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Dr. Andrew Rynne
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Dr. Andrew Rynne

Family Physician

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Scheduled for pituitary tumor surgery. Interested in doing radiation treatment alone. Need suggestion

Answered by
Dr.
Dr. Sudhir Kumar

Neurologist

Practicing since :1994

Answered : 5906 Questions

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Posted on Fri, 25 Oct 2013 in Brain and Spine
Question: Will be scheduled soon for a third
Pituitary tumor surgery in 6 years, because it continues to return/refill. I want the new radiation treatment (CyberKnife) but was told the tumor needed to "drop down" off the optic nerve before the CyberKnife can be used.
In your opinion, what if the tumor does NOT 'drop down' as after the first surgery, I was told it was the "membrane" that appeared on the follow up MRI after the 1st. surgery in 2007.

Thank you for your "opinion/suggestion" (as to what you would do if it were you) ?
doctor
Answered by Dr. Sudhir Kumar 9 hours later
Brief Answer:
Decision depends on the size and location of tumor

Detailed Answer:
Hi,

Thank you for posting your query.

The decision to do surgery or to go for radiation (Cyberknife) depends on the size of tumor and the location of its recurrence. If the tumor can be accessed and completely removed by surgery, then, surgery is the best choice.

However, if the location of tumor is such that the entire tumor can not be removed by surgery, or it can be removed only partly, or if the tumor is aggressive, then, radiation either alone or following surgery is considered.

In your case, I would prefer surgery.

Best wishes,

Dr Sudhir Kumar MD DM (Neurology) XXXXXXX Consultant Neurologist
Apollo Hospitals, Hyderabad
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sudhir Kumar 19 hours later
Maybe I did not make myself clear enough. CyberKnife will supposedly destroy the tumor once and for all. As I was told the tumor is once again very large, "surgery would be necessary to reduce the size so the radiation can be used.

I am sure you understand I dislike having a third surgery in six years... obviously the first to failed to destroy it. My hopes were to pinpoint radiation (CyberKnife) so nothing else in the area (the 'Pituitary gland') would be affected.

You should understand my frustration of needing '3' surgeries ..by 3 different Neurosurgeons...and my lack of confidence that the tumor can be removed entirely during the 3rd. surgery... Are you saying to do the surgery AND the follow up CyberKnife radiation...as your answer to my question appears you "would prefer surgery" and just 'hope' it works?

I appears you have said to do the surgery....ONLY?
doctor
Answered by Dr. Sudhir Kumar 8 hours later
Brief Answer:
I meant surgery followed by radiation

Detailed Answer:
Thank you for getting back. I am sorry I did not make myself clear.

I can understand your frustration regarding multiple surgeries and the associated morbidity with them. However, recurrence of pituitary tumor is common after surgery.

As you have understood, a relatively large tumor can not be treated by radiation (cyberknife) alone. It needs surgery to remove as much as possible without damaging the optic nerve, and then follow it up with radiation.

However, I think there is one misconception still on your side. That the radiation (Cyberknife) removes 100% of tumor and thus would cure you for ever. Unfortunately, it is not correct. Recurrence can occur after Cyberknife too.

Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sudhir Kumar 8 hours later


One last question...(I am disappointed knowing radiation will not completely destroy the tumor)...

If full (or older) radiation was used...and destroyed the Pituitary as it "feeds" this tumor, would that eliminate my problem?

I feel strong and healthy enough to live to 90+, except for this tumor problem. Is there no answer? Thank you for your time here.
doctor
Answered by Dr. Sudhir Kumar 13 hours later
Brief Answer:
Radiation may not eliminate the risk of recurrence

Detailed Answer:
As I mentioned, radiation can eliminate the tumor at that point of time! but does not eliminate the risk of recurrence in future.

I am sure. you would live upto 100, as pituitary tumors are benign, and do not shorten the lifespan. Just that, if there is a recurrence, surgery with or without radiation is required.

Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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