Debbie,
Yes, it can be very confusing when one starts looking at the different treatment and machine options involved in radiosurgery. I'm not familiar with the Miami Neuroscience Center and no one in this forum has ever referenced it before so I can't help you there, but I'll offer a couple of thoughts on your other questions which may or may not help with your confusion
1) Fractionated vs. One dose - The theory with doing the treatment in fractions is that it is less toxic on the healthy tissue by giving it time to recover between treatments as opposed to the abnormal DNA of the tumor which is unable to do so.There is not long term studies on FSR results as opposed to the one dose, but the preliminary studies that are typically in the 5-7 year range do show improved hearing and facial nerve preservation results compared to one dose with comparable tumor control. So either protocol choice is reasonable with perhaps slightly better preservation odds with FSR.
2) I would agree with Dr. Friedman that experience of the team counts, but less so than in surgery when one considers that treatment plans are generated by highly sophisticated computer software and reviewed separately by the neurosurgeon, radiation oncologist and physcists. On the other hand surgery involves two docs in real time and you hope they have a good day
. Published articles are nice and generally reflect a lot of experience, but also are associated with teaching medical centers, so someone like Friedman ( Shands - U of FL) or Chang or Jackler, who I'm familiar with at Stanford, will generate a lot of articles because of the culture of their institution. One can find equivalent treatment experience without articles.
3) GK has been around longer , so by definition has longer term studies. However, all the machines have the same biological approach to killing the tumor. I've never understood the argument some folks make that GK is somehow more proven that the newer technology machines which employ the same approach. Kind of an extreme analogy, but its like saying I'd rather drive the 1990 Buick because I'm just not sure the 2006 BMW has been out long enough
4) While I agree with Dr. Friedman that any of the machines on the market today are adequate to treat an AN, I would not share his perspective that they are all the same. Only two ( GK and CK) are true radiosurgery machines and have the highest level of accuracy. Accuracy really has two elements which most folks don't think about. The common interpretation is that less accurate machines allow more adjacent healthy tissue to receive part of the dose which is true. Equally important is whether the beam is precise enough to conform to the AN shape which is almost always irregular. Machines that can't do that will over dose some areas ( hot spots) and potentially under dose others ( cold spots). The LINAC radiotherapy machines typically are in this category which is why they do such small doses over so many fractions ( 25-30). While I have never seen any studies one way or the other on these machines, I think one of my personal concerns is the ability to exactly replicate the head / mask position 25-30 times vs. , say 3.
So, my personal opinion, and it is only that, would be
1) Choose a team with a lot of AN experience
2) Choose a radiosurgery machine, either CK or GK
3) If you believe fractionating the treatment improves hearing preservation, then you pick CK ( typically 3) because GK isn't used that way usually
4) if you're more comfortable with a one dose approach, either GK or CK are essentially equal in accuracy and your choice is whether the head frame with GK bothers you or not. There are obviously a lot of folks here who have had GK and some thought it was no big deal while others had discomfort with it. From my perspective, if the GK headframe provided some enhanced performance over what CK does without it, then it might be worth it, but it doesn't , so why go through it. However, I think the issues in points 2, 3 and 4 are all secondary to number 1. Either CK or GK have been proven to work well and comfort and trust in your docs should be the tipping point.
Hope that helps
Mark
