Author Topic: GK vs. CK and are there any truly happy stories out there?  (Read 8057 times)

eab

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GK vs. CK and are there any truly happy stories out there?
« on: June 18, 2009, 05:08:51 pm »
Hi,
Thank you for your many posts,they have been so helpful as I wade through the unbelievable amount of info, research and opinion on ANs.  I was diagnosed on June 2, 2009 with a left side 2.5x1.7x1.5cm AN.  I had limited hearing loss so the ENT ordered an MRI, just in case. Glad he did, my thanks to a Dr. being on the ball and a hair overly cautious.  I continue to be blown away by how polarizing this topic is, surgery vs. GK vs. CK, there are no gray areas, just very stark opinions both from Drs. and patients.  I realize I'm preaching to the choir here, keep skimming the questions are coming...
1. So I've ruled out surgery for a variety of reasons and am now firmly on the fence between GK & CK. It is apparent that Dr. Chang at Stanford is the the guy to go to for CK, but what about GK?  I've met with Dr. Duma, and according to him he's it on the west coast (I live outside of LA), anyone else have an opinion on Duma or his competitors?

2. I would like to keep my good hearing so I would like to go with CK, however when I search ck acoustic on pubmed.com there are 6 published articles, whereas there are 573 on GK - for anyone who had CK what sources did you use to gain confidence in CK?

3. In looking through the posts I see a lot of post CK/GK dizziness.  Is there anyone out there who has the truly happy story of getting their tumor radiated with little or no side effects? 

4. Besides dizziness, what are the other post-treatment side effects that are common with CK/GK?

Again, my thanks to each of you for checking this forum and posting - as a new kid on the block it is great to know that I am not alone, nor am I the first nor last AN patient out there.

Beth
Left side AN 2.5x1.7x1.5cm, limited hearing loss, limited tin., good balance
GK 7/6/09 Hoag Hospital; MRIs at 2, 6 & 12 months show no change in tumor size - hearing etc. same as before GK.

CHD63

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Re: GK vs. CK and are there any truly happy stories out there?
« Reply #1 on: June 18, 2009, 05:24:35 pm »
Beth ....

Welcome to the world of ANers!  Glad you posted your question to all of the wonderful people on this Forum.  I wish I could relate my experience, but I went the surgery route ..... with great success, I might add.  There are many others here who will post soon who had GK or CK, so keep checking and asking away ......

Clarice
Right MVD for trigeminal neuralgia, 1994, Pittsburgh, PA
Left retrosigmoid 2.6 cm AN removal, February, 2008, Duke U
Tumor regrew to 1.3 cm in February, 2011
Translab AN removal, May, 2011 at HEI, Friedman & Schwartz
Oticon Ponto Pro abutment implant at same time; processor added August, 2011

sgerrard

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Re: GK vs. CK and are there any truly happy stories out there?
« Reply #2 on: June 18, 2009, 09:46:31 pm »
Hi Beth,

First, let me say I am slightly partial to Dr. Chang and CK at Stanford.

1. There are a few references to Dr. Duma in the forum, if you do a search for Duma. All I know is that he does GK, but you already know that.

2. I went with the Chang 2005 article, plus the information available from the Cyberknife forum, which is at http://www.cyberknife.com/Forum.aspx.

3. Balance can be an issue. The main key is whether you have balance issues before treatment, and if in doubt, it is worth getting it tested at a vestibular lab. Radiation will generally not fix a balance issue if you have one, although sometimes the issues clear up on their own.

4. The main after effect is some form of swelling, anytime in the next 3 to 18 months after treatment. It can be mild ear fullness, or sudden hearing loss, or headaches, or any other symptoms it feels like dishing up. If needed, steroids seem to control it pretty well.

 I think I can say I am truly happy with my result, and that I had little or no side effects. My hearing isn't the greatest, but I am glad I got to keep what is left of it. I had a bad week about 3 months after treatment, but I have been doing fine for a year now.

I think GK and CK are pretty close, and people have good results with both of them. Given the choice, I would pick CK, but I would be happy with GK as well.

Steve
8 mm left AN June 2007,  CK at Stanford Sept 2007.
Hearing lasted a while, but left side is deaf now.
Right side is weak too. Life is quiet.

Mark

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Re: GK vs. CK and are there any truly happy stories out there?
« Reply #3 on: June 18, 2009, 11:28:33 pm »
I would echo Steve's comments , especially about Dr. Chang as I'm an alum from being treated at Stanford as well.

The published studies tally is a fairly meaningless statistic to me for a couple of reasons. First, GK has been around for almost 40 years and CK for about 10, so it should have more studies. Second, CK works on the same proven radiation to tumor biology as GK, it's just a newer , more versatile technology. Would you worry that a new BMW won't out perform a 10 year old one simply because there aren't as many reviews out yet?

I think most folks who go through radiosurgery have varying degrees of reactions over the time frame Steve described which for the most part are transitory. I had one bad day of vertigo about 6 weeks after treatment and virtually nothing other than that, so I consider myself very fortunate.

Fundamentally, the primary difference between CK and GK is comfort and fractionation. CK doesn't require a head frame to be pinned into the skull during treatment and CK allows for fractionation of treatment which studies continue to demonstrate results in higher hearing retention than one dose. Either one will be effective in killing the AN.

Mark
CK for a 2 cm AN with Dr. Chang/ Dr. Gibbs at Stanford
November 2001

ppearl214

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Re: GK vs. CK and are there any truly happy stories out there?
« Reply #4 on: June 19, 2009, 06:45:29 am »
Hi Beth and welcome!  I'm glad you found us here and hope you achieve answers to help you out.

I am 3 years Post-CK.  I had mine done in Boston at Beth Israel Deaconess.......  As Mark noted, CK can be done in "fractionated" (broken up over a number of days) vs GK which is typically done in 1 day (multiple doses in the one day).  I will only note for me that I opted for CK as my personal goal was to save my hearing, which has been achieved (pre-treatment... I had approx 92% of my hearing... this past Feb hearing test shows I am at the same level, thus, my personal goal was achieved).


As Steve and Mark note, there may be varying degrees of post-treatment issues ("individual results may vary"....) and in my case, I did run into some temp post-CK swelling (treated with short term course of steroids) but for the most part, I have no residual affects from the CK.   I have other medical issues that can mirror AN symptoms (pre and post-treatment) but for the most part, I have been fortunate that I have no after affects and am doing well. There are those on this site (and the CK Forums, that Steve provided the web link) that will note some after affects such as enhanced balance/vertigo issues as well as hearing loss.  Again, everyone will react differently.

GK and CK are both proven, viable treatments for ANs and it really is a personal decision as to which one to go for. Both have very high success rates (over 90%) and I'm hoping your research here of patient-to-patient knowledge and experiences will help you decide which will be best for you and your personal situation (ie: where you live, how you feel, AN specifics, financial, etc).

You noted on the subject line about "are there any truly happy stories out there?"......  I did my 3 yr AN journey update in this thread:

http://anausa.org/forum/index.php?topic=9242.0

May be worth a peek.... just a thought.

Hoping this helps... and again, welcome.
Phyl
"Gentlemen, I wash my hands of this weirdness", Capt Jack Sparrow - Davy Jones Locker, "Pirates of the Carribbean - At World's End"

eab

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Re: GK vs. CK and are there any truly happy stories out there?
« Reply #5 on: June 19, 2009, 05:40:37 pm »
Many thanks for your responses - I continue to pour over the older posts and am finding more happy stories, but gosh there are a lot of dizzy people out there.  The more I stare at the computer the more dizzy I get - a product of AN or just making myself crazy, it's hard to tell.

To quote Ann: "I hate this."

Again, my thanks for your responses!
Beth
Left side AN 2.5x1.7x1.5cm, limited hearing loss, limited tin., good balance
GK 7/6/09 Hoag Hospital; MRIs at 2, 6 & 12 months show no change in tumor size - hearing etc. same as before GK.

mk

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Re: GK vs. CK and are there any truly happy stories out there?
« Reply #6 on: June 19, 2009, 07:38:54 pm »
Hi Beth and welcome,

it is all so confusing, isn't it, and just sifting through all the information can be overwhelming.
Dizziness is a symptom experienced by many ANers, both before and after treatment (both surgery and radiosurgery). Generally I would say that with radiosurgery, what you have going in is pretty much what you will have going out. So if you suffer from vertigo, dizziness etc. prior to treatment, you will probably have the same issue afterwards, at least for a while, although some people have reported improvements in the long term.

I would say that there are many "happy" stories around, both with CK/GK and with surgery, lots of them very recent. There are many people who had radiosurgery during the last year, with very good results and minimal complications. Of course every story is different, so reading through them will give you an idea of the variety of responses that people have.

Similar to what you mentioned in your first post, I pretty much ruled out surgery for several personal reasons, which led me to have GK, for an AN which is larger than yours. I am now 14 months post-GK, and I haven't had any new symptoms or other problems. My MRIs have shown stable size and necrosis.

Regarding the choice of medical team, GK (and CK) is so standardized now, so all groups pretty much use the same equipment and approaches. University of Pittsburgh is considerd the golden standard for GK, with many publications of their outcomes. An important issue that people have identified here though, is the need to make sure that you will have proper follow up from the medical team.

The recommendation I would give you is to do your research and consult as much as you can. Feel free to ask questions, this forum is an increadible source of information.

Marianna
GK on April 23rd 2008 for 2.9 cm AN at Toronto Western Hospital. Subsequent MRIs showed darkening initially, then growth. Retrosigmoid surgery on April 26th, 2011 with Drs. Akagami and Westerberg at Vancouver General Hospital. Graduallly lost hearing after GK and now SSD but no other issues.

Sefra22

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Re: GK vs. CK and are there any truly happy stories out there?
« Reply #7 on: June 19, 2009, 08:08:55 pm »
Hi Beth,
I for one am happy with my decision for GK. Because neither GK or Ck are available in Maine, I chose Gk so that I could have it done it one shot. I could have gone to Boston for CK, but that would have meant 5-6 hours of commuting each day, or paying to stay in a hotel for a number of days. Had it been more accessible, I probably would have chosen CK.

I did consider surgery at first, but a short recovery time was important to me. I was back to work within a week, with surgery, I was told to plan on being out anywhere form 4-6 weeks.

My hearing loss was sudden and quite severe before treatment,(which is what lead to the discovery of AN), so that wasn't a concern for me at the time I made my decision.

Good Luck with whatever you choose,

Lisa
Lisa from Portland, Maine age 46
Diagnosed June 2006
15mm X 17mm AN right side 80% hearing loss
GK March 14,2007 Dr. Noren, Providence RI
1 Year follow-up MRI shows "slight shrinkage".
2 Year follow-up MRI shows "No Change".
3 Year follow-up MRI "stable".
BAHA surgery 4-22-09 BP100 Sept. 2009

Tumbleweed

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Re: GK vs. CK and are there any truly happy stories out there?
« Reply #8 on: July 01, 2009, 12:32:56 am »
Hi, Beth:

I had CK 1 year ago and considered it to be very successful. More on that in a bit, but first here's what I would say about the comparisons between CK and GK:

CK delivers a more homogeneous dose to the tumor compared with GK. CK delivers only 15% higher dose to the center of the tumor than at the periphery, whereas GK delivers fully double (100% greater) dose at the center compared to at the periphery. CK advocates believe that GK's higher dose at the center of the tumor increases the chance of damage to nearby healthy tissue. Also, GK delivers one large dose to the tumor because one treatment is all you can do with GK (this is because a ring is fitted to your head for the treatment and, once it's removed, there's no way to get it exactly in the same place for a second treatment). With CK, on the other hand, a thermoplastic mask is custom-fitted to your head and the tumor's location (in relation to the mask and your bony structures) is plotted into the computer; on followup visits for treatment, they put the mask on your head again and you're ready for the next dose. This flexibility allows CK to apply smaller doses to the tumor than GK with each treatment; together, the smaller doses add up to the same total biologically equivalent dose as you would get with GK's one and only treatment, but (theoretically, at least) the hearing nerve and other healthy tissue has time to recover in between treatments (whereas the tumor supposedly doesn't recover as quickly). Presumably due to the fractionating of dosage, studies show CK yields slightly better results at preserving hearing compared with results for GK. Furthermore, GK's ring is screwed into the head (the screws stop at the skull) to keep it stationary (so that the radiation stays focused on the tumor), a mildly invasive procedure. CK is totally non-invasive: a series of overhead X-rays tracks the patient's head movements and tells the computer-controlled CyberKnife machine which way to move to track any small movements the patient may make so that the radiation stays centered on the tumor. GK advocates say that's all well and good, but GK has about 40 years of track record, whereas CK has been around a lot less time and is not as proven of a treatment as GK. (CK was approved by the FDA in 1999, although Stanford University Medical Center has been using it since 1994 in clinical trials because their Dr. Adler invented CK.)

Like a number of other people who have posted on this thread, I also had CK performed by Dr. Chang. I have the highest regard for him. If I had to choose GK, I would've chosen Univ of Pittsburgh. I agree with Marianna that they are the gold standard for GK treatment.

Here's my experience with CK (your mileage will vary): Much of my experience was unusually difficult and also unusually beneficial compared to what others have experienced after CK. My first 2 months after treatment were very difficult. I suffered profound fatigue, accompanied by shortness of breath, and my disequilibrium became (subjectively) about 15 to 20% worse. I also had about a week of hyperacusis, accompanied by slight hearing loss, about 4-1/2 months after treatment. Overall, I lost about 20 dB of hearing in my midrange frequencies over the course of a year post-treatment.

That's the bad news. The good news is equally unusual. Immediately after CK, the pulsatile component of my tinnitus disappeared completely, never to return since. The ringing tinnitus I'd suffered for the previous 8 years or so was also quite dramatically lower in volume. My first followup MRI (taken 5 months post-treatment) showed unusually widespread necrosis (tissue death) spreading nearly throughout the entire tumor. Unfortunately, my tumor had also swelled 36% in volume. But at the 6-month mark post-CK, I began to feel rapidly better. My balance improved significantly, and I now have decidedly better balance than I did before receiving CK. In fact, my balance is better now than it's been in the past 9 years.

When it came time for my 1-year followup MRI a couple weeks ago, I was nervous that the tumor may have swelled more. To my (and everyone else's) surprise, the tumor had shrunk -59% in the past six months! To those lucky enough to have their tumor shrink, that degree of shrinkage usually takes five years (according to Dr. Chang).

My results from CK are unusual in many ways, so you shouldn't expect to have the same benefits (or the difficult side effects immediately after treatment) to the degree I have had them. But you asked to hear positive stories about CK, and I certainly regard my outcome to be very positive. I am 100% happy with my decision to have CK with Dr. Chang at Stanford. It's one of the best decisions I've ever made in my life. The road to recovery was rough for me for the first six months after treatment, but the ride was worth it because of the eventually very positive outcome.

May your journey be smooth and peaceful and your healing swift and thorough.

Best wishes,
TW
L. AN 18x12x9 mm @ diagnosis, 11/07
21x13x11 mm @ CK treatment 7/11/08 (Drs. Chang & Gibbs, Stanford)
21x15x13 mm in 12/08 (5 months post-CK), widespread necrosis, swelling
12x9x6 mm, Nov. 2017; shrank ~78% since treatment!
W&W on stable 6mm hypoglossal tumor found 12/08

Tisha

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Re: GK vs. CK and are there any truly happy stories out there?
« Reply #9 on: July 01, 2009, 09:40:11 am »
Another Dr. Chang alumni raising her hand!  I had mine 6 months ago.  My unbalanced symptoms were the first that showed up.  I didn't do anything about it for 2 years because I thought it was related to menopause.  It wasn't until my hearing was affected that I went to find out why.

Dr. Chang told me that post-CK, roughly 2/3 have the same unbalance or dizziness that that had pre-CK. 1/3 get better and 5% get worse.  I find that so far I am lucky in that my dizziness actually seems better, in terms of severity and frequency.  I still have it, but it just doesn't have the impact that it did before.  I would say it's 50%+ better in severity and frequency.

I have my 6 month MRI and audiology test next week.  I had sudden hearing loss 3 weeks after CK, but steroids fixed it.  I would say that my hearing is about the same right now then before CK.  My ears feel stopped up still, but really no worse.  I have to say that I think my pure tones are probably worse after my SHL, but I'll find out next week.

Remember, the goal of radiation is not to be as you were before your symptoms.  It is to stop the growth of the tumor before it gets worse and you get worse and don't have options.  Even if the tumor shrinks in size, you will still have a foreign object in your ear pushing on your nerves.  It's just that the high possibility of facial paralysis and other complications scared me to much to have surgery, and I still had the option of radiation.

Good luck with your decision!  Tisha
1.7 x 1.0 x .9 cm (diagnosed Oct 2008)
1.8 x 1.2 x 1.1 cm  (July 2010-swelling)
1.5 x .9 x .9 cm  (Mar 2013 - 5 yr MRI)
Cyberknife at Stanford, week of 1/12/09 -  Drs. Chang and Soltys

ppearl214

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Re: GK vs. CK and are there any truly happy stories out there?
« Reply #10 on: July 01, 2009, 06:42:38 pm »
Tisha! I haven't "seen" you in ages and thrilled that you are doing so well.  Don't be such a stranger and those wellness wishes still continue your way!  Great news!
Phyl
"Gentlemen, I wash my hands of this weirdness", Capt Jack Sparrow - Davy Jones Locker, "Pirates of the Carribbean - At World's End"

Tumbleweed

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Re: GK vs. CK and are there any truly happy stories out there?
« Reply #11 on: July 02, 2009, 01:30:58 am »

Dr. Chang told me that post-CK, roughly 2/3 have the same unbalance or dizziness that that had pre-CK. 1/3 get better and 5% get worse. 

Thanks for sharing that info, Tisha! I hadn't heard that before.

I am so happy that your balance has improved.Yea!!!!!!!!!!!!

Good luck on your followup MRI and audiogram next week. I'll be thinking of you! Please let us know what you find out.

Best wishes,
TW
L. AN 18x12x9 mm @ diagnosis, 11/07
21x13x11 mm @ CK treatment 7/11/08 (Drs. Chang & Gibbs, Stanford)
21x15x13 mm in 12/08 (5 months post-CK), widespread necrosis, swelling
12x9x6 mm, Nov. 2017; shrank ~78% since treatment!
W&W on stable 6mm hypoglossal tumor found 12/08

Tisha

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Re: GK vs. CK and are there any truly happy stories out there?
« Reply #12 on: July 02, 2009, 06:32:56 am »
Thanks Phyl,

I don't read the boards as much as I used to, but usually stop in about once a week.  The summer has been so busy, with working and teens at home and that chaos, etc., that sometimes I don't feel the energy to post.  I still get very nervous about my AN, and I do find that at times reading the boards constantly only elevates that feeling, for some reason.  I don't know why.  So I try to limit it for now. 

I do feel that I'm doing well enoughl.  If I maintained where I am now for the remainder of my life I would feel lucky.  It's not terrific, but it's very manageable. 

My hats are off to you , and all those who keep the board strong and your faithful presence for all the newbies.  I will try post more often.

Tumbleweed,  My MRI is Tuesday.  As soon as I hear back from Dr. Chang (I'm hoping last next week), I'll report back as to the findings.  Thanks for the good wishes!  Tisha
1.7 x 1.0 x .9 cm (diagnosed Oct 2008)
1.8 x 1.2 x 1.1 cm  (July 2010-swelling)
1.5 x .9 x .9 cm  (Mar 2013 - 5 yr MRI)
Cyberknife at Stanford, week of 1/12/09 -  Drs. Chang and Soltys

ppearl214

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Re: GK vs. CK and are there any truly happy stories out there?
« Reply #13 on: July 02, 2009, 06:39:56 am »
I do feel that I'm doing well enoughl.  If I maintained where I am now for the remainder of my life I would feel lucky.  It's not terrific, but it's very manageable. 

My hats are off to you , and all those who keep the board strong and your faithful presence for all the newbies.  I will try post more often.


Sounds good... I know many of us just try to deal as best as we can with any potential residual affects (ie; tinnitus, balance, etc) and here's hoping things calm down soon to make things even more manageable... and if not, that's ok too as it sounds like you are embracing the you that you are now and yes, you are certainly lucky! Hats off to you!  Thanks for the kind words... but it's folks like you that keep us strong around here, so don't be such a stranger, ok? :)

Phyl :)
"Gentlemen, I wash my hands of this weirdness", Capt Jack Sparrow - Davy Jones Locker, "Pirates of the Carribbean - At World's End"

eab

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Re: GK vs. CK and are there any truly happy stories out there?
« Reply #14 on: July 02, 2009, 07:29:26 am »
Thank you for all the posts and updates, great to hear so many stories of lives that have moved on from the world of AN.  To each of you, my best wishes in your continued success!

I had my GK pre-op yesterday and I'm going in on Monday to get it done.  I am so ready!

Beth
Left side AN 2.5x1.7x1.5cm, limited hearing loss, limited tin., good balance
GK 7/6/09 Hoag Hospital; MRIs at 2, 6 & 12 months show no change in tumor size - hearing etc. same as before GK.