Anyone have a second Gamma Knife surgery?

[AKgirl]

I had a Gamma Knife procedure in October 2013.  Three years out, and the tumor continues to grow in volume from 0.9 originally to 1.2, then 1.69.  The dimensions went from 16 x 10 x 8 to 16 x 11 x 10.

On paper this rate of growth seems small, but the neurosurgeon and Gamma Knife doctor both recommend we do something.  My choices are:  surgery, or a second Gamma Knife.

The doctor says a first Gamma Knife has a success rate of 95%, and my procedure is considered a failure.  He said that a second Gamma Knife has a success rate of 75%.

The surgeon says that since the tumor has been radiated already, the surgery will be a little more difficult because now the tumor is "sticky." 

I'd like to go with the non-surgical option BUT I'd really like to hear from someone who's had to make this choice.  Thanks.

[Blw]

I would suggest talking to the very best people. Lunsford at Pittsburgh is probably the best--I believe he trained with Leksell and they may have gotten the first gamma knife. I would also suggest Chang at Stanford. They have Cyber knife. Those guys will know the data on repeat treatments. That was my foremost worry--what to do in the event of failure. I think the outcomes are still very good for  second treatment, but I think hearing loss will be 100%, and if you have facial nerve symptoms, that might be a little worrisome. Here is a small study by Lunsford.

Int J Radiat Oncol Biol Phys. 2010 Feb 1;76(2):520-7. doi: 10.1016/j.ijrobp.2009.01.076. Epub 2009 Sep 23.
Repeat stereotactic radiosurgery for acoustic neuromas.
Kano H1, Kondziolka D, Niranjan A, Flannery TJ, Flickinger JC, Lunsford LD.
Author information
Abstract
PURPOSE:

To evaluate the outcome of repeat stereotactic radiosurgery (SRS) for acoustic neuromas, we assessed tumor control, clinical outcomes, and the risk of adverse radiation effects in patients whose tumors progressed after initial management.
METHODS AND MATERIALS:

During a 21-year experience at our center, 1,352 patients underwent SRS as management for their acoustic neuromas. We retrospectively identified 6 patients who underwent SRS twice for the same tumor. The median patient age was 47 years (range, 35-71 years). All patients had imaging evidence of tumor progression despite initial SRS. One patient also had incomplete surgical resection after initial SRS. All patients were deaf at the time of the second SRS. The median radiosurgery target volume at the time of the initial SRS was 0.5 cc and was 2.1 cc at the time of the second SRS. The median margin dose at the time of the initial SRS was 13 Gy and was 11 Gy at the time of the second SRS. The median interval between initial SRS and repeat SRS was 63 months (range, 25-169 months).
RESULTS:

At a median follow-up of 29 months after the second SRS (range, 13-71 months), tumor control or regression was achieved in all 6 patients. No patient developed symptomatic adverse radiation effects or new neurological symptoms after the second SRS.
CONCLUSIONS:

With this limited experience, we found that repeat SRS for a persistently enlarging acoustic neuroma can be performed safely and effectively.

[arizonajack]

I'd like to go with the non-surgical option BUT I'd really like to hear from someone who's had to make this choice.  Thanks.

What is your age?

That could be a factor in your decision. The older you are the more risky invasive surgery tends to be.

[mcrue]

It would be very interesting to know what percentage of regrowth occurs from traditional microsurgery vs. radiation. Perhaps it also depends on the individual patient as well.

Unfortunately, we've seen regrowth occur in both groups.

I would consult with Lunsford, Chang, Kondziolka, and Sheehan regarding radiation.

Schwartz and Friedman regarding microsurgery.