Is Surgery after Radiation more difficult?

[jerseygirl]

Steve,

You always seem to have the words of wisdom! I had the regrowth and also found out that the scar tissue is the problem after the first surgery. My first tumor was huge and the scar tissue was very extensive. Interestingly, different neurosurgeons were afraid of the scar tissue at different sites. For some, it is at the entry point but not so much at the brainstem, for others, it is at the brainstem but not at the entry point. There were also very competent neurosurgeons who refused me by saying that they don't want to deal with any scar tissue the second time around and if they operated, I would have been guaranteed a poor outcome!

I investigated GK only so I cannot make any claims regarding CK. One of the neurosurgeons who does both radio- and micro- told me that GK can be done again and the surgery after GK is NOT more difficult. His criteria was no growth after two years and surgery if there continued growth after two years. I suspect that time after the radiosurgery might be an issue. The change in tumor texture is probably not instantaneous and happens over a period of years, so it becomes more difficult to operate seven years after the radiotherapy than two.

I wish I could follow your plan A!

                    Eve

[jb]

I can't turn down free popcorn!   

Similar to the Japanese study, some of the patients (6 of 13) in the Mayo/UPMC study had undergone microsurgery prior to their treatment with GK.  In the body of the paper, the results were broken out along those lines:

Of note, five (83%) of the six patients who had
undergone prior microsurgery were believed to have tumors
more difficult to resect, compared with three (43%)
of seven patients who had not undergone prior surgical
resection.

I think this addresses some of Steve's prior questions pretty directly and explains why the Mayo/UPMC researchers reported no direct link between GK (alone) and difficulty of follow-up surgery.

[ppearl214]

*passes popcorn down the line*

[leapyrtwins]

Steve -

thanks for the clarification and the wise words of Dr. Chang.

I'm ending my participation in this livey discussion for now - mainly because I don't have a dog in this fight; and hopefully never will.

As far as I know, my AN has not returned.  I won't know for sure until May or June when I have my 1st annual MRI though, so I'll keep this post handy.

Phyl, thanks for the new bag of popcorn; glad you made it.  You might want to pop another; this topic has the potential of being discussed for quite a while 

Jan

[Kate B]

Boy this popcorn tastes great

After rereading (yes, I've read it twice) there was a really important piece of information buried in all of that detail. 

<Radiation related cranial neuropathies (facial nerve) occur in less than 10% of patients. They seem to appear between 6 months to 18 months after radiosurgery. Operations after radiosurgery should be avoided during that time following radiosurgery as that is when the cranial nerves and the brainstem are at their maximum point  of injury  secondary to radiation treatment.>

Also, they mentioned that the original radiosurgeon should be in communication with the surgeon. In the first case study on an elderly woman, her surgery may have been unnecessary.

When I read all of this information, it reminds me how tricky these tumors become as they grow larger.

Who wants the popcorn next?  Please pass the pop as well.

Kate

[sgerrard]

As far as I know, my AN has not returned.  I won't know for sure until May or June when I have my 1st annual MRI though, so I'll keep this post handy.

Jan, for some reason, I thought you were further along than that. The first annual MRI will be a nice milestone to reach. I'm betting yours will be whistling clean.    And you can always stick around for the snacks, even if you don't have a dog in the fight. 

Radiation related cranial neuropathies (facial nerve) occur in less than 10% of patients. They seem to appear between 6 months to 18 months after radiosurgery. Operations after radiosurgery should be avoided during that time following radiosurgery as that is when the cranial nerves and the brainstem are at their maximum point  of injury  secondary to radiation treatment.

Kate, that is a really good point. It makes sense, since radiation treatment does take a while to take full effect (drums fingers on desk...). You really need to wait two years before deciding if you have regrowth, and certainly before doing anything further. I think these tumors are tricky whatever size they are.

Okay, enough popcorn, got any peanuts? 

Steve

[ppearl214]

*passes bag of trail mix with peanuts, raisins, cashews and M&M's.......... sits back to see the ongoing (and I commend you all, highly respected) debate!*

[leapyrtwins]

Ah, now Phyl's bringing out the chocolate    Maybe, as Steve suggested, I should stick around for the snacks LOL

Thanks for the kind thoughts re my 1st MRI Steve; I'm fairly confident it won't show regrowth, but never say never.  Only time will tell.

[FlyersFan68]

The title question is a tough one to answer that's for sure. From my own reading over the years I guess the answer in my inexperienced mind would be yes and no. Maybe 75/25 being harder or 80/20. My guess would be that the 75-80% of tumors that are harder to remove post radiation are medium to large and the better outcomes were likely with the smaller tumors??? Rick Friedman from House has a powerpoint presentation posted on the net done around 2004. It showed a tumor prior to first time surgery and a tumor prior to microsurgery following radiation. The tumor that was NOT radiated was clearly defined whereas the radiated tumor was splayed and less defined making it more challenging to remove. Scar tissue is a problem and common following both surgery and radiation so to what extent does this affect the outcome?? I don't know! My gut feeling tells me that if one doesn't work try the other. For instance, if you have a failed surgery try radiation and vice versa. There are many fine institutions that can handle these tumors the first time but when dealing with a regrowth from either surgery or radiation then I suggest the best in both fields. However, that is not always the case. Another one size doesn't fit all situation. I'm sure there are patients that are willing to give both treatments a second chance. On a recently purchased cd from last years symposium Dr. Brackman did state that hearing is not possible to save following radiation and the facial outcome was good but not as good as first time surgery and the larger tumors tend to fall a grade on the scale. That's what I gathered.

[Sheryl]

Gee - this is better than watching Hillary and Obama - oops, hope this doesn't get into a political debate!!   

Sheryl (6 year wait and watcher)
Larry (CK on meningioma regrowth 10/1/07)

[sgerrard]

I wanted to thank jb for posting that quote from the Mayo/UPMC article. Its good to see there are some reports that acknowledge that scar tissue forms with either kind of treatment. I also like FlyersFan68's answer to the title question: "yes and no", which pretty much sums it up. I suppose another way to say it would be "what, did you think it would be easier?"

It just got a little closer to home for me, since I just made the appointments for my 6 month MRI and hearing test in March. Hopefully plan A - no regrowth - will apply to me. Actually it's the hearing test that I like the least. Although my hearing doesn't seem to be any worse, I'm pretty sure the ENT is going to suggest a hearing aid for my left ear. If this topic runs out of steam, maybe we can discuss whether "use it or lose it" really applies to partial hearing loss...

Thanks for the change in snacks, Phyl.    Hey, who picked out all the cashews already?

Steve

[leapyrtwins]

It wasn't me; but I did pick out the M&Ms 

Chocolate gets me every time 

[Kate B]

Time for another handful of popcorn and trail mix (this is a fine bunch in that all the M and M's and cashews are gone). Dibs on the almonds.

....I posted this same lead question on the Cyberknife forum and I am appreciative for the quick response from Dr. Medbury.

"THere is a lot of prejudice but precious little data. One obvious problem is that it is very difficult to quantify "more difficult". Another problem is that radiosurgery failures are sufficiently infrequent that there are not many cases requiring surgery after radiosurgery. We have had only a single AN failure, and it was operated on without difficulty. THe surgeon said it was no more difficult than usual. Given the success rate of radiosurgery (95-98%), I'm not sure it is even a pertinent discussion. You don't make today's choice based on a 2-5% chance of failure."
I will keep looking for info...

Kate

[Kate B]

It just got a little closer to home for me, since I just made the appointments for my 6 month MRI and hearing test in March. Hopefully plan A - no regrowth - will apply to me. Actually it's the hearing test that I like the least. Although my hearing doesn't seem to be any worse, I'm pretty sure the ENT is going to suggest a hearing aid for my left ear. If this topic runs out of steam, maybe we can discuss whether "use it or lose it" really applies to partial hearing loss...

Steve,

When is your date for your MRI?

Kate

[sgerrard]

Tuesday, March 12, 2008. 8:45 am. PST.

It seems to me that everyone I encounter who has tried hearing aids (not talking BAHA or TransEar here) complains about them - things like noise, feedback, echoes. Maybe I will just make do with what I have, I seemed to be getting pretty used to it now.

Eh, what was that?

Steve