Interesting article

[allegro17]

Not sure if it belongs here or not, but with all the "statistics" talk going on recently, I found this article to be very interesting.


http://www.metroatlantaotolaryngology.org/journal/sept06/Acoustic_SRS.pdf

[Pooter]

Interesting read..  Not being a doctor, I didn't understand all of it, but I found it fascinating to read and try to make sense of it all.  Thanks for sharing!

Regards,
Brian

[Jim Scott]

Laura:

What I took from the article was that a team of medical researchers working out of Kaiser Permanente in San Diego, California, culled through all the available literature pertaining to radiosurgical therapy (this would encompass many years of data, some of it outdated) and came to the conclusion that AN patients treated with radiation therapy and those whose AN was left untreated ('Watch-and-Wait') showed little difference in tumor growth.  Their conclusion was that the medical literature pertaining to radiation treatment for acoustic neuromas is flawed.  They recommend better long-term tracking of patients treated with radiation and a more precise definition of the term 'tumor control', which they state should be zero growth.  The article also has a section (at the bottom) explaining the continued reduction of radiation levels used on AN patients; from 45 Gy at one time to about 12 Gy, today.  The copyright on the article is 2006.  Things change, but it makes a valid point regarding the need for better long-term follow-up of AN patients treated with radiosurgery to obtain reliable, accurate numbers.  However, I suspect the authors may have had their own agenda.

Jim

[Pooter]

Wow.. You summed it up nicely, Jim.  Perhaps you should get a job of writing a "Conclusion" section of medical studies for us lay-people.  I should have waited for your synopsis because it would have saved me about an hour.     Good job.

Regards,
Brian

[Mickey]

As a 60 yr. old W+W patient this does sound very interesting to me. I`ve known thru similar aticles that AN`s kinda stablize as we get older. Radiosurgery may be less of an option now that I`ve seen this. I`m just keep hoping that mine stays stable. Hopfully over the next decade more news and treatment options will come about. Thanks, Mickey

[Keeping Up]

Hey Laura and others

I will have to print it off for a more detailed read but would agree with the basis of Jim's summary. 

I had just asked the EXACT same question last week to my ENTs.  I have been craving research that compares radiosurgery to conservative mgmt.  It will be interesting if my ENT team (widely published as pro-conservative AN mgmt) provides the same research or hopefully more independent research on the outcome.  The research I have read fully supports the basis of the article, in particular for the small intracanicular tumors (so not even small, medium or large tumors in the CPA - the purely ICA tumors) as watch and wait rarely shows any growth for the intracanicular tumors (so very specifically located tumor). 

I admit I laughed quite hardily when they made the comment about no longer using 'actuarial' estimates in radiosurgery research.  I can't say I understand the basis for using actuarial estimates in medical research - I am an accountant, and understand actuarial estimates in financial statements - despite being rather flawed at times, in general, makes good sense - medical research doesn't make any sense and makes me much less confident wrt to radiosurgery research.  I like Jim suspect that these radiosurgery research papers have their own agenda.  What happened to unbiased research?  Interestingly, this is all about tumor control - and I believe the research shows that high doses of radiation control tumors quite well - but really kill the hearing.  Thus, if tumor control is similar (or not significantly different) at mega high doses of radiation to doing absolutely nothing for small intracanicular tumors ... which would you chose.  You do lose hearing regardless of your choice - but perhaps at a different rate.

Nevertheless, thanks for the research - it will point me in a few new directions. I will come back to visit this thread if my ENTs provide any similar research on the effectiveness of radiosurgery versus watch & wait.  Mine responses will be very swayed to the intracanicular crowd, as I too have an agenda!

[sgerrard]

To me, comparing a group of 111 watch and wait patients, with an average age of 71, and monitored for 3 years and 2 months, to a grand total of 5 published radiation articles, is not nearly as conclusive as they were so willing to put it.

I will buy that suitable watch and wait candidates can fare as well as radiation patients, but not that all 20,000 plus AN radiation patients could just as well have done nothing.

Apples to apples for me, please.

Steve

[mk]

I admit I laughed quite hardily when they made the comment about no longer using 'actuarial' estimates in radiosurgery research.  I can't say I understand the basis for using actuarial estimates in medical research - I am an accountant, and understand actuarial estimates in financial statements - despite being rather flawed at times, in general, makes good sense - medical research doesn't make any sense and makes me much less confident wrt to radiosurgery research. 

OK, so what is exactly the "actuarial" rate? Following the recent discussions on statistics, I  found a few published articles, with follow ups of up to 10 years, but most of them report "5 year actuarial rates". Any ideas what this actually means?

Marianna

[sgerrard]

It is not easy to find a definition for actuarial rates in medicine. 

I believe a calculated 5 year actuarial rate means that the study did not necessarily have any 5 year results, but used standard statistical formulas to calculate or extrapolate a 5 year control rate. It is a little like the EPA's mileage estimates: it is a fair way to compare results between studies, but individual mileage may vary. I'm pretty confident that everyone uses the same formulas to calculate them, at least.

Steve