Necrosis before radiation?!?

[Betsy]

Hi everybody,

This afternoon I picked up a copy of my most recent MRI from the hospital.  I knew my AN had grown since April, but what the doctor didn't mention was there is some necrosis...and I haven't been zapped yet.  How can this be?  The exact verbiage is "There is interval development of approx 6-mm central necrosis of the tumor in the extracanalucular portion in the cerebellopontine angle cistern."

I know necrosis is a good thing and I'm certainly not complaining, but does this kind of thing happen?  I won't be able to talk to the doctor until Monday so I'm hoping someone here will have heard of this.  Is this possible?

Betsy

[BeJoi]

My tumor also showed signs of necrosis at one end before any treatment.  I was not told this either, but the radiologist was showing me the MRI, and when I asked what the black spot was on the end, he read the report and it stated that it was an area of necrosis.  So I am also curious what others may have to say about this.

Beverly

[Mark]

Betsy,

I had a similar experience with my 1st and second MRI's where there dark spots of necrosis noticeable in the otherwise white contrast of the tumor. I believe my next consult was with Dr Jackler, then at UCSF, and he informed me that it is not uncommon to see some low level of necrosis in an otherwise ( forgive the expression) "healthy, i.e. growing AN" . As they grow there will always be the natural cycle of cell replication where new ones are created and old ones die. The difference after the radiosurgery treatment is that the field or quantity of necrosis is dramatically larger which indicates the cells that were killed outright and, ideally, those that aren't destroyed initially have their DNA so damaged that as they die they aren't replaced.

One of the aspects you see a lot of folks who have been "zapped" post about is that they have some after effects (vertigo usually) off and on months after treatment. The Doctors will tell you this is typically irritation of the adjacent nerves, usually the hearing and balance where the AN arose. While in the first couple of months it could be related to AN swelling, I believe in later months it is a reaction to continued necrosis in the tumor as damaged cells continue to die off.

The above reflects what I've learned from my docs concerning the biology of how AN's die post radiation, but you might check with yours to see how accurate my recollection of those conversations is. At any rate, I'm pretty sure what you see in your MRI is a normal level of necrosis. I remember pointing it out to Dr. Jackler and then double checking his answer with Dr.Chang and having the air taken out of my balloon. I was so excited to think maybe it was killing itself and I wouldn't have to make a decision on a treatment, what a bummer  .

Mark

[Raydean]

I'm not a doctor or anything, but we were told that if the blood supply to the tumor is unable to substain it, that the portion of the tumor that is not receiving blood will start to die.  I stress that this does not apply to the whole tumor, just the portion that is not receiving blood.  In my husbands case the tumor (very large) outgrew the blood supply.  I'm not sure if this would apply to smaller tumors, but it is a possible explanation.

When we attended the symposium in Los Angeles there was talk of hoping someday to  be able to develope a pill that would interfere with the ability of the tumor to create it's blood supply. basically stop the blood supply, stop the growth.   Sure hope that day comes!!!

Best to you
Raydean

 

[ceeceek]

For those of you not familiar with me a brief background. I have a vidian nerve schwanomma..similar to an AN,,which is how I became a member of this happy little family...I have attempted surgery via endoscopic approach, but alas, my little tumor (3cm..so not so little) turned out to be so hard it could not be removed...it is showing signs of necrosis and calcification...on the surface a good thing. Many people tend to opt for watch and wait, as often the these types of growths will indeed, stop growing as the blood supply has run out. On the other hand, they may seek new blood supply and then grow suddenly, faster than normal etc. So the fact that you are seeing necrosis, is in some ways good,,may make it easier to treat as it appears that some of it is dying, but as stated above, there is still new cell growth, and schwanommas tend to seek out blood supply so don't be fooled into thinking that it is completely dying. You may be a good candidate for watch and wait age depending,,,
Me, mine is up under my brain and if it grows anymore, I will experience problems, so I opted to treat aggresively. But that is personal choice. I have paid in some ways for surgery and I am not sure what the results of CK will be in my near future, but hope for the best. I am hopefull that I will not experience much swelling of the tumor itself and if I can limit swelling of surrounding tissue I will be in good shape.
One of the reasons both myself and concurring Drs. do not think the tumor will swell...(some swelling of tumor is typical from radiation..approximately up to 15%), is due to the fact that it IS showing signs of necrosis, that will be in your favor if you opt for radiation. It always helps if the tumor is struggling to live to begin with and then you radiate it....making it harder for it to grow.
After following this board and the cyber site, I have so far found it common for many schwanommas (dont forget an AN is a schwanomma), to have necrosis before treatment....
Many individuals have chosen watch and wait status due to this reason....not for me, and of course your situation may be vastly different if the tumor is causing you problems..me, I just didnt want to wait and see if it was going to give me problems,,unlike an AN, my tumor will cause double vision, speech loss, and poss siezures compared to hearing loss and balance issues,,but very similar in nature.
Good luck with your decision and it seems to me that you are on the right path, and if it is dying in some ways,,,,take advantage while it is weak...
Take care
Ceeceek

[Betsy]

Whew!!  Thank you....I'm relieved to know this has happened before.  And as my sister pointed out, this MRI was taken in smaller slices.  It's possible that the necrosis was there before but didn't show up on the film.  I thought I was finally mellowing out a little, but that MRI report got me going again.  Thanks for the reassurances.

Ceeceek, I'm going to hold onto the thought that a little necrosis will help prevent swelling.  A little hope can go a long way.

I'm still going ahead with radiosurgery...I want the whole thing to die!

Betsy