FSR Fractionated Stereotactic Radiotherapy reply

[Trish G]

Hello,

This is my first post to the board but have been lurking since January . What a wealth of information.

 I was diagnosed with a small acoustic neuroma in January and started FSR two weeks ago (will get 26 treatments).  So, not only used for post surgical patients.

I was told it is used to help preserve hearing with the hope of local control of the tumor.  I am glad that I had this option. It involves the neurosurgeon, radiation oncologist, and neurophysicist.

Trish

 

[Jim Scott]

Hi, Trish...and welcome.

I'm pleased to learn that the ANA discussion forums have been helpful for you.

Yes, FSR (I also had 26 treatments) is used as a primary method of treating acoustic neuroma as well as a follow-up approach.  Although my hearing nerve had already been fatally compromised prior to my AN diagnosis (the result of my procrastination) my neurosurgeon included it in his plan to attack my large (4.5 cm) AN without causing undue damage to my facial nerve.  First, the 'de-bulking' surgery that reduced the size of the tumor (to approximately 2.5 cm) then severing it's blood supply.  That went exceedingly well - no facial nerve damage to speak of.  The 26 FSR treatments (a total 27 Gy) were intended to destroy the remaining tumor's ability to re-grow.  They were uneventful and six years later, the doctor's plan seems to have been very successful.  I hope you'll have a similar experience (sans surgery). 

[Taiwan Jesse]

I also choose FSR and started treatment one year ago this month, 26 in all. I wondered why it hasn't been chosen for many other radiotherapy AN patients, who usually choose GK or CK. Some doctors claim the latter are more precise, but I'm not sure. My neuroma was 3cm, and the 9th month MRI showed signs of necrosis. However, I've had to battle some symptons such as dizziness, a 'wonky' head, and tinnitus. I have had a lot of swelling which is normal but contributed to some of those symptons. I'm not out of the woods yet but I've also heard it can take up to 2 years to make a good recuperation so it's good to be patient. Most important to know is if the tumor is alive or not.   

[richcooks]

Trish,

  I had FSR about 16 months ago.  My tumor initially grew a little, but appears to be smaller.   Remember when they are measuring and comparing MRIs that are 6 months apart, it is difficult to discern small measurements.  Anyway, I have had absolutely no adverse symptoms, my hearing tests show that my hearing has not changed,  the tinnitus is still the same intensity and frequency and all is the same EXCEPT all signs show that the FSR was successful.   Keep in mind my tumor is only 8 mm.  It is considered very small.  However, it was found 7 years ago at 1mm and I waiting and watched it grow every year.

  Hope you have the same outcome.  And I agree, I do not know why people do not select FSR in lieu of GK.   I did a lot of research before selecting this procedure to include going to a GK expert in AN.   

Rich

[Trish G]

After I had made my decision for FST and started to see how few people commented on it, I started to get concerned and wondered if I had missed something and made the wrong decision.   I, too, would be interested to know why other members did not go this route.

[Ned]

I have recently returned to this site and I also was curious that not many had chosen FSR.  My tumor has shrunk almost 40% from its original size.  I had swelling for about 2 months post treatment and took Decadron that greatly helped.  Hearing has stayed about the same, maybe a little worse because I am aging, 62.  Good luck and feel safe to know others have been down the same path and can help when issues arise.

[sunfish]

The only reason I didn't consider this treatment is that it wasn't offered to me in this area where I live, by the docs I talked to.  I think it can be a very, very good choice.

[nftwoed]

Hi;
  I think 26 session protocol is becomming less common. Seems 5 session protocol is more the norm anymore.
  For brain stem ANs, 26, may, or not be more appropriate.
  Seems the large treating centers are gravitating back to GK? JHH is.
  FSR seems to be more of an Oncologist's tool than in the 90s and early 2000s.
  I'm not an expert, of course...
  Looks like Proton Beam is making some gains as it's rays are absorbed by target and do no exit the brain as all other radiation types.

[PaulW]

FSR in 25-30 fractions was originally developed due to the inaccuracies of the equipment, treatment planning and imaging methods
By using probability, the bulk of the radiation would fall within the "Bell Curve" therefore treating the tumour without damaging surrounding tissue.

Radio Surgeons always wanted to Zap it with one shot, but the innaccuracies meant that all too often they would miss.
That left them with no choice but to look to probability to deliver the dose accurately.

As a result of this, FSR treatment has a long history, and results are well documented.
As older machines are replaced the need to deliver the doses in 25-30 fractions is possibly no longer required.
But as the results are well documented and the results well known FSR continues to be a viable option.

There is a theory that fractionation may reduce tissue damage, how this applies to AN's remains unknown.
But as results in theory maybe better than single fraction it is commonly practiced.
Many theorise that there is no additional benefit from fractionation beyond 3-5 fractions.
Others say that single fraction gives the smallest amount of radiation over all and is therefore the method of least harm.
The debate over fractions for AN's continues in medical circles, without definitive proof either way.

Proton Beam should in theory provide the best results of all, however that has yet to materialize in the medical literature for treatment of AN's. The Cost of Proton Beam also remains prohibitive.

As always, dont take my word for it, please do your own research, all of the above is my personal opinion only.


 

[neuroma_racer]

so, i may be a little confused, please help clear me up, on FSR . . .

a) my impression is that gamma knife is a one shot proposition, and as such, is considered radio surgery.*(see ps, below)
b) same with SINGLE-dose cyberknife, etc.
c) however, if cyberknife, (or novalis, or accukinfe, etc.), are divided into 2, 3, 5, or twenty-something treatments, . . . then it becomes FSR(T).
with a higher total dose, but a smaller dose-per-treatment day (and hopefully less side-effects/damage to good tissue)

i found a case study, of a lady whose case EXACTLY mirrors mine, and she had 30 stereotactic doses at mayo, and a great outcome. it was an accuknife, i believe)

i recently saw a different neuro-otologist, who dismissed the article as irrelevant, saying it was NOT stereotactic, and i was comparing apples to oranges.
unfortunately, since it had been about 6 weeks since i read it, i assumed he was right, and thought, well, i'll just do a single dose of something (gamma, or cyber) and be done

this MD was saying it was something totally different from cyberknife, (without having looked at or read the 2007 article), he said it sounded like she received external beam radiation(which is NOT stereotactic))

of course, once i got home, and RE-reviewed it, it was indeed stereotactic, and the article was even from the "journal of STEREOTACTIC radio surgery"

the neurosurgeon i am fixing to see, says perhaps 5 doses of cyberknife, is what he'd recommend, if thats what i want
(i know treatment courses seem to be becoming shorter and shorter than what they were, years ago)

so i guess i am looking to see if my understanding of FSRT, as i wrote up top is correct?
or is FSRT totally different from multi-dose cyber knife.

thanks,
jesse

ps,
yes, i know that they can now fractionate gamma knife treatments, with a different kind of frame, and positioned which goes in your mouth and gets suctioned up to the hard palate

[Sarah Jane]

    A small AN was found on 2/6/12.  I am seriously considering FSR as my best option.  I am a single mother and wonder if the side effects will make it necessary for me to hire some help.  Are you tired?  Can you continue your normal activities, etc.?  I read that Jim S. drove himself to the appointments and that information was VERY helpful since I am 70 miles away from where I will be treated.   

[Jim Scott]

Sarah Jane ~

Hi, and welcome!

Although I can only relate my personal experience with FRS I can state that the experience was 'uneventful'.  Yes, I drove myself to and from the 26 daily 40-minute  sessions (Monday through Friday, week-ends off) for a round-trip of just over 60 miles each day.  I had one day where I felt just a tinge of nausea but that passed quickly and I never had it again during my FSR treatments.  No headaches, either.   I received a total of approximately 27Gy radiation, very specifically targeted, of course.  I did not suffer any localized hair loss or other side effects.  I continued my normal activities during this time (retired but active).

I cannot guarantee the exact same outcome for you or any other FSR AN patient but I found the experience more tedious than stressful and would recommend it if your doctor agrees. I hope this information is useful in helping you make a treatment decision.

Jim

[JWW]

It is interesting to me Jim that your FSR was "26 treatments and a total of 27 Grays". I am wondering if the Grays were less because of your previous surgery?

When I was considering FSR, two different radiation oncologist both offered me 26 treatments with a total of 40-50 Grays (1.8Gy -2Gy) per treatment.
Trying to make sense of the different approach. My L. AN is now 1cm x 7mm x?

I am having SRS with the mask this Tuesday, July 31....total of 12.5 Grays.

JW

[Jim Scott]

It is interesting to me Jim that your FSR was "26 treatments and a total of 27 Grays". I am wondering if the Grays were less because of your previous surgery?

When I was considering FSR, two different radiation oncologist both offered me 26 treatments with a total of 40-50 Grays (1.8Gy -2Gy) per treatment.
Trying to make sense of the different approach. My L. AN is now 1cm x 7mm x?

I am having SRS with the mask this Tuesday, July 31....total of 12.5 Grays.

JW ~

An astute observation...and the answer is 'yes'.  My 4.5 cm AN had been debulked down to approximately 2.5 cm so the remaining tumor was quite thin and very vulnerable to the effects of radiation.  Both my neurosurgeon and radiation oncologist teamed up to 'map' my FSR (via MRI and CT scans).  They wanted to offer me the minimum amount of radiation that would do the job of destroying the remaining tumor's DNA (ability to re-constitute).  Their efforts were successful.  I suffered no side effects, not even localized hair loss and the remaining AN showed necrosis within two years of the FSR.  Obviously, each AN patient presents a different challenge and every doctor has a slightly different approach to each case. 

Jim