Hi Karen:
Since radiotherapy has been recommended to you, you might want to research Cyberknife as well GK (that is, if hearing preservation in your AN ear is a concern for you) in considering next steps.
I had a 2.6 cm AN and had an excellent consultation at House (not Brackman, but a Dr. William Slattery). His basic conclusion as between surgery and radiotherapy was "it's up to you." When I asked about GK v. CK, his opinion was that GK was the way to go due primarily to his views regarding the accuracy of the machine and the fact that it has been in use for a long time. After that consultation, I asked many questions of Dr. Chang at Stanford and the docs on the Cyberknife message board, and read the abstracts available on Pubmed. Ultimately, I concluded that CK was at least as accurate as GK (or the differences were so miniscule it wouldn't make a difference in my case) and that Stanford's track record with fractionated radiotherapy was solid enough to conclude that the tumor control rates with CK were at least as good as GK (on the order of 98+%). Since CK meaningfully improves the odds of hearing preservation (and 9 months later, my hearing remains unaffected and I'm doing well) and does not require the headframe, I went with it.
I say all this because I think House is a conservative institution, which means they will likely wait years before they start recommending CK (which was introduced in the late 1990s) as a matter of course. But there are other well-respected institutions and physicians (Stanford, Barrow in Phoenix) out there that are treating ANs with CK now, with good results, and if your AN-side hearing is a concern, you might check into it to see if it something that might work for you.
If you want to talk more about my experience, please do not hesitate to email me.
Best of luck to you.
Francesco
