› Forums › General Melanoma Community › craniotomy or SRS?
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Janner.
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- October 28, 2012 at 1:44 pm
I have a question for people who have had radiation vs craniotomys and how they did
I am having a cranitomy tomorrow. I had a tumor SRS in june and unfortunately the area has kept slowly swelling to the point that we need to take that out.
I have a question for people who have had radiation vs craniotomys and how they did
I am having a cranitomy tomorrow. I had a tumor SRS in june and unfortunately the area has kept slowly swelling to the point that we need to take that out.
Meanwhile they found another 1cm met on the other side. I was told that the surgeon would rather I try radiating second tumor because that one is by my temple and trickier. I am just wondering if people would suggest to just do a craniotomy on the second one (once i have recovered from first) or do SRS again and hope that I dont have to deal with time frame of swelling again
The reason I ask is I have been off any treatment since april when I finished Ippi. I feel my time is runing out to hope the ippi is keeping my tumors under control that long. I have bad pain in side and tumrs in lung, liver, adrenal and in arms and legs all being kept fairly stable for now but you can understand why i want to get brain hopefully clear so we can start a new treatment.
I did BRAF but it only worked for 3 months with me. My doctor is hopeful that we can clear brain asap and get me into pd-1 trial.
so question is would you do craniotomy on second (risking possibility of right hand being effected by surgery) or do radiation and hope that it worked on this tumor?
I realize that a lot depends on how well i recover from tomorrows surgery, but they say it should be easy
thank you for your help – you are all in my prayers
laurie from maine
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- October 28, 2012 at 4:52 pm
HI Laurie,
Good luck tomorrow. Are you going into MGH for the neurosurgery? They're ranked #3 neurosurgery facility in country in one assessment (my current hospital is ranked #6).
I can't really say about the preferability of craniotomy vs. radiation. I've had both variations done. The location issues that you mention contibute to the decision being very unique to each person.
Qualifying for clinical trials with a history of brain mets is trickier than it already is without (except for the rare trials specifically tailored for brain met patients) because of the typical exclusions unless brain mets are both treated and stable for a period of time. This will likely makes it harder to get systemic treatment quickly post-craniotomy. The FDA approved immunotherapy alternative to anti-PD1, namely Ipilimumab/Yervoy, doesn't have that problem, which made it a possibility for me. Even though PD1 seems to have (phase I only) response rates a little higher. My history in the brain:Round 1:
*Oct 2010: craniotomy left occipital
*Nov 2011: cyberknife to resected tumor bed, also to new left parietal tumorRound 2
*June 2011: double craniotomy (the left parietal tumor previously cyberknifed), plus new right temporal tumor
*June 2011: Gamma Knife to resected tumor beds, plus to 2 addt'l new small brain mets (bringing total to 5)
*June-Aug 2011: Ipilimumab (Yervoy)So far since round 2, my brain has been stable.
Differences between my rounds 1 and 2:
*Systemic immunotherapy treatment — Yervoy — beginning very shortly after surgery. Maybe I've been lucky enough to be a responder.
*My 2nd radiation oncologist (for the 2nd round) favors the Gamma Knife system for radiating brain tumors.
*Finally, there's been some recent speculation (by oncologists) about synergy between radiation and immune therapies like IPI. The radiation blasts lots of melanoma cells apart, the theory being that leaves a lot of raw material for the immune system to develop a response against. My first IPI started 16 days after the 2nd craniotomy. Could that be helping in my case?Best of luck tomorrow and keep us posted.
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- October 28, 2012 at 4:52 pm
HI Laurie,
Good luck tomorrow. Are you going into MGH for the neurosurgery? They're ranked #3 neurosurgery facility in country in one assessment (my current hospital is ranked #6).
I can't really say about the preferability of craniotomy vs. radiation. I've had both variations done. The location issues that you mention contibute to the decision being very unique to each person.
Qualifying for clinical trials with a history of brain mets is trickier than it already is without (except for the rare trials specifically tailored for brain met patients) because of the typical exclusions unless brain mets are both treated and stable for a period of time. This will likely makes it harder to get systemic treatment quickly post-craniotomy. The FDA approved immunotherapy alternative to anti-PD1, namely Ipilimumab/Yervoy, doesn't have that problem, which made it a possibility for me. Even though PD1 seems to have (phase I only) response rates a little higher. My history in the brain:Round 1:
*Oct 2010: craniotomy left occipital
*Nov 2011: cyberknife to resected tumor bed, also to new left parietal tumorRound 2
*June 2011: double craniotomy (the left parietal tumor previously cyberknifed), plus new right temporal tumor
*June 2011: Gamma Knife to resected tumor beds, plus to 2 addt'l new small brain mets (bringing total to 5)
*June-Aug 2011: Ipilimumab (Yervoy)So far since round 2, my brain has been stable.
Differences between my rounds 1 and 2:
*Systemic immunotherapy treatment — Yervoy — beginning very shortly after surgery. Maybe I've been lucky enough to be a responder.
*My 2nd radiation oncologist (for the 2nd round) favors the Gamma Knife system for radiating brain tumors.
*Finally, there's been some recent speculation (by oncologists) about synergy between radiation and immune therapies like IPI. The radiation blasts lots of melanoma cells apart, the theory being that leaves a lot of raw material for the immune system to develop a response against. My first IPI started 16 days after the 2nd craniotomy. Could that be helping in my case?Best of luck tomorrow and keep us posted.
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- October 28, 2012 at 4:52 pm
HI Laurie,
Good luck tomorrow. Are you going into MGH for the neurosurgery? They're ranked #3 neurosurgery facility in country in one assessment (my current hospital is ranked #6).
I can't really say about the preferability of craniotomy vs. radiation. I've had both variations done. The location issues that you mention contibute to the decision being very unique to each person.
Qualifying for clinical trials with a history of brain mets is trickier than it already is without (except for the rare trials specifically tailored for brain met patients) because of the typical exclusions unless brain mets are both treated and stable for a period of time. This will likely makes it harder to get systemic treatment quickly post-craniotomy. The FDA approved immunotherapy alternative to anti-PD1, namely Ipilimumab/Yervoy, doesn't have that problem, which made it a possibility for me. Even though PD1 seems to have (phase I only) response rates a little higher. My history in the brain:Round 1:
*Oct 2010: craniotomy left occipital
*Nov 2011: cyberknife to resected tumor bed, also to new left parietal tumorRound 2
*June 2011: double craniotomy (the left parietal tumor previously cyberknifed), plus new right temporal tumor
*June 2011: Gamma Knife to resected tumor beds, plus to 2 addt'l new small brain mets (bringing total to 5)
*June-Aug 2011: Ipilimumab (Yervoy)So far since round 2, my brain has been stable.
Differences between my rounds 1 and 2:
*Systemic immunotherapy treatment — Yervoy — beginning very shortly after surgery. Maybe I've been lucky enough to be a responder.
*My 2nd radiation oncologist (for the 2nd round) favors the Gamma Knife system for radiating brain tumors.
*Finally, there's been some recent speculation (by oncologists) about synergy between radiation and immune therapies like IPI. The radiation blasts lots of melanoma cells apart, the theory being that leaves a lot of raw material for the immune system to develop a response against. My first IPI started 16 days after the 2nd craniotomy. Could that be helping in my case?Best of luck tomorrow and keep us posted.
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- October 28, 2012 at 5:12 pm
Laurie, I missed that you more recently already have done a course of IPI.
Do your docs feel you've been a responder to IPI in your body? Sounds like they do since the body's been stable? Since you've already been on a course of IPI, it makes sense that anti-PD1 would be a desirable goal. If for whatever reason you can't get a trial slot, I wonder if another course of IPI would be an alternative. Or if you can get the brain stable, there's other clinical trials out there too that your docs probably know about, like anti-PDL1, for one.
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- October 28, 2012 at 5:12 pm
Laurie, I missed that you more recently already have done a course of IPI.
Do your docs feel you've been a responder to IPI in your body? Sounds like they do since the body's been stable? Since you've already been on a course of IPI, it makes sense that anti-PD1 would be a desirable goal. If for whatever reason you can't get a trial slot, I wonder if another course of IPI would be an alternative. Or if you can get the brain stable, there's other clinical trials out there too that your docs probably know about, like anti-PDL1, for one.
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- October 28, 2012 at 5:12 pm
Laurie, I missed that you more recently already have done a course of IPI.
Do your docs feel you've been a responder to IPI in your body? Sounds like they do since the body's been stable? Since you've already been on a course of IPI, it makes sense that anti-PD1 would be a desirable goal. If for whatever reason you can't get a trial slot, I wonder if another course of IPI would be an alternative. Or if you can get the brain stable, there's other clinical trials out there too that your docs probably know about, like anti-PDL1, for one.
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- October 29, 2012 at 12:59 am
Laurie,
I'm wishing you the best tomorrow. When I had my crainectomy I recovered quickly which they did because the edema was so bad. When I had 2 more SRS's both of those ended up bleeding. We talked to my nuerosurgeon but he was against 2 more crainectomies unless necessary because each time there can be to much brain damage.
I only took a few pain pills while in the hospital and none at home. The worse part was the high steroids but at that point I had been on them for 6 months before and was so anxious to get off of them.
Post when you can so we know how you are!
Linda
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- October 29, 2012 at 12:59 am
Laurie,
I'm wishing you the best tomorrow. When I had my crainectomy I recovered quickly which they did because the edema was so bad. When I had 2 more SRS's both of those ended up bleeding. We talked to my nuerosurgeon but he was against 2 more crainectomies unless necessary because each time there can be to much brain damage.
I only took a few pain pills while in the hospital and none at home. The worse part was the high steroids but at that point I had been on them for 6 months before and was so anxious to get off of them.
Post when you can so we know how you are!
Linda
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- October 29, 2012 at 12:59 am
Laurie,
I'm wishing you the best tomorrow. When I had my crainectomy I recovered quickly which they did because the edema was so bad. When I had 2 more SRS's both of those ended up bleeding. We talked to my nuerosurgeon but he was against 2 more crainectomies unless necessary because each time there can be to much brain damage.
I only took a few pain pills while in the hospital and none at home. The worse part was the high steroids but at that point I had been on them for 6 months before and was so anxious to get off of them.
Post when you can so we know how you are!
Linda
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- October 29, 2012 at 3:10 am
Hi Laurie from Maine…..I just want to wish you good vibes for your procedure tomorrow. I wish I had something I could offer, but I don't have any experience for the procedure you are asking about. However, without a doubt, I will be thinking of you and sending positive thoughts to help you get through this procedure with good results! With all the knowledge on this site, hopefully someone can offer you helpful insight and answers to your questions. Thanks for the update on your situation and good luck with your treatment. Keep up your positive attitude and keep us posted!
Swanee
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- October 29, 2012 at 3:10 am
Hi Laurie from Maine…..I just want to wish you good vibes for your procedure tomorrow. I wish I had something I could offer, but I don't have any experience for the procedure you are asking about. However, without a doubt, I will be thinking of you and sending positive thoughts to help you get through this procedure with good results! With all the knowledge on this site, hopefully someone can offer you helpful insight and answers to your questions. Thanks for the update on your situation and good luck with your treatment. Keep up your positive attitude and keep us posted!
Swanee
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- October 29, 2012 at 3:10 am
Hi Laurie from Maine…..I just want to wish you good vibes for your procedure tomorrow. I wish I had something I could offer, but I don't have any experience for the procedure you are asking about. However, without a doubt, I will be thinking of you and sending positive thoughts to help you get through this procedure with good results! With all the knowledge on this site, hopefully someone can offer you helpful insight and answers to your questions. Thanks for the update on your situation and good luck with your treatment. Keep up your positive attitude and keep us posted!
Swanee
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- October 29, 2012 at 12:08 pm
Laurie, you will be in my prayers today, with hope for a wonderfully positive outcome for you! I am in awe of your courage. {{{}}}
If someone else is reading, would you be so kind as to let me know what IPI is? I tried a search, but not coming up with anything that applies here…many thanks.
All best,
Caretaker
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- October 29, 2012 at 12:08 pm
Laurie, you will be in my prayers today, with hope for a wonderfully positive outcome for you! I am in awe of your courage. {{{}}}
If someone else is reading, would you be so kind as to let me know what IPI is? I tried a search, but not coming up with anything that applies here…many thanks.
All best,
Caretaker
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- October 29, 2012 at 12:08 pm
Laurie, you will be in my prayers today, with hope for a wonderfully positive outcome for you! I am in awe of your courage. {{{}}}
If someone else is reading, would you be so kind as to let me know what IPI is? I tried a search, but not coming up with anything that applies here…many thanks.
All best,
Caretaker
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