Re: FSR feedback from docs ABC Nightly World News tonight

[Guest guest]

Marnie,

<< This was quite interesting, and I wish you good luck; however I would take

issue with a few statements by Dr. Chang. marie >>

What do you mean by taking a few issues by Dr. Chang?

Sally

[Guest guest]

Marnie,

<< This was quite interesting, and I wish you good luck; however I would take

issue with a few statements by Dr. Chang. marie >>

What do you mean by taking a few issues by Dr. Chang?

Sally

[Guest guest]

Yeah---no kidding!!

TR

In a message dated 8/28/00 3:38:24 PM Pacific Daylight Time, mcdrew@...

writes:

<< however I would take

issue with a few statements by Dr. Chang. >>

[Guest guest]

Yeah---no kidding!!

TR

In a message dated 8/28/00 3:38:24 PM Pacific Daylight Time, mcdrew@...

writes:

<< however I would take

issue with a few statements by Dr. Chang. >>

[Guest guest]

Yeah---no kidding!!

TR

In a message dated 8/28/00 3:38:24 PM Pacific Daylight Time, mcdrew@...

writes:

<< however I would take

issue with a few statements by Dr. Chang. >>

[Guest guest]

Ok, this statement will probably send a lot of arms flying in the air (oh my

haha)

-----

Sally s,

Thanks for writing. Your AN's are benign. You do not have primary cancer.

I don't believe housing personnel should be making these claims without

speaking to the referring physician (me).

For patients who are not taking steroids prior to administration of FSR, no

new steroids are started. For patients who are taking steroids, they are

continued during the FSR (this is a small group; almost all patients are not

taking steroids at the time of evaluation or treatment).

I hope this helps, and please reply with any additional questions that you

may have. Thanks.

Jeffery A. , M.D.

[Guest guest]

Ok, this statement will probably send a lot of arms flying in the air (oh my

haha)

-----

Sally s,

Thanks for writing. Your AN's are benign. You do not have primary cancer.

I don't believe housing personnel should be making these claims without

speaking to the referring physician (me).

For patients who are not taking steroids prior to administration of FSR, no

new steroids are started. For patients who are taking steroids, they are

continued during the FSR (this is a small group; almost all patients are not

taking steroids at the time of evaluation or treatment).

I hope this helps, and please reply with any additional questions that you

may have. Thanks.

Jeffery A. , M.D.

[Guest guest]

Ok, this statement will probably send a lot of arms flying in the air (oh my

haha)

-----

Sally s,

Thanks for writing. Your AN's are benign. You do not have primary cancer.

I don't believe housing personnel should be making these claims without

speaking to the referring physician (me).

For patients who are not taking steroids prior to administration of FSR, no

new steroids are started. For patients who are taking steroids, they are

continued during the FSR (this is a small group; almost all patients are not

taking steroids at the time of evaluation or treatment).

I hope this helps, and please reply with any additional questions that you

may have. Thanks.

Jeffery A. , M.D.

[Guest guest]

Also, both Stanford University and s Hopkins said this.

Sally

[Guest guest]

Also, both Stanford University and s Hopkins said this.

Sally

[Guest guest]

Also, both Stanford University and s Hopkins said this.

Sally

[Guest guest]

This was quite interesting, and I wish you good luck; however I would take

issue with a few statements by Dr. Chang. marie

FSR feedback from docs ABC Nightly World News tonight

>Ok guys, I've been busy. First I don't have Cancer (phew) the guy in the

>housing should not have been making those claims that was a no no.

>

>Those of you out in California would be interested in the bottom post

becuase

>it is done at Stanford University. Dr. at the s

Hopkins

>in Baltimore, land says close to the same about FSR. So whomever is

>geographically convenient. I am by the way, taking the plunge (smile). I

will

>leave for s Hopkins for simulator testing on the 6th return (because

they

>are doing construction on a new building) then go back for FSR treatment

the

>14th until Sept. 27th. Right smack dab in my first week of college

(aaawwww).

>But it's my senior year (yyyeeeaaa).

>

>

>-----------

>Hi Salley,

>

>Dr. Adler has forwarded your message to me. I am a neurosurgeon at

>Stanford that is currently performing most of the radiosurgery for patients

>with acoustic neuromas. I hope the following answers your questions:

>

>1. Radiosurgery as a whole is fairly safe for acoustic neuromas, with

>facial nerve injuries on the ordr of 1-2%. We beleive that this number is

>even smaller for FSR, and using the cyberknife fractionated treatment

>protocol at Stanford, we have not had any patients which have had facial

>nerve injury.

>

>2. The likelyhood of regrowth after FSR is very low, on the order of 2-3%.

>If there is regrowth, the tumor can be retreated with FSR. As a

>neurosurgeon who performs both conventional surgery and radiosurgery on

>acoustic neuromas, I do not believe that microsurgery is more difficult

>after radiosurgery. I have not noticed any significant scaring that makes

>the surgery more difficult.

>

>3. There is minimal to no swelling after FSR.

>

>4. With respect to techniques, there are several different modalities of

>FSR. None of the Gamma knife centers that I know of use FSR due fact that

>the frame is on the patients head. Some other centers used a bite block

>type of frame. We use the Cyberknife system at Stanford, which I beleive

>is the most accurate FSR system, and also the most comfortable for the

>patient. You can learn more about this system at www.accuray.com. Also,

>we are being profiled on ABC Nightly World News tonight, so you may get

>more information there.

>

>5. I do not know of any doctors in chicago that perform FSR.

>

>6. We beleive that FSR is the preferred method for treating acoustic

>neuromas since we feel that this allows a higher hearing preservation rate

>and lower complication rates that single fraction radiosurgery.

>

>7. Your 3.5 cm acoustic neurom on the right side is at the upper limit of

>radiosurgical size, but we have treated tumors that large with FSR.

>

> Chang, MD

>Stanford University

>Department of Neurosurgery

>

>Here's his second post to me today...

>

>Hi Sally,

>

>We use three fractions of 600 rads per day. The more you fractionate, the

>lower the risks, but the lower the theoretical chance of killing the tumor.

> While nobody knows what the best fractionation protocol is, we believe

>that more than three fractions reduces chances of killing the tumor. The

>cyberknife system also uses the mask, but a digital camera takes near real

>time images of the patients head at various intervals, and feeds this data

>into the cyberknife computer which then can detect and adjust for small

>amounts of patient movement (which occur when using masks). The problem

>with using the mask alone is that the mask is not totally rigid, and hence

>there is still some small amount of movement that occurs. Without the

>imaging, there is no guarantee that the mask holds the patient in the exact

>same postion on subsequent days compared to the first day. The digital

>imaging allows the patient to be brought into optimal position at various

>intervals during the treatment on a given day, and hence in our opinion,

>increases accuracy of radiation delivery.

>

>

>

>

[Guest guest]

This was quite interesting, and I wish you good luck; however I would take

issue with a few statements by Dr. Chang. marie

FSR feedback from docs ABC Nightly World News tonight

>Ok guys, I've been busy. First I don't have Cancer (phew) the guy in the

>housing should not have been making those claims that was a no no.

>

>Those of you out in California would be interested in the bottom post

becuase

>it is done at Stanford University. Dr. at the s

Hopkins

>in Baltimore, land says close to the same about FSR. So whomever is

>geographically convenient. I am by the way, taking the plunge (smile). I

will

>leave for s Hopkins for simulator testing on the 6th return (because

they

>are doing construction on a new building) then go back for FSR treatment

the

>14th until Sept. 27th. Right smack dab in my first week of college

(aaawwww).

>But it's my senior year (yyyeeeaaa).

>

>

>-----------

>Hi Salley,

>

>Dr. Adler has forwarded your message to me. I am a neurosurgeon at

>Stanford that is currently performing most of the radiosurgery for patients

>with acoustic neuromas. I hope the following answers your questions:

>

>1. Radiosurgery as a whole is fairly safe for acoustic neuromas, with

>facial nerve injuries on the ordr of 1-2%. We beleive that this number is

>even smaller for FSR, and using the cyberknife fractionated treatment

>protocol at Stanford, we have not had any patients which have had facial

>nerve injury.

>

>2. The likelyhood of regrowth after FSR is very low, on the order of 2-3%.

>If there is regrowth, the tumor can be retreated with FSR. As a

>neurosurgeon who performs both conventional surgery and radiosurgery on

>acoustic neuromas, I do not believe that microsurgery is more difficult

>after radiosurgery. I have not noticed any significant scaring that makes

>the surgery more difficult.

>

>3. There is minimal to no swelling after FSR.

>

>4. With respect to techniques, there are several different modalities of

>FSR. None of the Gamma knife centers that I know of use FSR due fact that

>the frame is on the patients head. Some other centers used a bite block

>type of frame. We use the Cyberknife system at Stanford, which I beleive

>is the most accurate FSR system, and also the most comfortable for the

>patient. You can learn more about this system at www.accuray.com. Also,

>we are being profiled on ABC Nightly World News tonight, so you may get

>more information there.

>

>5. I do not know of any doctors in chicago that perform FSR.

>

>6. We beleive that FSR is the preferred method for treating acoustic

>neuromas since we feel that this allows a higher hearing preservation rate

>and lower complication rates that single fraction radiosurgery.

>

>7. Your 3.5 cm acoustic neurom on the right side is at the upper limit of

>radiosurgical size, but we have treated tumors that large with FSR.

>

> Chang, MD

>Stanford University

>Department of Neurosurgery

>

>Here's his second post to me today...

>

>Hi Sally,

>

>We use three fractions of 600 rads per day. The more you fractionate, the

>lower the risks, but the lower the theoretical chance of killing the tumor.

> While nobody knows what the best fractionation protocol is, we believe

>that more than three fractions reduces chances of killing the tumor. The

>cyberknife system also uses the mask, but a digital camera takes near real

>time images of the patients head at various intervals, and feeds this data

>into the cyberknife computer which then can detect and adjust for small

>amounts of patient movement (which occur when using masks). The problem

>with using the mask alone is that the mask is not totally rigid, and hence

>there is still some small amount of movement that occurs. Without the

>imaging, there is no guarantee that the mask holds the patient in the exact

>same postion on subsequent days compared to the first day. The digital

>imaging allows the patient to be brought into optimal position at various

>intervals during the treatment on a given day, and hence in our opinion,

>increases accuracy of radiation delivery.

>

>

>

>

[Guest guest]

Well when he said there is " no swelling or minimal swelling after FRS " -

that is not what I was told by a neurologist and neurosurgeon in Pgh. They

indicated that was an unknown; if there is no swelling, why do they give

patients steroids after FRS?? Marie

Re: FSR feedback from docs ABC Nightly World News

tonight

>Marnie,

>

><< This was quite interesting, and I wish you good luck; however I would

take

> issue with a few statements by Dr. Chang. marie >>

>

>What do you mean by taking a few issues by Dr. Chang?

>

>Sally

>

>

>

>

[Guest guest]

Well when he said there is " no swelling or minimal swelling after FRS " -

that is not what I was told by a neurologist and neurosurgeon in Pgh. They

indicated that was an unknown; if there is no swelling, why do they give

patients steroids after FRS?? Marie

Re: FSR feedback from docs ABC Nightly World News

tonight

>Marnie,

>

><< This was quite interesting, and I wish you good luck; however I would

take

> issue with a few statements by Dr. Chang. marie >>

>

>What do you mean by taking a few issues by Dr. Chang?

>

>Sally

>

>

>

>

[Guest guest]

Well when he said there is " no swelling or minimal swelling after FRS " -

that is not what I was told by a neurologist and neurosurgeon in Pgh. They

indicated that was an unknown; if there is no swelling, why do they give

patients steroids after FRS?? Marie

Re: FSR feedback from docs ABC Nightly World News

tonight

>Marnie,

>

><< This was quite interesting, and I wish you good luck; however I would

take

> issue with a few statements by Dr. Chang. marie >>

>

>What do you mean by taking a few issues by Dr. Chang?

>

>Sally

>

>

>

>

[Guest guest]

Would they give steroids after FRS to prevent the possibility of swelling? Edema is no fun. I experience headaches for months because of swelling cause from my radio surgery. It could be given just as a precautionary action.

Greg

Re: FSR feedback from docs ABC Nightly World Newstonight>Marnie,>><< This was quite interesting, and I wish you good luck; however I wouldtake> issue with a few statements by Dr. Chang. marie >>>>What do you mean by taking a few issues by Dr. Chang?>>Sally>>>>

[Guest guest]

Would they give steroids after FRS to prevent the possibility of swelling? Edema is no fun. I experience headaches for months because of swelling cause from my radio surgery. It could be given just as a precautionary action.

Greg

Re: FSR feedback from docs ABC Nightly World Newstonight>Marnie,>><< This was quite interesting, and I wish you good luck; however I wouldtake> issue with a few statements by Dr. Chang. marie >>>>What do you mean by taking a few issues by Dr. Chang?>>Sally>>>>

[Guest guest]

Would they give steroids after FRS to prevent the possibility of swelling? Edema is no fun. I experience headaches for months because of swelling cause from my radio surgery. It could be given just as a precautionary action.

Greg

Re: FSR feedback from docs ABC Nightly World Newstonight>Marnie,>><< This was quite interesting, and I wish you good luck; however I wouldtake> issue with a few statements by Dr. Chang. marie >>>>What do you mean by taking a few issues by Dr. Chang?>>Sally>>>>

[Guest guest]

That was why I questioned the indication that Dr. Chang and Dr. are both saying they do not? I have always had them after microsurgery. This saying that there is no danger of swelling after FRS is news to me. And again, Barb who just had 28 shots, was definitely given steroids. And she was NOT taking them before.

Marie

Re: FSR feedback from docs ABC Nightly World News tonight

Would they give steroids after FRS to prevent the possibility of swelling? Edema is no fun. I experience headaches for months because of swelling cause from my radio surgery. It could be given just as a precautionary action.

Greg

Re: FSR feedback from docs ABC Nightly World Newstonight>Marnie,>><< This was quite interesting, and I wish you good luck; however I wouldtake> issue with a few statements by Dr. Chang. marie >>>>What do you mean by taking a few issues by Dr. Chang?>>Sally>>>>

[Guest guest]

Marie and Sally,

Why there is a difference is because each facility through out the world has

their own FSR variation.

As an example one facility will in the main do two fractions, one on Monday

and the next one on Friday at 1000 rads others will do four fractions, two a

week for two weeks at 500 rads others will do three in one week (every

second day) at 700 rads. This is a true story, this person had 7 brain

tumours all overlapping. Bilateral Vestibular Schwannomas and 5 others. The

surgeons could only remove 2 leaving 5 others to contend with later, and

there may not have been a later or have all 7 treated at the same time doing

FSR.

The patient received 200 rads per day for 5 days for 5.5 weeks treating all

tumours at the same time. As you can imagine the patient became very sick,

and as soon as treatment was finished, went on steroids to control swelling,

7 weeks later had to have a shunt to control the swelling and now is doing

physical therapy.

So I think it comes down to location - how many tumours - what number of

rads - how many fractions ect - ect.

I personally don't think that there can be any hard and fast rules for any

form of FSR as there are too many variables.

Usually with a higher number of fractions, the less likelihood of swelling

if there is only one tumour to be treated.

.....

Re: FSR feedback from docs ABC Nightly World News

> tonight

>

>

> >Marnie,

> >

> ><< This was quite interesting, and I wish you good luck; however I would

> take

> > issue with a few statements by Dr. Chang. marie >>

> >

> >What do you mean by taking a few issues by Dr. Chang?

> >

> >Sally

> >

> >

> >

> >

>

>

>

>

[Guest guest]

Marie and Sally,

Why there is a difference is because each facility through out the world has

their own FSR variation.

As an example one facility will in the main do two fractions, one on Monday

and the next one on Friday at 1000 rads others will do four fractions, two a

week for two weeks at 500 rads others will do three in one week (every

second day) at 700 rads. This is a true story, this person had 7 brain

tumours all overlapping. Bilateral Vestibular Schwannomas and 5 others. The

surgeons could only remove 2 leaving 5 others to contend with later, and

there may not have been a later or have all 7 treated at the same time doing

FSR.

The patient received 200 rads per day for 5 days for 5.5 weeks treating all

tumours at the same time. As you can imagine the patient became very sick,

and as soon as treatment was finished, went on steroids to control swelling,

7 weeks later had to have a shunt to control the swelling and now is doing

physical therapy.

So I think it comes down to location - how many tumours - what number of

rads - how many fractions ect - ect.

I personally don't think that there can be any hard and fast rules for any

form of FSR as there are too many variables.

Usually with a higher number of fractions, the less likelihood of swelling

if there is only one tumour to be treated.

.....

Re: FSR feedback from docs ABC Nightly World News

> tonight

>

>

> >Marnie,

> >

> ><< This was quite interesting, and I wish you good luck; however I would

> take

> > issue with a few statements by Dr. Chang. marie >>

> >

> >What do you mean by taking a few issues by Dr. Chang?

> >

> >Sally

> >

> >

> >

> >

>

>

>

>

[Guest guest]

Marie and Sally,

Why there is a difference is because each facility through out the world has

their own FSR variation.

As an example one facility will in the main do two fractions, one on Monday

and the next one on Friday at 1000 rads others will do four fractions, two a

week for two weeks at 500 rads others will do three in one week (every

second day) at 700 rads. This is a true story, this person had 7 brain

tumours all overlapping. Bilateral Vestibular Schwannomas and 5 others. The

surgeons could only remove 2 leaving 5 others to contend with later, and

there may not have been a later or have all 7 treated at the same time doing

FSR.

The patient received 200 rads per day for 5 days for 5.5 weeks treating all

tumours at the same time. As you can imagine the patient became very sick,

and as soon as treatment was finished, went on steroids to control swelling,

7 weeks later had to have a shunt to control the swelling and now is doing

physical therapy.

So I think it comes down to location - how many tumours - what number of

rads - how many fractions ect - ect.

I personally don't think that there can be any hard and fast rules for any

form of FSR as there are too many variables.

Usually with a higher number of fractions, the less likelihood of swelling

if there is only one tumour to be treated.

.....

Re: FSR feedback from docs ABC Nightly World News

> tonight

>

>

> >Marnie,

> >

> ><< This was quite interesting, and I wish you good luck; however I would

> take

> > issue with a few statements by Dr. Chang. marie >>

> >

> >What do you mean by taking a few issues by Dr. Chang?

> >

> >Sally

> >

> >

> >

> >

>

>

>

>

[Guest guest]

They did to me---and these are the guys who did my FSR

TR

In a message dated 8/28/00 7:05:06 PM Pacific Daylight Time,

GREGIERY@... writes:

<< Would they give steroids after FRS to prevent the possibility of swelling?

>>

[Guest guest]

They did to me---and these are the guys who did my FSR

TR

In a message dated 8/28/00 7:05:06 PM Pacific Daylight Time,

GREGIERY@... writes:

<< Would they give steroids after FRS to prevent the possibility of swelling?

>>