Radiation Oncologist

Since there is no official connection between our original Oncologist and the Radiation Oncologist (RO), this is actually our first second opinion.

Our meeting with our RO went well-not so much for the statistics or miraculous cures but just the amount of useful information.  There was so much information that I do not know of a logical manner to present it all.  I will do my best to do it justice.

We asked a few basic questions:

1. What are pro’s and con’s to full brain radiation?
2. Please provide more information on the Cyberknife procedure and is it really a panacea for brain tumors?
    

Full brain radiation is the old-school standard for metastatic brain tumors.  Using this technique may result in dimentia, loss of higher-cognitive functons, loss of short term memory, fatigue, hair loss, and skin irritation.  It is also quite alarming to note that these issues may not surface until months or years after treatment has been given.  The presence of any of these may likely effect the personality and behavior of the patient.  Before the late ’80’s, that is all that was available so these effects were livable given the lack of alternative.

The advantage of full brain radiation is that tumor recurrence rate is reduced to approximately 50% down from 75% for non-full brain radiated patients.  

In and of itself, this statistic seems positive however if you consider long-term survivability as the ultimate measure of success (as we do), both full brain radiated and non-radiated yielded very similar long-term survivability rates according to the most recent studies published (Dr. Aoyama published in the Journal of the American Medical Association June 2006) .  This was a bit surprising to me.

As it is, it comes down to a quality of life issue.

While full brain radiation may increase the time between recurrence, it will do so at the expense of your mind and personality.  You may not be able to live the life you had previously.  And in the end, the long-term survivability is the same.  In other words, you won’t live any longer if you get full brain radiation so why risk dimentia?

The Cyberknife procedure is not as easy as earlier presented to me.  It will be a several hour outpatient procedure and may take several sessions depending upon the size and location of the tumor.  Satomi’s tumor is located between the brain stem and cerebellum.  The RO indicated that this is the most senstive and dangerous operation that could be done.  As many of you know, the brain stem controls breathing, the heart pumping, digenstion, to name a few so it is essential for life.  The RO indicated that this operation should be taken very seriously.

To confuse the issue a bit, the RO explained that all focused radiation devices, such as the Cyberknife, will do some damage to surrounding and passed-through brain tissue.  Remember that tumors located near the center of the brain will require that all radiation pass though good brain tissue before reaching their respective tumors.  This effect is cumulative and will eventually result in radiation damage to those localized areas.  Given this phenomenon, the RO indicated that their basic rule is the removal of up to and including (4) tumors using the Cyberknife procedure before overall brain damage will be approaching that attained following full brain radiation.  If it the tumors are persistent and numerous, the full brain radiation therapy will be re-considered as the issue then will be life-preservation and not-quality-of-life.

Of course all of my jibber-jabber is an over-simplification but right now, I like simple.