Failed CK

[JLR]

My AN has slightly grown since CK 5 years ago. My doctor will do another MRI in 3 months and if AN is still growing will recommend surgery. Yikes. He said he doesn't recommend radiation a second time. I thought that would be possible. If there anyone on this forum with failed CK that was retreated with same. Thanks much. Joan

[PaulW]

Hi Joan,
I think it is important to understand the growth? You mentioned edema in another post I believe some tumors can get cystic growth even after 5 or more years. A growing cystic component is not necessarily cells multiplying again. Also many tumours are treated a second time with radiation and I believe a second treatment also has good success rates.. Often they do not treat the whole tumour they just re-radiate the growing part..
Due to so few failures with radiation your current specialist may not have a lot of experience with radiation failures.. Maybe worth getting a second opinion.

[JLR]

Thanks so very much. I think your right. I will get another opinion. Again thanks. I do feel better knowing re treatment with radiation is a possibility. Joan

[LoriIN]

HI Failed CK,

I am going through the same thing. I had been diagnosed with AN in 11.2011 and had CK done in Jan 2012.  I thought everything was fine up until April 2015 when I had an MRI done and they told me that my treatment failed and it appeared that the AN grew a Cm.  It is about an inch right now. I was told by my Dr he would not perform CK again due to my age and due to the risks.  He also discovered I have a vascular Malformation on the same side as the AN (right side) and that was not there prior to CK?? due to its location, the surgeons I have spoken to said they will not do surgery on it b/c I could have permanent disabilities.  Talk about a double whammy!?  I spoke with Dr Chang at Stanford as well and he said no to CK? Said I needed surgery now.  I thought for sure I could have CK again as well. I have spoken to Dr Zomoradi at Duke Health and I am going to speak with Dr Schwartz at House clinic before making my decision on where to go. I think it is important to get more than one opinion. 

Any suggestions or advice would be greatly appreciated!

[Blw]

Surg Neurol Int. 2015 Sep 28;6:153. doi: 10.4103/2152-7806.166173. eCollection 2015.
Repeat Gamma Knife surgery for vestibular schwannomas.
Lonneville S1, Delbrouck C2, Renier C3, Devriendt D4, Massager N1.

BACKGROUND:

Gamma Knife (GK) surgery is a recognized treatment option for the management of small to medium-sized vestibular schwannoma (VS) associated with high-tumor control and low morbidity. When a radiosurgical treatment fails to stop tumor growth, repeat GK surgery can be proposed in selected cases.
METHODS:

A series of 27 GK retreatments was performed in 25 patients with VS; 2 patients underwent three procedures. The median time interval between GK treatments was 45 months. The median margin dose used for the first, second, and third GK treatments was 12 Gy, 12 Gy, and 14 Gy, respectively. Six patients (4 patients for the second irradiation and 2 patients for the third irradiation) with partial tumor regrowth were treated only on the growing part of the tumor using a median margin dose of 13 Gy. The median tumor volume was 0.9, 2.3, and 0.7 cc for the first, second, and third treatments, respectively. Stereotactic positron emission tomography (PET) guidance was used for dose planning in 6 cases.
RESULTS:

Mean follow-up duration was 46 months (range 24-110). At the last follow-up, 85% of schwannomas were controlled. The tumor volume decreased, remained unchanged, or increased after retreatment in 15, 8, and 4 cases, respectively. Four patients had PET during follow-up, and all showed a significant metabolic decrease of the tumor. Hearing was not preserved after retreatment in any patients. New facial or trigeminal palsy did not occur after retreatment.
CONCLUSIONS:

Our results support the long-term efficacy and low morbidity of repeat GK treatment for selected patients with tumor growth after initial treatment.

[ANGuy]

Surg Neurol Int. 2015 Sep 28;6:153. doi: 10.4103/2152-7806.166173. eCollection 2015.
Repeat Gamma Knife surgery for vestibular schwannomas.
Lonneville S1, Delbrouck C2, Renier C3, Devriendt D4, Massager N1.

BACKGROUND:

Gamma Knife (GK) surgery is a recognized treatment option for the management of small to medium-sized vestibular schwannoma (VS) associated with high-tumor control and low morbidity. When a radiosurgical treatment fails to stop tumor growth, repeat GK surgery can be proposed in selected cases.
METHODS:

A series of 27 GK retreatments was performed in 25 patients with VS; 2 patients underwent three procedures. The median time interval between GK treatments was 45 months. The median margin dose used for the first, second, and third GK treatments was 12 Gy, 12 Gy, and 14 Gy, respectively. Six patients (4 patients for the second irradiation and 2 patients for the third irradiation) with partial tumor regrowth were treated only on the growing part of the tumor using a median margin dose of 13 Gy. The median tumor volume was 0.9, 2.3, and 0.7 cc for the first, second, and third treatments, respectively. Stereotactic positron emission tomography (PET) guidance was used for dose planning in 6 cases.
RESULTS:

Mean follow-up duration was 46 months (range 24-110). At the last follow-up, 85% of schwannomas were controlled. The tumor volume decreased, remained unchanged, or increased after retreatment in 15, 8, and 4 cases, respectively. Four patients had PET during follow-up, and all showed a significant metabolic decrease of the tumor. Hearing was not preserved after retreatment in any patients. New facial or trigeminal palsy did not occur after retreatment.
CONCLUSIONS:

Our results support the long-term efficacy and low morbidity of repeat GK treatment for selected patients with tumor growth after initial treatment.

Did the study address the risk of malignancy resulting from repeat treatments?