Dear Dr. Sheehan….
I am a 51yr old male recently
diagnosed by MRI (11/16/2006)with a left Acoustic Neuroma 1.0cm
x1.6cmx1.0cm located in the cp angle cistern. I have lost 70% of my
hearing, as well as having moderate tennitius. I have been able to
discuss treatment with Tomotherapy with a Radiation Oncologist. I
also have consults scheduled with Neurosurgery and Neurotology. My
primary physician was not able to discuss with me the advantages (or
disadvantages) of each option. Given my tumor size, age and current
hearing loss, is Gamma Knife the best long term option? any help in
understanding my options is appreciated…
Thanks Dave Bueby
Bueby,
Thank you for your question. The standards of treatment for acoustic
neuromas include surgical resection or stereotactic radiosurgery
(i.e. using image guidance to give a high dose of radiation to the
tumor with a steep fall off to surrounding tissues). Long-term (>10
year) follow-up results for both approaches have been published in
peer reviewed journals. Tomotherapy, although a promising technique,
and one we utilize at the University of Virginia has not been well
studied for acoustic neuromas nor has it been applied with any
significant frequency for this indication.
At our center, Gamma Knife surgery, considered by most to be the gold
standard for intracranial radiosurgery, offers a 98% chance of local
tumor control, a less than 1% chance of facial palsy, and a 60%
chance of hearing preservation. The results from center to center
vary and likely depend not just upon the radiosurgical device
utilized but also upon the experience of treating team. This is
stated quite well on the bottom of the acoustic neuroma association
(ANA) web page: http://www.anausa.org/
Of note, the risk of secondary malignancy as a result of radiosurgery
also appears substantially less than with fractionation schemes like
tomotherapy or intensity modulation radiation therapy.
If you would like a more formal review of your case, please follow
the instructions at the following link:
http://www.healthsystem.virginia.edularsleksell.cfm
Best wishes,
Jason Sheehan
<http://www.anausa.org/treatment_options.html>
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