knowing the level of peer review that went into this study , it is hard for me not to consider there is a degree of self serving conclusions given the small sample and lack of statistical data to back up the conclusions.

It is what it is, but from an academic standpoint it's fairly weak basis to draw the stated conclusions. They may be correct but there is insufficeint data to support them in my view

Mark