Maria,

Please look at these search terms?on google too? GOOD LUCK and may GOD Bless us
all??
It is much more complicated than we think, and the medical jargon can be very
confusing, much more than any lay person can understand, that's why I say
ask?your doctor, or any good brain tmor doctor and get a second opinion, I am
not a doctor,? I had to look up lots of these words in the Merck manual, and it
might not be good for you read so much right now sweetie
You will only get overloaded with information you do not understand or remember
correctly, that can be an even bigger problem, spend 40 minutes tops, ?PLEASE
then go do something else?you really enjoy? and enjoy the time with your hubby
and kids honey

If they do a needle biospy first, then they can be sure it is not a small bad
astro or oligio,??or if they monitor it for 3 to 6 months or even a few years,
and it doesn't change, ?if it grows only a few mm instead of?a cm, then they can
be sure that its not one of the more aggressive ones that can kill before any
serious late radiation effects occur??? .If it?grows 1 cm and they do
surgery?right away, then they will know the neuropathology and you can have a
second opinion on that too.????

Initial misdiagnosis of tumor type based on what it looks like under one MRI,
maybe one of the major causes of other potential brain complications from
treatment later on,?

There are three stages of possible radiation injury listed below,?we have to ask
ourselves more specifically about the length of bt patient follow up time and
the quality of life, when they start quoting percentages, I want to know?are
they still functioning and?working? or how long before they are living in an
assisted living facility or a nursing home??Sure its good if it gets smaller,
but it might not,, and it might have?some additional brain swelling nearby in a
year or two afterwards?
I also think examining the time factor is critically important?folks, I want you
all to live a long time,
(For example,?in plain english the word acute means very serious, but in this
fancy medical jargon below, it means immediately, in less than a month or two)

1, Acute=short term, one month or two, possibly minor skin rashes, small patch
of lost hair, generally?mild temporary symptoms for a few weeks

2. Early delayed=6 to 18 months,?we need to ask our readers how long ago was the
one shot focal radiation treatment given to them?, Fractionation doses are given
over five weeks, one kind id called intensity modulated radiation therapy or
IMRT because some doctors believe the near by normal brain cells the rads?have
to go through recover better from radiation exposure than tumor cells because of
lower daily doses, instead of higher ne shot therapy.? Some swelling or edema
may occur later on, and how near the rads get to the pituitary master gland and
the optic nerves is important later on because of other complications that may
arise too. Most later problems can be treated with steriod drugs, but we might
have other long term side effects from those too, I was so sick and tired six
months to a year after my first surgery in 1986, when they finally took me off
steroids and anti-seizure meds and my body tried to get back to my own new
normal.?After the second surgery in Phoenix, by Dr Robert Spectzler, in 2000 I
didn't need any extra drugs before or even after to bring home,???We can ask the
researchers to spend more money on our benign meningiomas rather than on the
GBMs?

3.Late sequelae = 5 to 20 years and 30 years, if GK when given to young adults
twenty years ago, a lot of them are not 45 yet,?are they still doing well? how
can we find out? The best Gamma knife facilities are brand new like the one you
mentioned in la Jolla, so they have few longterm previous patient histories
there at all and?the old GK established places?rarely keep track of all their bt
patients for more than five to seven years, IN FACT sometimes they destroy all
the old records, if they have recurrence anytime afterwards, they often go right
back to the BEST neurosurgeons.?? GK practioners?have not fully published all
their bt patient records from the past thirty years of treatment in the US,
especially when they selectively?focus on the best candidates of small benign
brain tumors, small, round, oval regular shapes..but brain radiation and brain
surgery might lower our immune systems in those locations in our brain too???.

Every five years or so they sell the hospitals new brand name machines and they
replace the radioactive cobalt element every so often in the old ones because it
loses some power as the cobalt deteriorates, so your dose is figured out on the
computer with a time to decomposition variable built into the computer plan, no
two treatments are exactly the same.? Please be sure the Gk
operators/technicians who do the computer programming for our doctors are smart
enough to understand their brand new computers, sometimes I have a hard time
working and controling mine, lol???

Leukoencephalopathy basically means the myelin protective coverings of the
nerves?very slowly get weaker and break down from the radiation treatment,
vasculitis is a type of tiny leaky capillary blood vessels I think, with pooling
sluggish blood flow, instead of strong flows?pumped up the arteries into the
brain, it leads to slow viral infection, in this case in your brain...radiation
necrosis means "dead cells in there"?caused by radiation?,
.
I wonder where?are the thousands of bt patients who had GK more than ten years
ago???Or twenty years ago?
How come at the GK website and the nice?folks who are writing to us in plain
English are mostly patients treated very recently, certainly less than five
years ago

GK is still considered experimental by some excellent experienced doctors,
although it is widely marketed to the public and to investors, there is an
apparent lack of good solid medical research directly comparing the longtern
quality of life?in ten years or more after either brain surgery or brain
radiation, The only one I know of is old too, history of outcomes of meningioma,
from 1997. bt Bridget McCarthy.? I still getting a ?call from the Arizona cancer
registry HURRAH ?..

The medical issue of brain surgery vers brain radiation is not new? folks, it is
not a problem between you and me hon, we are all medical patients hoping to find
out more information about our symptoms, side effects and our current treatment
options now and perhaps later on in the future.?

The doctor is not lying, but I guess he might be quoting the recent marketing
results from a few years ago, if you ask him again about what time frame he used
and if you are only interested in the short term results less than five years OK
but?I guess those percentages he gave you are not scientifically?fully
documented or medically proven yet....it might be a?carefully selected sample of
their best bt patient outcomes for marketing purposes to sell their product to
us.? does that make sense to you? Medicine is big business today, that's why I
say find a doctor you trust.??

I am just writing what I think, this is my own humble opinion, and you may
disagree, thats OK with me, this is an open forum for all of us to share our
medical experiences and our opinions and I am very glad all you dear sweet
newbies are here, but please get another opinion before you let anyone cut or
burn in your brain,?and I wish there were more very longterm bt survivors like
me for me to swap my two past surgery stories with. .? ????????,???

Most of the article below talks about other types of radiation. we all know
whole brain radiation can cause?dementia?in?a few years, especially in?people my
age.?? We have a primary CNS tumor, some radiation patients they talk about
below have secondary metastatic brain disease from breast cancer or lung cancer
etc before they got a brain tumor, or they may have a malignant meningioma and
not know it if they have immediate GK or any other form of radiotherapy or
radiosurgery, which includes GK,? GBYAY Anne Breen???

Synonyms, Key Words, and Related Terms: leukoencephalopathy, radiation therapy,
adverse effects of radiation therapy, radiotherapy effects, radiation therapy
complications, radiotherapy complications, radiation injury, radionecrosis
Please click here to view the full topic text: Radiation Necrosis



Background

Radiation necrosis, a focal structural lesion that usually occurs at the
original tumor site, is a potential long-term central nervous system (CNS)
complication of radiotherapy or radiosurgery. Edema and the presence of tumor
render the CNS parenchyma in the tumor bed more susceptible to radiation
necrosis. Radiation necrosis can occur when radiotherapy is used to treat
primary CNS tumors, metastatic disease, or head and neck malignancies. It can
occur secondary to any form of radiotherapy modality or regimen.

In the clinical situation of a recurrent astrocytoma (postradiation therapy),
radiation necrosis presents a diagnostic dilemma. Astrocytic tumors can mutate
to the more malignant glioblastoma multiforme. Glioblastoma multiforme's
hallmark histology of pseudopalisading necrosis makes it difficult to
differentiate radiation necrosis from recurrent astrocytoma using MRI.

Therapeutic effects of radiotherapy

Radiation creates ionized oxygen species that react with cellular DNA. Tumor
cells have less ability than healthy cells for DNA repair. Thus, between
fractionation doses, healthy cells have a greater probability than tumor cells
of repairing themselves. With each subsequent mitosis, the cumulative effects of
unrepaired DNA result in apoptosis (cell death) of these tumor cells.

Central nervous system syndromes secondary to radiotherapy

Radiation necrosis is part of a series of clinical syndromes related to CNS
complications of radiotherapy. These syndromes occur in a distinct chronologic
order and have characteristic pathophysiology. While the term radiation necrosis
is used to refer to radiation injury, pathology is not limited to necrosis and a
spectrum of injury patterns may occur.

Acute encephalopathy occurs during and up to 1 month after radiotherapy. This
acute encephalopathy is due to disruption of the blood-brain barrier.

Early delayed complications occur 1-4 months after radiotherapy. Early delayed
complications are caused by white matter injury characterized by demyelination
and vasogenic edema. Early delayed changes may produce a somnolence syndrome in
children, reappearance of the initial tumor's symptomatology, temporary decline
in long-term memory, and encephalopathy. In early delayed complications,
patients may have increased edema and contrast enhancement on MRI (both
symptomatic and asymptomatic) that may resolve spontaneously over a few months.
Both the acute and early delayed complications are steroid responsive.

Treatment-induced leukoencephalopathy is the leading toxicity after primary CNS
lymphoma and may be seen both early and as a delayed consequence of treatment.
It may be seen in greater than 90% of patients older than 60 years who have been
successfully treated with combination chemotherapy and whole-brain radiation. A
relationship between increased blood-brain barrier permeability and radiation
therapy has been posited to contribute to this leukoencephalopathy and to
methotrexate-induced vasculopathy. This also may be an etiology for the changes
seen with radiation necrosis.

Radiation necrosis and diffuse cerebral atrophy are considered long-term
complications of radiotherapy that occur from months to decades after radiation
treatment. As opposed to the focal nature of radiation necrosis, diffuse
cerebral atrophy is characterized by bihemispheric sulci enlargement, brain
atrophy, and ventriculomegaly. Diffuse cerebral atrophy clinically is associated
with cognitive decline, personality changes, and gait disturbances.

Pathophysiology

Radiation necrosis is coagulative and predominantly affects white matter. This
coagulative necrosis is due to small artery injury and thrombotic occlusion.
These small arteries demonstrate endothelial thickening, lymphocytic and
macrophagic infiltrates, presence of cytokines, hyalinization, fibrinoid
deposition, thrombosis, and finally occlusion.

The primary mechanism of the delayed injury in radiation associated with
necrosis is secondary to vascular endothelial injury or direct damage to
oligodendroglia. As a result, white matter tissue is often more affected than
gray matter tissue. Radiation may have effects on fibrinolytic enzyme systems,
with an absence of tissue plasminogen activator and an excess in urokinase
plasminogen activator impacting tissue fibrinogen and extracellular proteolysis
with subsequent cytotoxic edema and tissue necrosis. Whether immune-mediated
mechanisms may also contribute to radiation-induced neurotoxicity is unclear,
but an autoimmune vasculitis has been postulated as a secondary host response to
tissue damage.

Animals exposed to radiation and given antibodies to cytokines (tumor necrosis
factor, interleukin-1, tissue growth factor) have decreased survival compared to
animals that do not receive these antibodies. These cytokines may be involved in
initially protecting healthy tissue from the effects of radiation. With
prolonged radiation exposure, these particular cytokines are overexpressed and
result in a cascade of inflammatory events and vascular injury.

In addition to vessel occlusion with resultant tissue necrosis, telangiectatic
vessels, which may hemorrhage, occasionally form. Demyelination, oligodendrocyte
dropout, axonal swelling, reactive gliosis, and disruption of the blood-brain
barrier also can be observed.

Frequency

United States

Natural history of the tumor in terms of prognosis and survival may affect the
occurrence of radiation necrosis in a particular tumor population. In
glioblastoma multiforme or metastatic disease with a poor long-term prognosis,
the patient may not live long enough to develop radiation necrosis. Radiation
necrosis can occur as soon as a few months or as long as decades after
treatment. It generally occurs 6 months to 2 years after radiation therapy.
Radiation injury may occur in 5-37% of patients treated for intracranial
neoplasms.

Mortality/Morbidity

Radiation necrosis can be fatal. It also can cause problems associated with a
mass lesion, such as seizures, focal deficits, increased intracranial pressure,
and herniation syndromes.



Please click here to view the full topic text: Radiation Necrosis



GBYAY Anne McGinnis Breen
See my smiley face winking at you? &;>)
Keep your faith, cherish your reason, treasure your mind, hold to your own good
purposes...and be not afraid.
If you would like to visit my journal pages to read more about me and other grey
matters of great importance to me go to
http://journals.aol.com/anne91547/anne-mcginnis-breens-articles/



GBYAY Anne McGinnis Breen
See my smiley face winking at you? &;>)
Keep your faith, cherish your reason, treasure your mind, hold to your own good
purposes...and be not afraid.
If you would like to visit my journal pages to read more about me and other grey
matters of great importance to me go to
http://journals.aol.com/anne91547/anne-mcginnis-breens-articles/


[Non-text portions of this message have been removed]